Formulary
Imipramine hydrochloride: Indications, Dosing, Side Effects and Interactions
Imipramine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Imipramine hydrochloride: Indications, Dosing, Side Effects and Interactions
Imipramine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness**
- **Adult** (By Mouth): Initially up to 75 mg daily in divided doses, then increased to 150-200 mg daily, up to 150 mg may be given as a single dose at bedtime, dose to be increased gradually.
- **Elderly** (By Mouth): Initially 10 mg daily, increased to 30-50 mg daily, dose to be increased gradually.
**Depressive illness in hospital patients**
- **Adult** (By Mouth): Initially up to 75 mg daily in divided doses, dose to be increased gradually, increased to up to 300 mg daily in divided doses.
**Nocturnal enuresis**
- **Child** (By Mouth): 11-17 years 50-75 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months-full physical examination before further course.
**Nocturnal enuresis for imipramine hydrochloride**
- **Child 6-7 years** (By mouth): 25 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months-full physical examination before further course.
- **Child 8-10 years** (By mouth): 25-50 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months-full physical examination before further course.
- **Child 11-17 years** (By mouth): 50-75 mg once daily, to be taken at bedtime, initial period of treatment (including gradual withdrawal) 3 months-full physical examination before further course.
**Attention deficit hyperactivity disorder (under expert supervision) for imipramine hydrochloride**
- **Child 6-17 years** (By mouth): 10-30 mg twice daily.
Cautions
Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy (in adults); susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Treatment should be stopped if the patient enters a manic phase. M In adults: Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects. M
Contraindications
Acute porphyrias ; arrhythmia; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Side effects
Common or very common Anxiety; appetite decreased; arrhythmias; asthenia; cardiac conduction disorders; confusion; delirium; depression; dizziness; drowsiness; epilepsy; hallucination; headache; hepatic disorders; mood altered; nausea; palpitations; paraesthesia; postural hypotension; sexual dysfunction; skin reactions; sleep disorder; tremor; vomiting; weight changes Uncommon Psychosis Rare or very rare Aggression; agranulocytosis; alopecia; bone marrow depression; enlarged mammary gland; eosinophilia; fever; galactorrhoea; gastrointestinal disorders; glaucoma; heart failure; interstitial lung disease; leucopenia; movement disorders; mydriasis; oedema; oral disorders; peripheral vasospastic reaction; photosensitivity reaction; SIADH; speech disorder; thrombocytopenia Frequency not known Anticholinergic syndrome; cardiovascular effects; drug fever; hyponatraemia; increased risk of fracture; neurological effects; paranoid delusions exacerbated; psychiatric disorder; suicidal behaviours; tinnitus; urinary disorder; withdrawal syndrome Side-effects, further information The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning .
Interactions
**Severe interactions:**
- MAO inhibitors: Do not give Imipramine hydrochloride for at least 3 weeks after discontinuation of treatment with MAO inhibitors (there is a risk of severe symptoms such as hypertensive crisis,...
**Other interactions (25):**
- The same applies when giving a MAO inhibitor after previous treatment with Imipramine hydrochloride.
- In both instances Imipramine hydrochloride or the MAO inhibitors should initially be given in small, gradually increasing doses and its effects monitored.
- There is evidence to suggest that tricyclic antidepressants may be given as little as 24 hours after a reversible MAO inhibitor such as moclobemide, but the 3 week wash-out period must be observed...
- Fluvoxetine and fluvoxamine may also increase plasma concentrations of imipramine, with corresponding adverse effects, resulting in increased plasma levels of tricyclic antidepressants, a lowered...
- CNS depressants: Tricyclic antidepressants may also increase the effects of alcohol and central depressant drugs (e.g.
- Imipramine should be used cautiously when co-administered with: Buprenorphine/opioids as the risk of serotonin syndrome, a potentially lifethreatening condition, is increased (see section 4.4).
Pregnancy
Colic, tachycardia, dyspnoea, irritability, muscle spasms, respiratory depression and withdrawal symptoms reported in neonates when used in the third trimester.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
Renal impairment
Caution in severe impairment. M
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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