Indications and Dosage

Conditions Treated

- By Mouth (Adults): Up to 75 mg daily in divided doses, increased to 150–200 mg daily, with up to 150 mg as a single bedtime dose.
- By Mouth (Elderly): Start at 10 mg daily, increased to 30–50 mg daily, dose increases gradually.
- Hospital Patients: Initially up to 75 mg daily in divided doses, increased up to 300 mg daily in divided doses.

- By Mouth (Children 6–7 years): 25 mg once daily at bedtime. Treatment period is 3 months with a full physical exam before further treatment.
- By Mouth (Children 8–10 years): 25–50 mg once daily at bedtime. Same treatment period and conditions as above.
- By Mouth (Children 11–17 years): 50–75 mg once daily at bedtime. Treatment conditions apply similarly.

Imipramine is used for conditions such as emotional lability in multiple sclerosis and abdominal pain in patients unresponsive to standard treatments, though these are not licensed indications.

Acute recovery after myocardial infarction, arrhythmias, acute porphyrias, heart block, manic phase of bipolar disorder.

Cardiovascular disease, chronic constipation, diabetes, epilepsy, history of bipolar disorder or psychosis, hyperthyroidism, increased intra-ocular pressure, significant suicide risk, phaeochromocytoma, prostatic hypertrophy, susceptibility to angle-closure glaucoma, urinary retention.

Common/Very Common: Anxiety, decreased appetite, arrhythmias, asthenia, cardiac conduction disorders, confusion, delirium, dizziness, drowsiness, hallucinations, headache, hepatic disorders, hypotension, nausea, palpitations, paresthesia, sexual dysfunction, skin reactions, sleep disorders, vomiting, weight changes.
Uncommon to Rare: Psychosis, aggression, bone marrow depression, enlarged mammary gland, eosinophilia, fever, glaucoma, heart failure, leucopenia, movement disorders, mydriasis, oedema, oral disorders, peripheral vasospastic reaction, respiratory disorders, SIADH, speech disorder, thrombocytopenia.
Frequency Not Known: Anticholinergic syndrome, cardiovascular effects, drug fever, hyponatremia, increased fracture risk, neurological effects, paranoid delusions, psychiatric disorder, suicidal behaviors, tinnitus, urinary disorder, withdrawal syndrome.

Pregnancy: Use may cause symptoms like colic and respiratory depression in neonates if used in the third trimester.
Breastfeeding: The drug is present in breast milk but is considered too small to be harmful.
Hepatic and Renal Impairment: Use cautiously in mild to moderate hepatic impairment and severe renal impairment; avoid in severe hepatic conditions.
Withdrawal: Gradually reduce dosage to minimize withdrawal symptoms.