Dosing & Uses
Dosage Forms & Strengths
tablet
- 10mg
- 25mg
- 50mg
capsule
- 75mg
- 100mg
- 125mg
- 150mg
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
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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (19)
- disopyramide
imipramine and disopyramide both increase QTc interval. Contraindicated.
- dronedarone
dronedarone will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.
dronedarone will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increased potential risk of torsade's de pointes-type ventricular tachycardia. - eliglustat
imipramine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.
- fezolinetant
imipramine will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors
- ibutilide
imipramine and ibutilide both increase QTc interval. Contraindicated.
- indapamide
imipramine and indapamide both increase QTc interval. Contraindicated.
- iobenguane I 123
imipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid and imipramine both increase serotonin levels. Contraindicated.
- pentamidine
imipramine and pentamidine both increase QTc interval. Contraindicated.
- phenelzine
phenelzine and imipramine both increase serotonin levels. Contraindicated.
- pimozide
imipramine and pimozide both increase QTc interval. Contraindicated.
- procainamide
imipramine and procainamide both increase QTc interval. Contraindicated.
- procarbazine
procarbazine and imipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
- quinidine
quinidine and imipramine both increase QTc interval. Contraindicated.
- safinamide
imipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline and imipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated
- sotalol
imipramine and sotalol both increase QTc interval. Contraindicated.
- thioridazine
thioridazine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.
- tranylcypromine
tranylcypromine and imipramine both increase serotonin levels. Contraindicated.
Serious - Use Alternative (138)
- albuterol
imipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amiodarone
imipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amitriptyline
amitriptyline and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
amitriptyline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - amoxapine
amoxapine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
amoxapine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - apalutamide
apalutamide will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
- arformoterol
imipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- arsenic trioxide
imipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
imipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug. - benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and imipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- benzphetamine
imipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- buprenorphine
buprenorphine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine subdermal implant and imipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine transdermal
buprenorphine transdermal and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine transdermal and imipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine, long-acting injection
buprenorphine, long-acting injection and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine, long-acting injection and imipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buspirone
imipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.
- calcium/magnesium/potassium/sodium oxybates
imipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- chlorpromazine
chlorpromazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- ciprofloxacin
ciprofloxacin will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concurrent use of drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias. It is important to monitor therapy carefully.
- citalopram
citalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
- clarithromycin
clarithromycin will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug. - clomipramine
clomipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
clomipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - clonidine
imipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- cyclobenzaprine
imipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- dasatinib
dasatinib will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- desipramine
desipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
desipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - desvenlafaxine
imipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dexfenfluramine
imipramine, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dexmethylphenidate
imipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dextroamphetamine
imipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dextromethorphan
imipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.
- diethylpropion
imipramine, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dobutamine
imipramine, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dofetilide
imipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- dopamine
imipramine, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dopexamine
imipramine, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- doxepin
doxepin and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
doxepin and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - dronedarone
imipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
imipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- duloxetine
duloxetine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- ephedrine
imipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- epinephrine
epinephrine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
imipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - epinephrine racemic
epinephrine racemic and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
imipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - erythromycin base
erythromycin base will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. - erythromycin stearate
erythromycin stearate will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug. - escitalopram
escitalopram and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- fenfluramine
imipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- fexinidazole
fexinidazole and imipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fluconazole
fluconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
imipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug. - fluoxetine
fluoxetine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.
fluoxetine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
fluoxetine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - fluphenazine
fluphenazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- formoterol
imipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
imipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. - fosamprenavir
fosamprenavir increases levels of imipramine by decreasing metabolism. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- granisetron
granisetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- guanfacine
imipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.
- haloperidol
haloperidol will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
imipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug. - iobenguane I 131
imipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoproterenol
imipramine, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- itraconazole
imipramine and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.
- ketoconazole
imipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levalbuterol
imipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- levoketoconazole
imipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- levomilnacipran
levomilnacipran and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- linezolid
linezolid and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- lisdexamfetamine
imipramine, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- lofepramine
imipramine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug. - lonafarnib
lonafarnib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.
