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imipramine (Rx)Brand and Other Names:Tofranil, Tofranil-PM

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg

capsule

  • 75mg
  • 100mg
  • 125mg
  • 150mg
more...

Depression

Outpatient: 75 PO qDay initially; may increase to 150 mg/day gradually; not to exceed 200 mg/day outpatient; may give in divided doses or single dose HS

Inpatient: 100-150 mg/day PO; may increase gradually to 200 mg/day; if no response after 2 weeks, may increase further to 250-300 mg/day; not to exceed 300 mg/day; may give in divided doses or as a single dose at HS

Maintenance dose: 50-100 mg PO qDay

Dosing considerations

  • Patients may not see maximum antidepressant effect for >2 weeks

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg

capsule

  • 75mg
  • 100mg
  • 125mg
  • 150mg
more...

Enuresis

10-25 mg PO qHS initially; may increase by 10-25 mg q1-2Week 

6-12 years: Not to exceed 50 mg or 2.5 mg/kg/day HS

12-14 years: Not to exceed 75 mg/day

Depression (Off-label)

1.5 mg/kg/day PO divided q8hr; may increase every 3-4 days by 1 mg/kg; not to exceed 5 mg/kg/day 

Adolescents: 30-40 mg/day PO divided qDay or divided q8hr; not to exceed 100 mg/day

See Black Box Warning

Chronic Pain (Off-label)

0.2-0.4 mg/kg PO qHS; increase by 50% q2-3days to no more than 1-3 mg/kg PO qHS 

Depression

5-50 mg PO qHS; may increase q3days for inpatients and weekly for outpatient; not to exceed 100 mg/day

Dosing considerations

Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)

Consider alternatives; if must use, initiate with lower initial dose

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Interactions

Interaction Checker

imipramine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Fatigue

            Lethargy

            Sedation

            Weakness

            Constipation

            Dry mouth

            Blurred vision

            Agitation

            Anxiety

            Headache

            Insomnia

            Nausea

            Vomiting

            Sweating

            ECG changes, orthostatic hypotension, tachycardia

            Confusion, extrapyramidal symptoms (EPS), dizziness, paresthesia, tinnitus

            Rash

            Increased LFTs

            Sexual dysfunction

            Seizure

            Agranulocytosis

            Eosinophilia

            Leukopenia

            Thrombocytopenia

            SIADH

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            Warnings

            Black Box Warnings

            In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses

            This increase was not seen in patients aged over 24 years; a slight decrease in suicidal thinking was seen in adults aged over 65 years

            In children and young adults, risks must be weighed against the benefits of taking antidepressants

            Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments

            The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

            Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

            This drug is not approved for use in pediatric patients

            Contraindications

            Hypersensitivity

            Acute recovery post-MI

            Coadministration with serotonergic drugs

            • Concomitant with or within 14 days of MAOIs (serotonin syndrome)
            • Starting imipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
            • If linezolid or IV methylene blue must be administered, discontinue imipramine immediately and monitor for CNS toxicity; may resume imipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

            Cautions

            Risk of anticholinergic effects; use caution in BPH, urinary/GI retention, hyperthyroidism, oseizure disorder, brain tumor, respiratory impairment

            Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

            Clinical worsening and suicidal ideation may occur despite medication

            Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)

            May cause bone marrow suppression (rare)

            May cause orthostatic hypotension

            May cause sedation and impair physical or mental abilities

            Do not discontinue abruptly for prolonged high dosage

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; inhibits reuptake by neuronal membrane; may also down-regulate beta-adrenergic and serotonin receptors

            Absorption

            Bioavailability: Completely absorbed

            Onset: After >2 weeks

            Peak plasma time: 1-2 hr

            Distribution

            Vd: 18 L/kg

            Protein bound: 90%

            Metabolism

            Hepatic CYP1A2, CYP2C19, CYP2D6

            Metabolites: Desipramine

            Elimination

            Half-life: 6-18 hr

            Excretion: Urine

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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