III. Dosing: General

  1. Adult: 25-50 mg PO qhs

IV. Dosing: Nocturnal Enuresis in children

  1. Consider other measures for Nocturnal Enuresis first
  2. Consider baseline EKG before starting medication
  3. Initial dose
    1. Age 6-8 years: 25 mg PO one hour before bedtime
    2. Age 8-12 years: 50 mg PO one hour before bedtime
    3. Age over 12 years: 75 mg PO one hour before bedtime
  4. Maximum dosing: up to 0.9 to 1.5 mg/kg
  5. 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

V. Efficacy: Nocturnal Enuresis

  1. Response in up to 60% of children
  2. Relapse is common soon after stopping medication

VI. Pharmacokinetics

  1. Obtain serum levels in pediatric population
  2. Avoid as full dose Antidepressant
  3. Serum Half Life: 11 to 25 hours
  4. Therapeutic plasma level: 200 to 350

VII. Adverse effects

  1. See Tricyclic Antidepressants
  2. Significant adverse effects
    1. Anticholinergic Symptoms
    2. Drowsiness
    3. Sleep problems
    4. Gastrointestinal upset
    5. Orthostatic Hypotension
    6. Cardiac arrhythmia
    7. Weight gain

VIII. Precautions

  1. See Tricyclic Antidepressants
  2. Serious cardiotoxicity in overdosage

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Cost: Medications

imipramine (on 1/18/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
IMIPRAMINE HCL 10 MG TABLET Generic $0.12 each
IMIPRAMINE HCL 25 MG TABLET Generic $0.14 each
IMIPRAMINE HCL 50 MG TABLET Generic $0.21 each
IMIPRAMINE PAMOATE 100 MG CAP Generic $6.97 each
IMIPRAMINE PAMOATE 150 MG CAP Generic $8.79 each
IMIPRAMINE PAMOATE 75 MG CAP Generic $7.19 each

Ontology: Imipramine (C0020934)

Definition (NCI) A synthetic tricyclic derivative, antidepressant Imipramine enhances monoamine neurotransmission in certain areas of the brain. It also induces sedation through histamine 1 receptor blockage; hypotension through beta-adrenergic blockage; and diverse parasympatholytic effects. Imipramine has less sedative effect than other members of its therapeutic family. It is used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. (NCI04)
Definition (MSH) The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group.
Definition (CSP) dibenzazepine tricyclic antidepressant.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007099
SnomedCT 36113004, 372718005
LNC LP16166-8, MTHU005180
English Imipramine, Imidobenzyle, Imizin, Norchlorimipramine, 5H-Dibenz(b,f)azepine-5-propanamine, 10,11-dihydro-N,N-dimethyl-, Imipramine [Chemical/Ingredient], imipramine, IMIPRAMINE, Imipramine (product), Imipramine (substance)
Swedish Imipramin
Czech imipramin
Finnish Imipramiini
Russian IMIZIN, IMIDOBENZIL, IMIPRAMIN, ИМИДОБЕНЗИЛ, ИМИЗИН, ИМИПРАМИН
Japanese イミプラミン塩酸塩, イミドベンジル, イミドール, 塩酸イミプラミン, トフラニール, イミジン, イミプラミン
Croatian IMIPRAMIN
Polish Imipramina, Tofranil
Spanish imipramina (producto), imipramina (sustancia), imipramina, Imipramina, Imizina, Imidobencil
French Imipramine
German Imidobenzyle, Imipramin, Imizin
Italian Imipramina
Portuguese Imidobenzila, Imipramina, Imizina

Ontology: Tofranil (C0025231)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007099
English tofranil, Tofranil