Imipramine is a prescription tricyclic antidepressant used to treat symptoms of depression, anxiety, and panic attacks, as well as bed-wetting in childhood. [1] It helps to regulate the amounts of chemicals in your brain to lessen symptoms. It can be taken in both tablet and capsule form.

Imipramine brand names

Imipramine is available mainly under the brand name Tofranil. An intramuscular injection is available under the Tofranil-PM name [2]. It is available worldwide.

What is Imipramine prescribed for?

Imipramine is used to treat people with:

Imipramine prescriptions have decreased over recent years, as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to have fewer side effects. The drug is usually only prescribed if other treatments have not worked. Never take imipramine without proper medical advice and supervision.

How does imipramine work?

Imipramine is a type of tricyclic antidepressant medication. This class of drugs helps to regulate normal chemical levels in your brain to lessen the symptoms you’re experiencing.

It is not known precisely how it prevents bed-wetting, though it has been suggested that it prevents a type of chemical from being sent to the bladder.

How is Imipramine usually taken?

Imipramine comes in the form of tablets and capsules and are taken orally. Your dosage will depend on what your doctor thinks will be most effective; however, it is typically at least once a day. It can take up to three weeks for the drug to work to its maximum capacity. [1]

Try to take imipramine at the same time every day. If your child is taking it to prevent bed-wetting, it is recommended that it is taken an hour before bedtime.

Keep taking imipramine even if you no longer experience any of the main symptoms. Taking more than you need to can lead to severe side effects and potentially an overdose. If you are concerned or have any questions about your dosage, speak to your doctor as soon as possible.

What if I miss a dose of Imipramine?

If you miss a dose, take it as soon as you remember. However, if it is within a few hours of your next dose, it is okay to miss the dose and carry on taking it as normal. Never take more than your doctor has prescribed each day in order to catch up with any missed doses.

How long does Imipramine stay in your system?

This depends on how high your dosage is and how long you have been taking imipramine. Speak to your doctor if you are concerned about how long it remains in your system.

Imipramine side effects

Taking imipramine can cause side effects, which can range from mild inconveniences that you may wish to relay to your doctor, to severe side effects that can require urgent medical attention. [1] [3]

Mild side effects

  • Dizziness
  • Drowsiness
  • Lack of coordination
  • Headaches
  • Nightmares
  • Dry mouth
  • Nausea
  • Increased appetite
  • Cramps

Tell your doctor if these become a daily problem and don’t go away.

Severe side effects

  • Changes in heart rate and blood pressure that vary greatly from what is normal
  • Seizures
  • Insomnia
  • Hepatitis
  • Any signs of infection such as a fever or sore throat
  • Eye pain
  • Difficulty breathing
  • Muscle spasms

These are very rare; however, if you do experience any of them, it is important to speak to a doctor as soon as possible or seek urgent medical attention.

Imipramine precautions

Your doctor will ask you some questions before they prescribe Imipramine. This is to ensure that it is the correct drug for you and that your dosage is accurate. [1]

  • Tell your doctor if you know you are allergic to imipramine or any of its ingredients, as severe allergic reactions can occur, although rare. Ask your doctor or pharmacist for the list of ingredients if you are unsure.
  • Tell your doctor if you currently take, or have recently stopped taking, Monoamine Oxidate Inhibitors (MAOIs).
  • Your doctor will ask about any medications you are currently taking and any existing medical conditions. Be candid and thorough in disclosing everything you take, as even vitamins, dietary supplements, or herbal medications may cause adverse effects.
  • Tell your doctor if you are breastfeeding, plan to become pregnant, or do become pregnant whilst taking imipramine.
  • Be mindful that some side effects may take longer to appear/occur. Don’t drive or operate heavy machinery until you are aware of your side effects. Alcohol may make drowsiness worse.
  • If you are over the age of 65, speak to your doctor about any alternative drugs you can take to avoid certain side effects.
  • Smoking can reduce the effectiveness of imipramine, so tell your doctor if you do plan to smoke whilst taking it.
  • Tell your doctor if you have recently suffered a heart attack or any other heart-related issues.

Imipramine interactions

Unless your doctor tells you otherwise, continue with your normal diet. There are currently no known food groups that cause unwanted interactions with imipramine. Alcohol may make your side effects worse and your tolerance to alcohol may be weaker.

As mentioned before, tell your doctor if you are currently taking or have recently stopped taking MAOIs.

Imipramine storage

Imipramine should be kept at room temperature in a dry environment (i.e., not in the bathroom where it can get humid).

Imipramine and any other medication should be kept in a locked cupboard out of reach of children and pets. It is important you check that the packaging has a child-locked lid. If it does not, take extra precautions to make sure children do not have any access to it.

Do not dispose of the medication in general waste areas where children and pets may have access. If you have leftover doses, speak to a pharmacist about disposing of them (although your doctor will typically prescribe the exact amount).

Imipramine overdose

In high doses, imipramine, along with all other tricyclic antidepressants, can cause overdoses with severe symptoms. The main symptoms of tricyclic antidepressant overdoses include:

  • Irregular or fast heartbeat
  • High body temperature
  • Sleepiness
  • Confusion
  • Seizures
  • Blurred vision and dilated pupils
  • Cardiac arrest
  • Kidney failure [4]

If no symptoms have occurred within six hours, it is unlikely that you will suffer an overdose. [5] However, if you think you have taken too many pills, or are displaying any of the above symptoms or know of anyone that has, it is extremely important to seek urgent medical attention.

If a doctor thinks you are displaying signs of an overdose, they will monitor you in intensive care for at least 12 hours. If your electrocardiogram has been clear for more than 24 hours, your doctor will likely discharge you. [4]

Resources:

  1. Medline Plus [Internet]. National Library of Medicine [2018]. Imipramine. Available from https://medlineplus.gov/druginfo/meds/a682389.html
  2. Swiss Pharmaceutical Society, Index Nominum 2000: International Drug Directory. Taylor & Francis. 2000. p. 546.Skidmore-Roth, L., ed. (2010). Mosby's nursing drug reference (23rd ed.). St. Louis, MO: Mosby Elsevier.
  3. Kerr G., McGuffie A., Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001; 18(4): 236–41.
  4. Woolf, A. D., Erdman, A. R., Nelson, L. S., Caravati, E. M., Cobaugh, D. J., Booze, L. L., Wax, P. M., Manoguerra, A. S., Scharman, E. J., Olson, K. R., Chyka, P. A., Christianson, G., & Troutman, W. G. (2007). Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical toxicology (Philadelphia, Pa.), 45(3), 203–233.