Imipramine

Aka: Imipramine, Tofranil

1. Indications
   1. Panic Disorder
   2. Pediatric Major Depression
   3. Attention Deficit Hyperactivity Disorder
   4. Nocturnal Enuresis (not first line agent)
2. Dosing: General
   1. Adult: 25-50 mg PO qhs
3. Dosing: Nocturnal Enuresis in children
   1. Consider other measures for Nocturnal Enuresis first
   2. Consider baseline EKG before starting medication
   3. Initial dose
      1. Age 6-8 years: 25 mg PO one hour before bedtime
      2. Age 8-12 years: 50 mg PO one hour before bedtime
      3. Age over 12 years: 75 mg PO one hour before bedtime
   4. Maximum dosing: up to 0.9 to 1.5 mg/kg
   5. Discontinue after 3-6 months (some guidelines suggest maximum of 3 months)
      1. Taper to one half dose nightly for 2 weeks
      2. Taper to one half dose every other night for 2 weeks
4. Efficacy: Nocturnal Enuresis
   1. Response in up to 60% of children
   2. Relapse is common soon after stopping medication
5. Pharmacokinetics
   1. Obtain serum levels in pediatric population
   2. Avoid as full dose Antidepressant
   3. Serum Half Life: 11 to 25 hours
   4. Therapeutic plasma level: 200 to 350
6. Adverse effects
   1. See Tricyclic Antidepressants
   2. Significant adverse effects
      1. Anticholinergic Symptoms
      2. Drowsiness
      3. Sleep problems
      4. Gastrointestinal upset
      5. Orthostatic Hypotension
      6. Cardiac arrhythmia
      7. Weight gain
7. Precautions
   1. See Tricyclic Antidepressants
   2. Serious cardiotoxicity in overdosage
8. References
   1. Thiedke (2003) Am Fam Physician 67:1499-510