Imipramine

Brand Name:Apo- Novo-Pramine, Tofranil

Prescription needed: Yes

What is this drug used for?

Imipramine is most commonly used to treat symptoms of depression. It can also be used for anxiety, different chronic pain conditions (e.g. fibromyalgia, nerve pain), migraines, eating problems, bedwetting, and attention deficit hyperactivity disorder (ADHS).

For depression, anxiety and other mood disorders, it works by increasing the amounts of so called “feel good” chemicals in the brain.

Is there any reason not to take this drug?

You should not take this drug if you are allergic to imipramine or similar medications such as amitriptyline, nortriptyline, doxepin and/or desipramine. Before taking this medication, tell your doctor specifically if you have or have ever had:

  • a problem with alcohol or drug abuse
  • a condition called bipolar disorder
  • a recent heart attack
  • an enlarged prostate
  • an overactive thyroid gland (hyperthyroidism)
  • any heart rhythm problems
  • difficulty going to the bathroom (e.g. urinary incontinence or urinary retention)
  • feelings of worsening depression or suicidal
  • glaucoma
  • problems with your liver or kidneys
  • seizures

What about possible side effects?

It is extremely important that you take this medication as prescribed by your doctor. Too much of this medication can cause severe side effects.

Side effects include:

  • feeling sleepy, tired and weak (this medication is usually started at bedtime to help decrease these symptoms)
  • dry mouth
  • constipation
  • difficulty urinating
  • dizziness, lightheadedness
  • feeling confused
  • weight gain

These side effects are usually related to dose, the use of other medications and other factors (e.g. older age, other medical conditions). As well, some of these side effects may go away with time. Talk to your doctor or pharmacist about whether you have any risk factors that may make you more sensitive to these side effects. Contact your doctor if these symptoms continue or become worse.

Other less common and possibly severe side effects include:

  • blurred vision
  • changes in sex drive or ability
  • excessive sweating
  • low blood pressure (feeling faint when standing up) and fast heartbeat - contact your doctor if you have these symptoms
  • rapid, pounding, or irregular heartbeat - contact your doctor immediately
  • severe skin rash or hives, increased sensitivity to the sun - contact your doctor immediately
  • seizures
  • very rare cases of hepatitis (inflammation of the liver) and jaundice (yellowing of skin and eyes) have been reported - call your doctor if you experience unexplained nausea, vomiting, stomach pain, fatigue, loss of appetite, dark urine, yellowing of the skin and/or eyes
  • tremors or shaking hands that you can’t control
  • jaw, neck, and back muscle spasms

This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication, ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or may change the safety or effectiveness of either drug. Tell your doctor specifically if you are taking any of these drugs as these are the most common interactions and he/she may need to make changes or monitor you more closely:
  • Phenelzine, tranylcypromine, moclobemide, selegeline, pargyline and other MAO-I inhibitors – Avoid the use of these drugs together. Must wait at least 2 weeks after stopping one before you can start the other.
  • Amiodarone, quinidine, erythromycin, clarithromycin, risperidone, sotalol - these drugs increase your chance of having heart rhythm side effects.

Drugs that can cause tiredness, sedation, dizziness or increase the chances of having the same side effects - talk to your doctor or pharmacist if you are taking any of the following drugs:

  • Antihistamines (e.g. diphenhydramine, hydroxyzine)
  • Opioid pain medications (e.g. codeine, oxycodone, morphine, hydromorphone)
  • Other antidepressants (e.g. sertraline, paroxetine, trazodone), medications for anxiety (e.g. lorazepam, diazepam) and antipsychotics (e.g. risperidone, haloperidol)
  • Muscle relaxants (e.g. cyclobenzaprine)
  • Drugs for epilepsy (gabapentin, phenytoin, phenobarbital, carbamazepine, valproic acid)
  • Oxybutynin, tolterodine - may increase your chance of side effects with urinating, constipation or dry mouth
  • Rifampin, carbamazepine, phenobarbital - may see decreased blood levels of imipramine and a decrease in how well the drug works
  • Amphetamine-like drugs, methylphenidate - may increase your chance of having side effects such as high blood pressure, rapid heartbeat
  • Cimetidine

This is not a complete list of drug interactions. Ask your doctor or pharmacist to review all of the medications you are currently taking.

Other information:

If you are taking this medication for depression or anxiety: It takes several weeks (4-6 weeks) before this medication will even start to work. Do not stop this medication if you don’t feel it is working. Your doctor will follow you and adjust the dose over time to find the right dose. Sometimes people feel worse in the beginning and want to stop their medication. This is usually due to side effects which tend to go away with time. However, if you feel any of the following symptoms, contact your doctor right away:

  • new or worsening feelings of depression
  • thoughts of suicide
  • extreme worry
  • agitation or panic attacks
  • aggressive behavior
  • acting without thinking
  • severe restlessness
  • frenzied abnormal excitement
  • any other sudden or unusual changes in behavior

If you are taking imipramine or other similar medications for a long time, you may have a greater chance of having problems with your teeth, mouth, gums or tongue, usually because this medication decreases your body’s production of saliva. Tell your dentist you are taking this drug, especially if you are going to have general anesthesia.

Sun Protection: Your skin may burn more easily while taking this medication. It is therefore recommended that you use sunscreen and wear protective clothing to decrease the chance of this happening.

Children: Can be used for specific situations. Doses will usually be based on weight. Talk to your doctor.

Seniors: Are more sensitive to side effects and lower doses are usually necessary, especially at the start of therapy.

Pregnancy: Talk to your doctor. Not treating the depression is often worse than the possible effects of the medication. You will need to weigh the benefits and risks of therapy.

Women who are nursing: This drug passes into breast milk. Talk to your doctor.

People who drive or operate machinery: Should not do so until they know how this drug affects them personally. Imipramine can cause drowsiness and blur your vision.

Alcohol: Avoid alcohol when taking this drug as it may increase the drug’s sedative effect.

Overdose: The risk of overdosing on this drug is high. If you experience palpitations or lose consciousness, or if you seriously exceed the recommended dosage, call 911 or have someone do it for you.

Stopping the drug: Talk to your doctor before you stop taking this drug. Withdrawal symptoms may include dizziness, vomiting, headache and irritability (this is not a complete list of withdrawal symptoms). Your doctor will probably decrease your dose gradually.

If you miss a dose: Take it as soon as you remember. If the next dose is due within 3 hours take the dose now and skip the next. Do not take a double dose.

Storage conditions: Closed container; cool, dry location away from excess moisture (not in the bathroom) and light; always out of reach of children.

Dietary precautions: None unless prescribed by your doctor