Pharm

Imipramine

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Imipramine, Tofranil

  • Background
  1. See Tricyclic Antidepressant
  2. Imipramine was the prototypal, first marketed Tricyclic Antidepressant (first synthesized in 1951, released in 1957)
  1. Adult: 25-50 mg orally at bedtime
  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. Tricyclic Antidepressant Overdose
  3. Significant adverse effects
    1. Anticholinergic Symptoms
    2. Drowsiness (but less than with Amitriptyline)
    3. Sleep problems
    4. Gastrointestinal upset
    5. Orthostatic Hypotension
    6. Cardiac Arrhythmia (Quinidine-like effect)
    7. Weight gain
  • Precautions
  1. See Tricyclic Antidepressants
  2. Serious cardiotoxicity in overdosage