Imipramine (Dosage)

Imipramine is a tricyclic antidepressant used mainly for the treatment of major depressive disorder and nocturnal enuresis in children. Its effectiveness and tolerability are associated with the metabolic activity of CYP2D6 and CYP2C19 cytochromes, so knowledge of the genetic profile can help in optimal dose adjustment.

Imipramine belongs to the family of third-generation tricyclic antidepressants, used in the treatment of major depression and nocturnal enuresis in children over 6 years of age. It has also been used for the treatment of other conditions such as agoraphobia, anorexia nervosa, attention deficit hyperactivity disorder, chronic pain or panic disorder.

MECHANISM OF ACTION

Imaprime is a tricyclic antidepressant used in psychiatry since the 1960s. Its mechanism of action is not entirely clear, although it is hypothesized that it inhibits serotonin/noradrenaline reuptake at nerve endings, increasing the bioavailability of these neurotransmitters in the central nervous system. The drug's mode of action in the control of childhood enuresis is thought to be independent of its antidepressant effect.

CONTRAINDICATIONS

Imipramine is contraindicated in patients who have previously shown hypersensitivity to this drug or to other dibenzazepines. It should not be used in the recovery of patients who have suffered an acute myocardial infarction or patients with cardiac conduction problems.

It is important to keep in mind that important adverse effects may occur when combined with other medications such as other antidepressants, opiates, alcohol or herbal medicines, among others. It is important that, if you are taking other medications or supplements, you consult your doctor.

Imipramine should be used with caution in patients over 65 years of age because of its anticholinergic and sedative effects, especially in those with cognitive impairment, risk of syncope, dementia or urinary tract problems. In addition, close monitoring is advised in people with cardiovascular disorders or a history of heart disease, diabetics, stroke, glaucoma or renal failure.

SIDE EFFECTS

Imipramine may produce adverse effects similar to other tricyclic antidepressants, most of them mild and transient, and they usually disappear with continued treatment. The most frequent adverse reactions are weight gain, restlessness, sleep disturbance, confusion, tremor, blurred vision, tachycardia, hypotension, constipation or excessive sweating, among others. In addition, although less frequently, drowsiness, dizziness, headaches, arrhythmias, nausea or vomiting and urination problems may occur.

BRAND NAMES

  • Tofranil®

Genes analyzed

CYP2C19 CYP2D6

Bibliography

Dean L. Imipramine Therapy and CYP2D6 and CYP2C19 Genotype. Medical Genetics Summaries. National Center for Biotechnology Information (US). March 23, 2017.

Hicks JK, Swen JJ, Thorn CF, et al. Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants. Clin Pharmacol Ther, 2013; 93(5):402–8.

Hicks JK, Sangkuhl K, Swen JJ, et al. Clinical pharmacogenetics implementation consortium guideline (CPIC) for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update. Clin Pharmacol Ther. 2017 Jul;102(1):37-44.

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