- lorcaserin
imipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- lumefantrine
lumefantrine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
imipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug. - maprotiline
imipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug. - mefloquine
mefloquine increases toxicity of imipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- meperidine
imipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
- metaproterenol
imipramine, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methamphetamine
imipramine, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methylene blue
methylene blue and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- methylenedioxymethamphetamine
imipramine, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- metoclopramide intranasal
imipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midodrine
imipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- milnacipran
milnacipran and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
imipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nefazodone
nefazodone and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- nilotinib
imipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- norepinephrine
imipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- nortriptyline
imipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - octreotide
imipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide (Antidote)
imipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
- olopatadine intranasal
imipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
ondansetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of imipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- paroxetine
paroxetine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
paroxetine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - pefloxacin
pefloxacin will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.
- perphenazine
perphenazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- phendimetrazine
imipramine, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phentermine
imipramine, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine
imipramine, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine PO
imipramine, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- pirbuterol
imipramine, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- pitolisant
imipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.
- promazine
promazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- propylhexedrine
imipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- protriptyline
imipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug. - pseudoephedrine
imipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- quinidine
quinidine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- rasagiline
rasagiline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.
- salmeterol
imipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- selegiline transdermal
selegiline transdermal and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- selinexor
selinexor, imipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- serdexmethylphenidate/dexmethylphenidate
imipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- sertraline
sertraline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
sertraline and imipramine both increase QTc interval. Avoid or Use Alternate Drug. - sodium oxybate
imipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- St John's Wort
imipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.
- tedizolid
tedizolid, imipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- terbutaline
imipramine, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- thioridazine
thioridazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
imipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
- trazodone
imipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
trazodone and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. - trifluoperazine
trifluoperazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
imipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
imipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. - umeclidinium bromide/vilanterol inhaled
imipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
- vandetanib
imipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- venlafaxine
venlafaxine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
imipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
- vilazodone
imipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
imipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
- xylometazoline
imipramine, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- yohimbe
yohimbe, imipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.
- yohimbine
imipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ziprasidone
imipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (400)
- 5-HTP
imipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.
- abiraterone
abiraterone increases levels of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of imipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .
- aclidinium
aclidinium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- acrivastine
acrivastine and imipramine both increase sedation. Use Caution/Monitor.
- albuterol
imipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and imipramine both increase sedation. Use Caution/Monitor.
- almotriptan
almotriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- alprazolam
alprazolam and imipramine both increase sedation. Use Caution/Monitor.
- amifampridine
imipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.
- amiodarone
amiodarone will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- amisulpride
imipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
- amitriptyline
amitriptyline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amitriptyline and imipramine both increase sedation. Use Caution/Monitor. - amobarbital
amobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
amobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
amobarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
amobarbital and imipramine both increase sedation. Use Caution/Monitor. - amoxapine
amoxapine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
amoxapine and imipramine both increase sedation. Use Caution/Monitor. - anagrelide
anagrelide and imipramine both increase QTc interval. Use Caution/Monitor.
- anticholinergic/sedative combos
anticholinergic/sedative combos and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- apomorphine
imipramine and apomorphine both increase sedation. Use Caution/Monitor.
- aprepitant
aprepitant will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- arformoterol
imipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
aripiprazole and imipramine both increase sedation. Use Caution/Monitor.
- armodafinil
armodafinil will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
armodafinil will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
imipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - asenapine
asenapine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
asenapine and imipramine both increase QTc interval. Use Caution/Monitor.
asenapine and imipramine both increase sedation. Use Caution/Monitor. - asenapine transdermal
asenapine transdermal and imipramine both increase QTc interval. Use Caution/Monitor.
asenapine transdermal and imipramine both increase sedation. Use Caution/Monitor. - atazanavir
atazanavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
atazanavir increases levels of imipramine by unspecified interaction mechanism. Use Caution/Monitor. - atracurium
atracurium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine
atropine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine IV/IM
atropine IV/IM and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- avapritinib
avapritinib and imipramine both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and imipramine both increase sedation. Use Caution/Monitor.
- azithromycin
imipramine and azithromycin both increase QTc interval. Use Caution/Monitor.
- baclofen
baclofen and imipramine both increase sedation. Use Caution/Monitor.
- belladonna alkaloids
belladonna alkaloids and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
belladonna and opium and imipramine both increase sedation. Use Caution/Monitor. - benperidol
benperidol and imipramine both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- benzphetamine
imipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benztropine
benztropine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use.
- bethanechol
bethanechol increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bortezomib
bortezomib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- brexpiprazole
imipramine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
brexpiprazole and imipramine both increase sedation. Use Caution/Monitor. - brimonidine
brimonidine and imipramine both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and imipramine both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and imipramine both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and imipramine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and imipramine both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
imipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
imipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- bupropion
bupropion will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
imipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible. - butabarbital
butabarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
butabarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
butabarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
butabarbital and imipramine both increase sedation. Use Caution/Monitor. - butalbital
butalbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
butalbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
butalbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
butalbital and imipramine both increase sedation. Use Caution/Monitor. - butorphanol
butorphanol and imipramine both increase sedation. Use Caution/Monitor.
