DOSE AND DOSAGE
- Adult Dose for Depression:
- Initial dose: 25 mg orally 1 to 3 times a day, increasing gradually as needed and tolerated.
- Maintenance dose: 75 to 150 mg/day.
- Maximum dose: 300 mg/day.
- Pediatric Dose for Depression:
- Not established for children under 12 years.
FREQUENCY
- The frequency of administration typically ranges from once daily to several times daily, depending on the prescribed dose and individual patient response.
ROA (Route of Administration)
- Imipramine is administered orally in the form of tablets or capsules.
MOA (Mechanism of Action)
- Imipramine, a tricyclic antidepressant (TCA), primarily inhibits the reuptake of norepinephrine and serotonin neurotransmitters in the synaptic cleft, thereby prolonging their actions at the post-synaptic receptors.
PK (Pharmacokinetics)
- Absorption: Imipramine is well absorbed orally but undergoes extensive first-pass metabolism in the liver.
- Distribution: It is widely distributed throughout the body, including the brain.
- Metabolism: Imipramine is extensively metabolized in the liver, primarily via demethylation and hydroxylation, to active and inactive metabolites.
- Elimination: The drug and its metabolites are excreted mainly in the urine, with a small portion eliminated in the feces.
PATHOPHYSIOLOGY
- Imipramine alleviates symptoms of depression by modulating the levels of neurotransmitters, such as norepinephrine and serotonin, in the brain. The exact pathophysiology of depression is complex and involves dysregulation of various neurotransmitter systems, neuroendocrine pathways, and brain regions associated with mood regulation.
INDICATIONS
- Imipramine is indicated for the treatment of major depressive disorder (MDD) and symptoms of depression, including depressed mood, loss of interest or pleasure, changes in appetite or weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty concentrating, and suicidal ideation.
CONTRAINDICATIONS
- Contraindications to imipramine use include:
- Hypersensitivity to tricyclic antidepressants (TCAs) or any components of the formulation.
- Recent myocardial infarction (within the past 6 months).
- Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs.
- Concurrent use of linezolid or intravenous methylene blue.
Please note: Always consult a healthcare professional for specific dosing instructions and recommendations tailored to individual patient needs and medical history.
Medication Information and Guidelines
| Question | Answer |
|---|---|
| What’s the purpose of taking this medication? | Imipramine is primarily used to treat major depressive disorder (MDD) and symptoms of depression, such as depressed mood, loss of interest, changes in appetite, etc. |
| How is one supposed to use this medicine? | Imipramine is typically taken orally in the form of tablets or capsules, with an initial dose of 25 mg orally 1 to 3 times daily, gradually increasing as needed and tolerated. |
| Are there other reasons people might use this medication? | Imipramine may also be used off-label for conditions such as panic disorder, anxiety disorders, neuropathic pain, and enuresis (bedwetting) in children. |
| Are there any specific things one need to be careful about while taking this medication? | Yes, individuals taking imipramine should be cautious about potential side effects such as dizziness, drowsiness, and orthostatic hypotension. They should also avoid abrupt discontinuation of the medication to prevent withdrawal symptoms. |
| Do one need to make any changes to diet while they are on this medication? | There are no specific dietary restrictions associated with imipramine use. However, individuals should maintain a balanced diet and avoid excessive alcohol consumption, which may exacerbate certain side effects. |
| What should one do if he/she forget to take a dose? | If a dose of imipramine is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Doubling up on doses should be avoided. |
| What are the possible side effects of this medication? | Common side effects of imipramine include dizziness, drowsiness, dry mouth, constipation, blurred vision, weight gain, and urinary retention. More serious side effects may include cardiac arrhythmias, seizures, and serotonin syndrome. |
| How should one store and dispose of this medication properly? | Imipramine should be stored at room temperature away from light and moisture. Unused or expired medication should be properly disposed of according to local regulations or guidelines, such as through medication take-back programs or community disposal sites. |
| What should one do if something goes wrong, as in an overdose or emergency situation? | In the event of an overdose or emergency situation, such as severe dizziness, fainting, seizures, or difficulty breathing, medical attention should be sought immediately. Individuals can also contact their local poison control center for assistance. |
| MONITORING AND LABORATORY TESTS | Periodic monitoring of blood pressure, heart rate, and electrocardiogram (ECG) may be recommended during imipramine therapy, especially during initiation and dose adjustments. Laboratory tests, such as complete blood count (CBC) and liver function tests, may also be performed periodically to monitor for potential adverse effects. |