How does this medication work? What will it do for me?
Imipramine belongs to the class of medications called tricyclic antidepressants (TCAs). Imipramine helps to elevate mood and eliminate or reduce other symptoms associated with depression. Tricyclic antidepressants such as imipramine work by increasing the amount of norepinephrine and serotonin neurotransmitters (chemical substances in the brain) available in certain parts of the brain.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
pms-Imipramine is no longer being manufactured for sale in Canada. For brands that may still be available, search under imipramine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.
How should I use this medication?
For the treatment of depression in adults, the recommended starting dose of imipramine is 25 mg three times daily, with or without food. This dose is usually increased gradually until the most effective dose is found. The maximum recommended daily dose is 300 mg. It may take several weeks before the medication has its full effect so you should be patient with the results. Your doctor will try to eventually prescribe the lowest dose that is effective. Once this dose has been reached, you may be able to take your entire dose at bedtime as recommended by your doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take imipramine if you:
- are allergic to imipramine or any ingredients of the medication
- are allergic to similar tricyclic antidepressants
- have taken a MAO inhibitor (e.g., phenelzine, tranylcypromine) in the last 14 days
- have recently experienced a heart attack
- have uncontrolled congestive heart failure
- have narrow-angle glaucoma
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
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Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- anxiety
- blurred vision
- breast enlargement
- confusion or delirium
- constipation (especially for seniors)
- delusions (believing things that are unrealistic and wrong)
- difficulty speaking or swallowing
- fast or irregular heartbeat (pounding, racing, skipping)
- hallucinations
- inappropriate secretion of milk
- increased frequency of infections with fever, chills, sore throat
- increased sensitivity to sunlight
- loss of balance control
- memory problems
- muscle twitching
- nervousness or restlessness
- new or worsening constipation, nausea, vomiting, dehydration, gas or stomach pain
- numbness or tingling sensation in arms and legs
- pinpoint red or purple spots on the skin
- problems with concentration
- red spots on the skin that burn, itch or sting
- ringing, buzzing, or other unexplained sounds in the ears
- shakiness or trembling
- shuffling walk
- signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
- signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- skin rash and itching
- slowed movements
- stiffness of arms and legs
- swelling of testicles
- symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
- symptoms of high blood pressure (e.g., shortness of breath, tiredness, dizziness or fainting, chest pain or pressure, swelling in the legs or ankles, fast or pounding heartbeat)
- symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
- symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)
- symptoms of low sodium levels in the blood (e.g., achy, stiff or uncoordinated muscles, confusion, tiredness, weakness)
- symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
- symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
- trouble with teeth or gums
- unusual swelling of hands, arms, legs, ankles, face, or airways
- withdrawal symptoms (e.g., nausea, vomiting, stomach discomfort, diarrhea, trouble sleeping, nervousness, anxiety, headache, irritability)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- seizures
- serotonin toxicity or neuroleptic malignant syndrome (signs include agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
- symptoms of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
- symptoms of DRESS (drug reaction with eosinophilia and systemic symptoms; e.g., fever, severe rash, swollen lymph glands, flu-like symptoms, peeling skin, shortness of breath, thirst urinating less often)
- symptoms of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
- symptoms of a severe allergic reaction such as swelling of the mouth or throat, chest tightness, or shortness of breath
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, thioridazine, chlorpromazine, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, dolasetron mesylate, tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation and should not be used in combination with imipramine. You are more at risk for this type of abnormal heart rhythm and its complications if you:
- are female
- are older than 65 years of age
- have a family history of sudden cardiac death
- have a history of heart disease or abnormal heart rhythms
- have a slow heart rate
- have congenital prolongation of the QT interval
- have diabetes
- have had a stroke
- have low potassium, magnesium, or calcium levels
- have nutritional deficiencies
If you have heart disease and abnormal heart rhythms, or people are taking certain medications (e.g., verapamil, atazanavir), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Alcohol and other medications that cause drowsiness: Do not combine this medication with alcohol or other medications that cause drowsiness (e.g., antidepressants, sleeping pills, anxiety medications) because imipramine can also cause drowsiness, and the combination can be dangerous.
Blood counts: Although rare, imipramine has been reported to cause a decrease in the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice any signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor immediately.
Diabetes: Both raising and lowering of blood sugar levels have been reported with imipramine use. People with diabetes or hypoglycemia (low blood sugar) should monitor their blood glucose levels closely while taking this medication.
Dizziness: Use caution (i.e., move slowly) when rising from a sitting or lying position since imipramine can cause sudden temporary low blood pressure resulting in dizziness.
Drowsiness/reduced alertness: Imipramine may impair the mental or physical abilities required for the potentially hazardous tasks such as driving a car or operating machinery. Use appropriate caution until you determine how this medication affects you.
Fractures: There is some evidence that people taking imipramine or other antidepressants may be at an increased risk of fractures (broken bones) when they first start to take this medication and after long term use. If you are a senior, have osteoporosis, or have other risk factors for bone fractures, take extra care to avoid falling by sitting or lying down if you feel dizzy or lightheaded. Contact your doctor if you experience dizziness or lightheadedness frequently.
Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Mania or hypomania: Imipramine may cause activation of mania or hypomania. If you have a history of mania or bipolar disorder, you should be closely monitored by your doctor while taking this medication.
Medical conditions: People with the following conditions should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed:
- benign prostatic hyperplasia (enlarged prostate)
- certain blood disorders
- increased eye pressure
- reduced liver function
- narrow-angle glaucoma
- seizures
- urinary retention
Other medications: The effects of imipramine can influence how the body deals with other medications. If you are taking blood thinners, imipramine may increase the length of time it takes for bleeding to stop. If you are having surgery, make sure your medical team know that you are taking imipramine. Talk to your doctor or pharmacist about any medications you are taking.
Serotonin toxicity/neuroleptic malignant syndrome: Severe reactions are possible when imipramine is combined with other medications that act on serotonin, such as other antidepressants and certain medications to treat migraine headaches. These combinations must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.
Suicidal thoughts: Imipramine may increase the risk of suicidal thoughts, especially when starting therapy or dosage adjustment. Seek medical attention at any signs of worsening condition.
Underactive thyroid: People taking thyroid hormone to treat underactive thyroid are at increased risk of heart problems when taking imipramine. Talk to your doctor or pharmacist about all the medications you are taking before starting a new medication.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
People who take imipramine in the during the last 6 months of pregnancy have been reported to have a higher risk of developing life-threatening high blood pressure. Babies who are born to people who have taken imipramine during the last 3 months of pregnancy experience withdrawal from the medication after birth.
Breast-feeding: Imipramine passes into breast milk. If you are breast-feeding and taking imipramine it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. Imipramine is not approved for use by children under the age of 18. There have been reports that use of this and similar medications by children under 18 years old may cause behavioural and emotional changes such as suicidal thoughts.
Seniors: Seniors are more likely to experience side effects of imipramine. Seniors should use this medication with caution and should not exceed the recommended dose.
What other drugs could interact with this medication?
For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.
If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/pms-Imipramine