- caffeine
imipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cannabidiol
cannabidiol will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.
- carbachol
carbachol increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
carbamazepine will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
carbamazepine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - carbinoxamine
carbinoxamine and imipramine both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and imipramine both increase sedation. Use Caution/Monitor.
- celecoxib
celecoxib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- cenobamate
cenobamate will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
- cevimeline
cevimeline increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and imipramine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and imipramine both increase sedation. Use Caution/Monitor.
- chloroquine
chloroquine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and imipramine both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and imipramine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and imipramine both increase sedation. Use Caution/Monitor.
- cholestyramine
cholestyramine decreases levels of imipramine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
- cigarette smoking
cigarette smoking will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- cimetidine
cimetidine will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
cimetidine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
cimetidine will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - cinnarizine
cinnarizine and imipramine both increase sedation. Use Caution/Monitor.
- cisatracurium
cisatracurium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clemastine
clemastine and imipramine both increase sedation. Use Caution/Monitor.
- clobazam
clobazam will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
imipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression). - clomipramine
clomipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
clomipramine and imipramine both increase sedation. Use Caution/Monitor. - clonazepam
clonazepam and imipramine both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and imipramine both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and imipramine both increase sedation. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of imipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.
- cocaine topical
imipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- codeine
codeine and imipramine both increase sedation. Use Caution/Monitor.
imipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine. - conivaptan
conivaptan will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cyclizine
cyclizine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
cyclizine and imipramine both increase sedation. Use Caution/Monitor. - cyclobenzaprine
cyclobenzaprine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
cyclobenzaprine and imipramine both increase sedation. Use Caution/Monitor. - cyclosporine
cyclosporine will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and imipramine both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and imipramine both increase sedation. Use Caution/Monitor.
- daridorexant
imipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darifenacin
darifenacin will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
darifenacin will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
darifenacin and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. - darunavir
darunavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.
- dasatinib
imipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- debrisoquine
imipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.
- degarelix
degarelix and imipramine both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and imipramine both increase sedation. Use Caution/Monitor.
desflurane and imipramine both increase QTc interval. Use Caution/Monitor. - desipramine
desipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
desipramine and imipramine both increase sedation. Use Caution/Monitor. - desvenlafaxine
desvenlafaxine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg
- deutetrabenazine
imipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
deutetrabenazine and imipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation). - dexchlorpheniramine
dexchlorpheniramine and imipramine both increase sedation. Use Caution/Monitor.
- dexfenfluramine
imipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely. - dexmedetomidine
dexmedetomidine and imipramine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
imipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
imipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
imipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor. - dextroamphetamine transdermal
imipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.
- dextromoramide
dextromoramide and imipramine both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and imipramine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and imipramine both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, imipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- dicyclomine
dicyclomine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- diethylpropion
imipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and imipramine both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and imipramine both increase sedation. Use Caution/Monitor.
- dihydroergotamine
imipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine intranasal
imipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- diltiazem
diltiazem will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and imipramine both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
diphenhydramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
diphenhydramine and imipramine both increase sedation. Use Caution/Monitor. - diphenoxylate hcl
diphenoxylate hcl and imipramine both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and imipramine both increase sedation. Use Caution/Monitor.
- dobutamine
imipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dolasetron
imipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
- donepezil
donepezil increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
donepezil and imipramine both increase QTc interval. Use Caution/Monitor. - dopamine
imipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
imipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
doxepin and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
doxepin and imipramine both increase sedation. Use Caution/Monitor. - doxylamine
doxylamine and imipramine both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and imipramine both increase sedation. Use Caution/Monitor.
- duloxetine
duloxetine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.
- echothiophate iodide
echothiophate iodide increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- efavirenz
efavirenz will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
efavirenz and imipramine both increase QTc interval. Use Caution/Monitor. - elagolix
elagolix will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
- eletriptan
eletriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eliglustat
eliglustat increases levels of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
eliglustat and imipramine both increase QTc interval. Use Caution/Monitor. - elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- entrectinib
entrectinib and imipramine both increase QTc interval. Use Caution/Monitor.
