- See Tricyclic Antidepressant
- Imipramine was the prototypal, first marketed Tricyclic Antidepressant (first synthesized in 1951, released in 1957)
- Unknown safety in pregnancy
- Safe in Lactation
- See Tricyclic Antidepressant
- Imipramine inhibits both Serotonin and Norepinephrine reuptake
- Imipramine is demethylated to Desipramine, which primarily inhibits Norepinephrine reuptake
- Obtain serum levels in pediatric population
- Avoid as full dose Antidepressant
- Serum Half Life: 11 to 25 hours
- Therapeutic plasma level: 200 to 350
- Adults
- Start: 50 to 75 mg orally at bedtime (or divided twice daily)
- Titrate to 75 to 100 mg orally at bedtime (or divided twice daily)
- Maximum: 150 mg mg/day
- Therapeutic range 50 to 150 mg/day
- Teens and Elderly
- Start 30 to 40 mg orally at bedtime
- Advance to 50 to 100 mg orally daily or divided twice daily as tolerated and to effect
- Maximum: 100 mg/day
- Consider other measures for Nocturnal Enuresis first
- Consider baseline EKG before starting medication
- Initial dose
- Avoid in age <6 years
- Start at 10 mg orally nightly given one hour before bedtime
- Maximum dosing: up to 0.9 to 1.5 mg/kg
- Age 6-8 years
- May increase dose by 10 mg every 1-2 weeks as needed up to 25-50 mg per night one hour before bed
- Age 8-12 years
- May increase dose by 10 mg every 1-2 weeks as needed up to 50 mg per night one hour before bed
- Age over 12 years
- 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)
- Taper to one half dose nightly for 2 weeks
- Taper to one half dose every other night for 2 weeks
- Response in up to 60% of children
- Relapse is common soon after stopping medication
- See Tricyclic Antidepressants
- Serious cardiotoxicity in overdosage
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
-
Thiedke (2003) Am Fam Physician 67:1499-510 [PubMed]
loading