Imipramine

See Tricyclic Antidepressant
Imipramine was the prototypal, first marketed Tricyclic Antidepressant (first synthesized in 1951, released in 1957)

See Tricyclic Antidepressant
Imipramine inhibits both Serotonin and Norepinephrine reuptake
Imipramine is demethylated to Desipramine, which primarily inhibits Norepinephrine reuptake

Adults
1. Start: 50 to 75 mg orally at bedtime (or divided twice daily)
2. Titrate to 75 to 100 mg orally at bedtime (or divided twice daily)
3. Maximum: 150 mg mg/day
4. Therapeutic range 50 to 150 mg/day
Teens and Elderly
1. Start 30 to 40 mg orally at bedtime
2. Advance to 50 to 100 mg orally daily or divided twice daily as tolerated and to effect
3. Maximum: 100 mg/day

Consider other measures for Nocturnal Enuresis first
Consider baseline EKG before starting medication
Initial dose
1. Avoid in age <6 years
2. Start at 10 mg orally nightly given one hour before bedtime
Maximum dosing: up to 0.9 to 1.5 mg/kg
1. Age 6-8 years
  1. May increase dose by 10 mg every 1-2 weeks as needed up to 25-50 mg per night one hour before bed
2. Age 8-12 years
  1. May increase dose by 10 mg every 1-2 weeks as needed up to 50 mg per night one hour before bed
3. Age over 12 years
  1. May increase dose by 10 mg every 1-2 weeks as needed up to 75 mg per night one hour before bed
Discontinue after 3-6 months (some guidelines suggest maximum of 3 months)
1. Taper to one half dose nightly for 2 weeks
2. Taper to one half dose every other night for 2 weeks