- ephedrine
imipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor. - epinephrine
imipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor. - epinephrine inhaled
imipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- epinephrine racemic
imipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. - ergotamine
imipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eribulin
eribulin and imipramine both increase QTc interval. Use Caution/Monitor.
- erythromycin base
erythromycin base will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, imipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- eslicarbazepine acetate
eslicarbazepine acetate will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- esomeprazole
esomeprazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- estazolam
estazolam and imipramine both increase sedation. Use Caution/Monitor.
- ethanol
imipramine and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and imipramine both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
fedratinib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary. - felbamate
felbamate will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- felodipine
felodipine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- fenfluramine
imipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
fenfluramine, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fesoterodine
fesoterodine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- fexinidazole
fexinidazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- fingolimod
fingolimod and imipramine both increase QTc interval. Use Caution/Monitor.
- flavoxate
flavoxate and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- flecainide
imipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.
- fluconazole
fluconazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- fluoxetine
imipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
fluphenazine and imipramine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and imipramine both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- formoterol
imipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosaprepitant
fosaprepitant will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- foscarnet
imipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
- fosphenytoin
fosphenytoin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- frovatriptan
frovatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- gabapentin
gabapentin, imipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, imipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- galantamine
galantamine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ganaxolone
imipramine and ganaxolone both increase sedation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and imipramine both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and imipramine both increase QTc interval. Use Caution/Monitor.
- glycopyrrolate
glycopyrrolate and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor. - glycopyrrolate inhaled
glycopyrrolate inhaled and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor. - glycopyrronium tosylate topical
glycopyrronium tosylate topical, imipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- granisetron
granisetron and imipramine both increase QTc interval. Use Caution/Monitor.
- grapefruit
grapefruit will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- haloperidol
haloperidol and imipramine both increase sedation. Use Caution/Monitor.
- henbane
henbane and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
homatropine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- huperzine A
huperzine A increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocodone
hydrocodone, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydromorphone
hydromorphone and imipramine both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and imipramine both increase sedation. Use Caution/Monitor.
hydroxyzine and imipramine both increase QTc interval. Use Caution/Monitor. - hyoscyamine
hyoscyamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine spray
hyoscyamine spray and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- iloperidone
imipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
iloperidone and imipramine both increase sedation. Use Caution/Monitor. - imatinib
imatinib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- indacaterol, inhaled
indacaterol, inhaled, imipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- indinavir
indinavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ipratropium
ipratropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.
- isoflurane
isoflurane and imipramine both increase QTc interval. Use Caution/Monitor.
- isoniazid
isoniazid will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
isoniazid will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
imipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely. - isoproterenol
imipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and imipramine both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketotifen, ophthalmic
imipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- L-tryptophan
imipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.
- lapatinib
imipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- lasmiditan
lasmiditan, imipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
imipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome. - lemborexant
lemborexant, imipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- letermovir
letermovir increases levels of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
imipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
imipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- levoketoconazole
levoketoconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levorphanol
levorphanol and imipramine both increase sedation. Use Caution/Monitor.
- levothyroxine
levothyroxine increases effects of imipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liothyronine
liothyronine increases effects of imipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- liotrix
liotrix increases effects of imipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- lisdexamfetamine
imipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s). - lithium
imipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
lithium and imipramine both increase QTc interval. Use Caution/Monitor. - lofepramine
imipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and lofepramine both increase sedation. Use Caution/Monitor. - lofexidine
imipramine and lofexidine both increase sedation. Use Caution/Monitor.
imipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor. - loprazolam
loprazolam and imipramine both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and imipramine both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and imipramine both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and imipramine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and imipramine both increase sedation. Use Caution/Monitor.
- lsd
imipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor, imipramine. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .
- lurasidone
lurasidone, imipramine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects ; Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- maprotiline
imipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and maprotiline both increase sedation. Use Caution/Monitor. - maraviroc
maraviroc will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- marijuana
marijuana will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
imipramine and marijuana both increase sedation. Use Caution/Monitor. - mavacamten
imipramine will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- meclizine
meclizine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- melatonin
imipramine and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and imipramine both increase sedation. Use Caution/Monitor.
- meprobamate
imipramine and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
imipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and imipramine both increase sedation. Use Caution/Monitor.
- methadone
imipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
methadone and imipramine both increase sedation. Use Caution/Monitor. - methamphetamine
imipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and imipramine both increase sedation. Use Caution/Monitor.
