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Psychotropic Drugs in Children: Imipramine (Tofranil)

tofranil

Table 3. Prescribing Information for Imipramine (Tofranil ®)
Optimum Dosage Usual maximum 5 mg/kg/dayEnuresis: 0-6 yr — not indicated

6-12 yr — up to 50 mg/day

12+ — up to 75 mg/day

ADD with anxiety or depression:

note maximum dose

Depression: some improve at serum levels of 150-200 ng/L

Some adolescent anorexics and bulemics respond to 150-200 mg/day

Major Side-Effectsa Cardiovascular effects:ECG changes (T-wave and P-R intervals affected at doses approaching 5 mg/kg/day) without cardiac injury (10%-30%)

Epileptic seizures (<2%)

Drug Interactions SedativesAnticholinergics

Epinephrine

Monoamine oxidase inhibitors

Minor Short-Term Transienta Side-Effects Anticholinergic effects:Dry mouth (>30%)

Blurred vision (10%-30%)

Constipation (10%-30%)

Sweating (10%-30%)

Delayed micturition (10%-30%); primarily in elderly

CNS effects:

Drowsiness (10%-30%)

Insomnia (10%-30%)

Excitement (10%-30%) (particularly in bi-polar patients) Headache (10%-30%)

Extrapyramidal effects:

Fine tremor (10%-30%)

Gastrointestinal distress (10%-30%)

Weight gain (>6 kg) (>30%)

Rash (<2%)

Cardiovascular effects:

Postural hypotension or dizziness (>30%)

Tachycardia (10%-30%)

Increase in blood pressure (at 3 mg/kg/day)b

Contra-indications Not to be used in conjunction with or within 14 days of using monoamine oxidase inhibitorsNot to be used in out-patient treatment of suicidal patients

Not to be used in presence of glaucoma

Caution with epilepsy

Drug Withdrawal EffectsAbdominal painNausea, vomiting

Drowsiness

Decreased appetite

Tearfulness

Agitation

Malaise

Headache

Concurrent Treatment and AlternativesAlarm blanket (enuresis)Psychotherapy

Family therapy

Behaviour therapy

Hospitalization or residential treatment

a. Frequencies from Bezchilibnyk-Butler and Jeffries.b. Reversible if medication is discontinued.

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