Pharm

Imipramine

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Imipramine, Tofranil

  • Indications
  1. Panic Disorder
  2. Pediatric Major Depression
  3. Attention Deficit Hyperactivity Disorder
  4. Nocturnal Enuresis (not first line agent)
  1. Adult: 25-50 mg PO qhs
  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
  1. Response in up to 60% of children
  2. Relapse is common soon after stopping medication
  • 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
  • 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
  • Precautions
  1. See Tricyclic Antidepressants
  2. Serious cardiotoxicity in overdosage
  • References
  1. Thiedke (2003) Am Fam Physician 67:1499-510 [PubMed]