- methscopolamine
methscopolamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methylenedioxymethamphetamine
imipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylphenidate
imipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methylphenidate transdermal
methylphenidate transdermal will increase the level or effect of imipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.
- mexiletine
mexiletine will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- midazolam
midazolam and imipramine both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, imipramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
imipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirabegron
mirabegron will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mirtazapine
imipramine and mirtazapine both increase sedation. Use Caution/Monitor.
imipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely. - modafinil
modafinil will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
modafinil will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
imipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - morphine
morphine and imipramine both increase sedation. Use Caution/Monitor.
imipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely. - motherwort
imipramine and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
imipramine and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
imipramine and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and imipramine both increase sedation. Use Caution/Monitor.
- naratriptan
naratriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- nefazodone
nefazodone will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nefopam
nefopam, imipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.
- nelfinavir
nelfinavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- neostigmine
neostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- norepinephrine
imipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - nortriptyline
imipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and nortriptyline both increase sedation. Use Caution/Monitor. - ofloxacin
imipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- olanzapine
olanzapine and imipramine both increase sedation. Use Caution/Monitor.
olanzapine and imipramine both increase QTc interval. Use Caution/Monitor. - oliceridine
imipramine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
imipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
imipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics. - olodaterol inhaled
imipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- omeprazole
omeprazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- onabotulinumtoxinA
onabotulinumtoxinA and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- opium tincture
opium tincture and imipramine both increase sedation. Use Caution/Monitor.
- orphenadrine
imipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
orphenadrine and imipramine both increase sedation. Use Caution/Monitor. - oxazepam
oxazepam and imipramine both increase sedation. Use Caution/Monitor.
- oxcarbazepine
oxcarbazepine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- oxybutynin
oxybutynin and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
oxybutynin topical and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
oxybutynin transdermal and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxycodone
oxycodone and imipramine both increase sedation. Use Caution/Monitor.
- oxymetazoline intranasal
imipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.
- oxymorphone
oxymorphone and imipramine both increase sedation. Use Caution/Monitor.
- paliperidone
imipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and imipramine both increase sedation. Use Caution/Monitor. - pancuronium
pancuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- papaveretum
papaveretum and imipramine both increase sedation. Use Caution/Monitor.
- papaverine
imipramine and papaverine both increase sedation. Use Caution/Monitor.
- parecoxib
parecoxib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
parecoxib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - paroxetine
imipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
imipramine and pazopanib both increase QTc interval. Use Caution/Monitor.
- peginterferon alfa 2a
peginterferon alfa 2a will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- peginterferon alfa 2b
peginterferon alfa 2b, imipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
- pentazocine
pentazocine and imipramine both increase sedation. Use Caution/Monitor.
imipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. - pentobarbital
pentobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
pentobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
pentobarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
pentobarbital and imipramine both increase sedation. Use Caution/Monitor. - perphenazine
perphenazine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
perphenazine and imipramine both increase sedation. Use Caution/Monitor. - phendimetrazine
imipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
phenobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
phenobarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
phenobarbital and imipramine both increase sedation. Use Caution/Monitor. - phentermine
imipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
imipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine ophthalmic
imipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- phenylephrine PO
imipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Consider phenytoin serum levels if a tricyclic antidepressant is added to therapy or if the patient begins to exhibit signs of toxicity; lower doses of phenytoin may be required. If phenytoin is added to tricyclic antidepressant therapy, monitor for clinical efficacy of the tricyclic agent. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression.
- pholcodine
imipramine and pholcodine both increase sedation. Use Caution/Monitor.
- physostigmine
physostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pilocarpine
pilocarpine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide and imipramine both increase sedation. Use Caution/Monitor.
- pipemidic acid
pipemidic acid will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- pirbuterol
imipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
imipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- pralidoxime
pralidoxime and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pregabalin
pregabalin, imipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
primidone will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
primidone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
primidone and imipramine both increase sedation. Use Caution/Monitor. - prochlorperazine
prochlorperazine and imipramine both increase QTc interval. Use Caution/Monitor.
prochlorperazine and imipramine both increase sedation. Use Caution/Monitor. - promethazine
promethazine and imipramine both increase QTc interval. Use Caution/Monitor.
promethazine and imipramine both increase sedation. Use Caution/Monitor. - propafenone
propafenone will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- propantheline
propantheline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- propofol
propofol and imipramine both increase sedation. Use Caution/Monitor.
- propylhexedrine
imipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
imipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and protriptyline both increase sedation. Use Caution/Monitor. - pyridostigmine
pyridostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quazepam
quazepam and imipramine both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and imipramine both increase sedation. Use Caution/Monitor.
