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