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imipramine (im-ip-ra-meen)

Apo-Imipramine, imageImpril, Norfranil, Novopramine, Tipramine, Tofranil, Tofranil PM


Therapeutic: antidepressants

Pharmacologic: tricyclic antidepressants


Various forms of depression. Enuresis in children. Unlabeled Use: Adjunct in the management of chronic pain, incontinence (in adults), vascular headache prophylaxis, cluster headache, insomnia.


Potentiates the effect of serotonin and norepinephrine. Has significant anticholinergic properties. Therapeutic Effects: Antidepressant action that develops slowly over several weeks.

Adverse Reactions/Side Effects

CNS: drowsiness, fatigue, agitation, confusion, hallucinations, insomnia. EENT: blurred vision, dry eyes. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, dry mouth, nausea, paralytic ileus, weight gain. GU: urinary retention, decreased libido. Derm: photosensitivity. Endo: gynecomastia. Hemat: blood dyscrasias.


Examination and Evaluation

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Measure blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

  • Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

  • Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

  • Assess confusion, agitation, hallucinations, or other alterations in mental status (See Appendix D). Notify physician promptly if these symptoms develop.

  • Be alert for sedation and fatigue, especially in older adults. Report excessive or prolonged symptoms that could affect balance, gait, and functional activities.

  • If used to treat chronic pain, assess pain levels periodically to help document drug efficacy.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.


  • Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall prevention strategies (See Appendix E).

  • Because of cardiac arrhythmias and hypotension, use caution during aerobic exercise and endurance conditioning. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

  • Help patient explore nonpharmacologic methods to reduce depression (exercise, counseling, support groups, and so forth).

  • If treating neuropathic pain, chronic headache, or other pain syndromes, implement appropriate interventions (physical agents, manual techniques, therapeutic ...

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