- quinacrine
quinacrine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- ramelteon
imipramine and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
ranolazine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
imipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely. - rapacuronium
rapacuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- remifentanil
imipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.
- remimazolam
remimazolam, imipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- ribociclib
ribociclib will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifabutin decreases levels of imipramine by increasing metabolism. Use Caution/Monitor. - rifampin
rifampin will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
rifampin will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
rifampin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - rifapentine
rifapentine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
imipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
risperidone and imipramine both increase sedation. Use Caution/Monitor. - ritonavir
ritonavir will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
ritonavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - rizatriptan
rizatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- rocuronium
rocuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- rolapitant
rolapitant will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- romidepsin
imipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.
- rucaparib
rucaparib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.
- salmeterol
imipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- SAMe
imipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.
- scopolamine
scopolamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scullcap
imipramine and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
secobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
secobarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
secobarbital and imipramine both increase sedation. Use Caution/Monitor. - sertraline
sertraline will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.
- sevoflurane
sevoflurane and imipramine both increase sedation. Use Caution/Monitor.
sevoflurane and imipramine both increase QTc interval. Use Caution/Monitor. - shepherd's purse
imipramine and shepherd's purse both increase sedation. Use Caution/Monitor.
- smoking
smoking will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of imipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
imipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of imipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.
- solifenacin
solifenacin and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
solifenacin and imipramine both increase QTc interval. Use Caution/Monitor. - sparsentan
sparsentan will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.
- St John's Wort
St John's Wort will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- stiripentol
stiripentol will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
stiripentol, imipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - succinylcholine
succinylcholine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sufentanil
sufentanil and imipramine both increase sedation. Use Caution/Monitor.
- sufentanil SL
sufentanil SL, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sulfamethoxazole
imipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.
- sumatriptan
sumatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- sumatriptan intranasal
sumatriptan intranasal and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- suvorexant
suvorexant and imipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tacrolimus
tacrolimus and imipramine both increase QTc interval. Use Caution/Monitor.
- tamsulosin
imipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tapentadol
tapentadol and imipramine both increase sedation. Use Caution/Monitor.
imipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. - tecovirimat
tecovirimat will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
- telavancin
imipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
- temazepam
temazepam and imipramine both increase sedation. Use Caution/Monitor.
- terbinafine
terbinafine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- terbutaline
imipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tetrabenazine
tetrabenazine and imipramine both increase QTc interval. Use Caution/Monitor.
- thioridazine
thioridazine and imipramine both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and imipramine both increase sedation. Use Caution/Monitor.
- thyroid desiccated
thyroid desiccated increases effects of imipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.
- tiotropium
tiotropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tobacco use
tobacco use will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- tolterodine
tolterodine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- topiramate
imipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and imipramine both increase sedation. Use Caution/Monitor.
imipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. - trazodone
imipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and trazodone both increase sedation. Use Caution/Monitor. - triazolam
triazolam and imipramine both increase sedation. Use Caution/Monitor.
- triclabendazole
triclabendazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.
- triclofos
triclofos and imipramine both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and imipramine both increase sedation. Use Caution/Monitor.
- trihexyphenidyl
trihexyphenidyl and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.
- trimethoprim
imipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trimipramine
imipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
imipramine and trimipramine both increase sedation. Use Caution/Monitor. - triprolidine
triprolidine and imipramine both increase sedation. Use Caution/Monitor.
- tropisetron
imipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
- trospium chloride
trospium chloride and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- valbenazine
valbenazine and imipramine both increase QTc interval. Use Caution/Monitor.
- valerian
valerian and imipramine both increase sedation. Use Caution/Monitor.
- vecuronium
vecuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- venlafaxine
venlafaxine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
imipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely. - verapamil
verapamil will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
verapamil will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. TCA level may be increased. - voriconazole
voriconazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
imipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely. - xylometazoline
imipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
imipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
imipramine and ziconotide both increase sedation. Use Caution/Monitor.
- zileuton
zileuton will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- ziprasidone
ziprasidone and imipramine both increase sedation. Use Caution/Monitor.
- zolmitriptan
zolmitriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
Minor (105)
- acarbose
imipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.
- amobarbital
amobarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- armodafinil
armodafinil will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atropine
imipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.
- atropine IV/IM
imipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- bazedoxifene/conjugated estrogens
bazedoxifene/conjugated estrogens, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- benazepril
imipramine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.
