Home Drug Guide Imipramine Hydrochloride

Drug Guide

Generic Name

Imipramine Hydrochloride

Brand Names Presamine, Tofranil, Janimine, Pramine

Classification

Therapeutic: Antidepressant, Tricyclic

Pharmacological: Tricyclic Antidepressant (TCA)

FDA Approved Indications

  • Major depressive disorder
  • Enuresis (bedwetting) in children over 6 years

Mechanism of Action

Inhibits reuptake of norepinephrine and serotonin in the central nervous system, increasing their availability in synaptic clefts.

Dosage and Administration

Adult: Initial dose 75 mg per day in divided doses; dosage may be titrated based on response and tolerability.

Pediatric: For enuresis, typical dose ranges from 10-25 mg at bedtime; adjustment based on response.

Geriatric: Start at lower doses (e.g., 25-50 mg at bedtime) due to increased sensitivity and risk of side effects.

Renal Impairment: Adjust dose based on clinical response, monitor closely.

Hepatic Impairment: Use with caution; start at lower doses, monitor liver function.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Wide distribution, crosses the blood-brain barrier.

Metabolism: Primarily hepatic conjugation and oxidative metabolism via CYP2D6, CYP1A2, CYP3A4.

Excretion: Renal elimination of metabolites.

Half Life: Approximately 8-16 hours, variable.

Contraindications

  • Recent myocardial infarction
  • Concomitant use of MAO inhibitors
  • Known hypersensitivity to TCAs

Precautions

  • History of seizure disorders, angle-closure glaucoma, urinary retention, hepatic impairment, bipolar disorder (risk of manic episodes).
  • Pregnancy category C; lactation may pass into breast milk.

Adverse Reactions - Common

  • Dry mouth (Common)
  • Drowsiness (Common)
  • Dizziness (Common)
  • Constipation (Common)

Adverse Reactions - Serious

  • Myocardial infarction (Rare)
  • Suicidal thoughts (Monitor closely, especially in young adults and adolescents)
  • Serotonin syndrome (Rare, especially when combined with other serotonergic drugs)

Drug-Drug Interactions

  • Monoamine oxidase inhibitors (risk of serotonin syndrome), other CNS depressants, anticholinergic agents, sympathomimetics.
  • QT prolongation drugs

Drug-Food Interactions

  • Avoid alcohol and CNS depressants.

Drug-Herb Interactions

  • St. John's Wort may increase serotonergic effects and risk of serotonin syndrome.

Nursing Implications

Assessment: Monitor mental status, suicidal thoughts, ECG for QT interval prolongation, blood pressure, and signs of anticholinergic effects.

Diagnoses:

  • Risk for suicide, risk for imbalanced fluid volume, activity intolerance.

Implementation: Administer at bedtime to minimize drowsiness. Regularly assess for side effects and therapeutic response.

Evaluation: Evaluate for improvement in depression symptoms or enuresis control, and monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed, do not discontinue abruptly.
  • Warn about potential side effects such as dry mouth, drowsiness, dizziness.
  • Caution about alcohol and other CNS depressants.
  • Report worsening depression or emergence of suicidal thoughts.
  • Avoid driving or complex tasks until response is known.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
  • Use with caution in cardiac patients due to potential for arrhythmias.

Genetic Factors: Metabolism affected by CYP2D6 polymorphisms, influencing drug levels.

Lab Test Interference: May interfere with certain lab tests, including serum glucose and thyroid function.

Overdose Management

Signs/Symptoms: Drowsiness, confusion, agitation, hallucinations, seizures, cardiac arrhythmias, hypotension.

Treatment: Supportive care, activated charcoal, sodium bicarbonate for cardiac toxicity, vasopressors for hypotension, lidocaine or magnesium for arrhythmias, cardiopulmonary resuscitation as needed.

Storage and Handling

Storage: Store at room temperature, protected from humidity and light.

Stability: Stable under normal storage conditions for prescribed duration.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.