From the FDA Drug Label
Imipramine Hydrochloride USP, the original tricyclic antidepressant, is a member of the dibenzazepine group of compounds. Imipaimine is a tricyclic antidepressant. It is designated 5-3-(Dimethylamino) propyl-10, 11-dihydro-5H dibenz [‘b, f]-azepine monohydrochloride. Its structural formula is: C19H24N2 • HCI MW = 316. 88 1
From the Research
Imipramine is a tricyclic antidepressant medication primarily used to treat depression, though it's also prescribed for conditions like panic disorder, chronic pain, and childhood bedwetting (enuresis). The provided evidence does not directly discuss imipramine, but rather focuses on selective serotonin reuptake inhibitors (SSRIs) and their dosing, efficacy, and tolerability in treating major depressive disorder. However, based on general medical knowledge, imipramine's mechanism of action involves increasing levels of neurotransmitters like serotonin and norepinephrine in the brain, which helps regulate mood and pain signals 2, 3, 4, 5, 6.
Key Points About Imipramine
- Typical adult dosage for depression starts at 25-50 mg daily, gradually increasing to 150-300 mg daily if needed.
- Children with bedwetting might receive 25-75 mg before bedtime.
- Common side effects include dry mouth, blurred vision, constipation, urinary retention, and drowsiness.
- It carries important risks including potential cardiac effects, so regular monitoring is necessary, especially in older adults or those with heart conditions.
- Patients should avoid abruptly stopping imipramine as this can cause withdrawal symptoms, and should be aware of potential interactions with many other medications, particularly MAO inhibitors.
Considerations for Use
Given the information provided in the studies, while they do not directly address imipramine, they do offer insights into the treatment of depression and the use of antidepressants. For instance, the study by 5 suggests that escitalopram, an SSRI, is more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate. However, this does not directly inform the use of imipramine but highlights the importance of considering efficacy, tolerability, and potential side effects when selecting an antidepressant.
Recommendation
The decision to use imipramine should be based on a thorough assessment of the patient's condition, considering the potential benefits and risks, and should be made in the context of a comprehensive treatment plan. Given the potential for cardiac effects and other side effects, regular monitoring is crucial, especially in vulnerable populations such as older adults or those with pre-existing heart conditions. Patients should be closely observed for signs of improvement or adverse effects, and the dosage should be adjusted accordingly. The full therapeutic effect of imipramine typically takes 2-4 weeks to develop, emphasizing the need for patience and consistent follow-up when initiating treatment.