- bosentan
bosentan will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- brimonidine
imipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.
- budesonide
budesonide will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- butalbital
butalbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- captopril
imipramine, captopril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.
- carbamazepine
carbamazepine decreases levels of imipramine by increasing metabolism. Minor/Significance Unknown.
- chlorpromazine
imipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - chlorpropamide
imipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.
- colestipol
colestipol decreases levels of imipramine by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- conjugated estrogens
conjugated estrogens, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- conjugated estrogens, vaginal
conjugated estrogens, vaginal, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- cortisone
cortisone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- deferasirox
deferasirox will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- desflurane
desflurane, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- dexamethasone
dexamethasone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexmethylphenidate
dexmethylphenidate increases effects of imipramine by decreasing metabolism. Minor/Significance Unknown.
- DHEA, herbal
DHEA, herbal will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- efavirenz
efavirenz will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- estradiol
estradiol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens conjugated synthetic
estrogens conjugated synthetic, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- estrogens esterified
estrogens esterified, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.
- estropipate
estropipate, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- ethanol
ethanol decreases levels of imipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.
- ethinylestradiol
ethinylestradiol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.
- etomidate
etomidate, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- etravirine
etravirine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
imipramine and eucalyptus both increase sedation. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fluphenazine
imipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - glimepiride
imipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.
- glipizide
imipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.
- glyburide
imipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.
- griseofulvin
griseofulvin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydroxyprogesterone caproate (DSC)
hydroxyprogesterone caproate (DSC), imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- insulin aspart
imipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin detemir
imipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glargine
imipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin glulisine
imipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin lispro
imipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin NPH
imipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.
- insulin regular human
imipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.
- isoniazid
isoniazid will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- isoproterenol
isoproterenol, imipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.
- ketamine
ketamine, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- lithium
lithium, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.
- lumefantrine
lumefantrine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- mestranol
mestranol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- metformin
imipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metronidazole
metronidazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miglitol
imipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.
- nateglinide
imipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- nevirapine
nevirapine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
nifedipine will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nilotinib
nilotinib will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- panax ginseng
panax ginseng increases effects of imipramine by pharmacodynamic synergism. Minor/Significance Unknown.
- pentobarbital
pentobarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- perphenazine
imipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - phenobarbital
phenobarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- pioglitazone
imipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- pleurisy root
pleurisy root decreases effects of imipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.
- posaconazole
posaconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prednisone
prednisone will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- primidone
primidone, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- prochlorperazine
imipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - progesterone micronized
progesterone micronized, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.
- promazine
imipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - promethazine
imipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - propofol
propofol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- repaglinide
imipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.
- rosiglitazone
imipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.
- rufinamide
rufinamide will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
imipramine and sage both increase sedation. Minor/Significance Unknown.
- saxagliptin
imipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- secobarbital
secobarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate increases effects of imipramine by decreasing metabolism. Minor/Significance Unknown.
- sevoflurane
sevoflurane, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.
- sitagliptin
imipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- sulfamethoxazole
sulfamethoxazole decreases levels of imipramine by unspecified interaction mechanism. Minor/Significance Unknown.
- thioridazine
imipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - tolazamide
imipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.
- tolbutamide
imipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.
- topiramate
topiramate will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- trifluoperazine
imipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
imipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects. - vasopressin
imipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.
- verapamil
verapamil increases levels of imipramine by decreasing metabolism. Minor/Significance Unknown.
- vildagliptin
imipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.
- voriconazole
voriconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zafirlukast
zafirlukast will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zolpidem
zolpidem, imipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
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
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
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.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
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
---|---|---|---|
imipramine oral - | 25 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 50 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 25 mg tablet | ![]() | |
imipramine oral - | 50 mg tablet | ![]() | |
imipramine oral - | 50 mg tablet | ![]() | |
imipramine oral - | 25 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 25 mg tablet | ![]() | |
imipramine oral - | 25 mg tablet | ![]() | |
imipramine oral - | 50 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 50 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() | |
imipramine oral - | 10 mg tablet | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
imipramine oral
IMIPRAMINE - ORAL
(ih-MIH-pra-meen)
COMMON BRAND NAME(S): Tofranil
WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
USES: This medication is used to treat depression. It is also used with other therapies for the treatment of nighttime bed-wetting (enuresis) in children. Using this medication to treat depression may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. Imipramine can help your child control nighttime bed-wetting.Imipramine belongs to a class of medications called tricyclic antidepressants. It works by restoring the balance of certain natural substances (neurotransmitters such as norepinephrine) in the brain. For bed-wetting, this medication may work by blocking the effect of a certain natural substance (acetylcholine) on the bladder.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking imipramine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 1 to 4 times daily. If you have daytime drowsiness, your doctor may direct you to take the entire dose once daily at bedtime. The dosage is based on your medical condition and response to treatment. In children, dosage may also be based on body weight. To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose.When used by children for bed-wetting, imipramine should be taken one hour before bedtime. If your child usually wets the bed early in the night, the drug may be given earlier in separate doses (such as one dose in the afternoon and one dose at bedtime).Follow your doctor's instructions carefully. Do not take more or less medication or take it more often than prescribed. Your condition will not improve any faster and your risk of side effects will increase. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day.This medication does not work right away. It may take up to 3 weeks before you experience the full benefits if you are taking this medication for depression.Keep taking this medication even if you feel well. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Your dose may need to be gradually decreased.When used for an extended period in children for bed-wetting, this medication may not work as well and may require different dosing. Talk with the doctor if this medication stops working well.Inform your doctor if your condition lasts or gets worse.
SIDE EFFECTS: See also Warning section.Dry mouth, blurred vision, headache, drowsiness, dizziness, constipation, nausea, vomiting, loss of appetite, diarrhea, stomach cramps, weight gain/loss, and increased sweating may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, depression, memory problems), enlarged/painful breasts, unusual breast milk production, irregular/painful menstrual periods, muscle stiffness, restlessness, ringing in the ears, sexual problems (such as decreased sexual ability, changes in desire), shakiness (tremors), numbness/tingling of the hands/feet, pain/redness/swelling of arms or legs, trouble urinating, easy bruising/bleeding, signs of infection (such as sore throat that doesn't go away, fever), severe stomach/abdominal pain, dark urine, yellowing of eyes/skin.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Get medical help right away if you have any very serious side effects, including: chest pain, slow/fast/irregular heartbeat, fainting, seizures, trouble speaking, weakness on one side of the body, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as desipramine, amitriptyline); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma, chronic bronchitis), personal or family history of glaucoma (angle-closure type), diabetes, eating disorders (such as bulimia), heart problems (such as arrhythmias, coronary artery disease, heart attack), liver problems, kidney problems, personal or family history of other mental/mood conditions (such as bipolar disorder, schizophrenia), seizures, overactive thyroid (hyperthyroidism), trouble urinating (such as due to enlarged prostate), any condition that may increase your risk of seizures (including alcohol/sedative dependency, use of electroconvulsive therapy, brain injury/disease such as stroke), certain types of tumors (such as pheochromocytoma, neuroblastoma).Imipramine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using imipramine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using imipramine safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.If you have diabetes, this drug may make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Older adults may be more sensitive to the side effects of this drug, especially dizziness (more likely when standing up), drowsiness, constipation, trouble urinating, mental/mood changes (such as confusion, agitation) and heart effects such as QT prolongation (see above). Dizziness, drowsiness, and confusion can increase the risk of falling.Children may be more sensitive to the side effects of this drug, especially heart effects.During pregnancy, this medication should be used only when clearly needed. Infants born to mothers who have taken similar medications during pregnancy may have symptoms such as trouble urinating, prolonged sleepiness, shaking, and seizures. Discuss the risks and benefits with your doctor.Since untreated mental/mood problems (such as depression, anxiety, panic disorders) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain drugs for high blood pressure (such as clonidine, guanadrel, guanethidine), digoxin, disopyramide, thyroid supplements, valproic acid.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Other medications can affect the removal of imipramine from your body, which may affect how imipramine works. Examples include barbiturates (such as phenobarbital), cimetidine, haloperidol, certain drugs for heart rhythm (such as flecainide, propafenone), halofantrine, certain HIV protease inhibitors (such as fosamprenavir), phenothiazines (such as thioridazine), pimozide, certain anti-seizure drugs (such as phenytoin), trazodone, among others.Many drugs besides imipramine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), sparfloxacin, among others. Before using imipramine, report all medications you are currently using to your doctor or pharmacist.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Check the labels on all your medicines (such as cough-and-cold products) because they may contain drowsiness-containing ingredients or decongestants that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.Imipramine is very similar to desipramine. Do not take medications containing desipramine while using imipramine.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fast/irregular heartbeat, fainting, hallucinations, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood counts, EKG, kidney function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised June 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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.