TCA·Psychiatry - Antidepressants

Imipramine

Major Depressive Disorder, Nocturnal enuresis (bedwetting)

PBSTCATofranil25 mg tabletS4+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

200 mg/day

Half-life

10-20 h

Enuresis

PAEDS USE

High risk: Toxicity in OD

CRITICAL

Cautions

Avoid / Cautions

Recent myocardial infarction, heart block, concurrent MAOIs, narrow-angle glaucoma.

Where it stands

Rapid Summary

Overview

The very first Tricyclic Antidepressant (TCA). A highly potent serotonin and noradrenaline reuptake inhibitor. Extremely toxic in overdose. Uniquely used in pediatrics for bedwetting.

Clinical Focus

As with all TCAs, a 10-day supply taken at once is a fatal cardiac overdose. Do not dispense large quantities to suicidal patients.

Bottom Line

Imipramine is a classic TCA for depression and nocturnal enuresis in children, but is cardiotoxic in overdose and has significant anticholinergic and sedative effects.

Formulation & Access

Brand Names

Tofranil

Oral Routes

Tablets (10, 25 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, Nocturnal enuresis (bedwetting).

Clinical Place

Largely obsolete for depression due to SSRIs. Retains a niche in treatment-resistant childhood bedwetting due to its profound anticholinergic bladder-relaxing effect.

Quick reference

Class & Role

TCA — The very first Tricyclic Antidepressant (TCA).

Route / Formulation

Tablets (10, 25 mg). (Tofranil)

Usual Dose & Max

Start PO 25-50 mg NOCTE. Titrate up to 100-200 mg/day. Max 200 mg/day (Depression).

Key Indication Doses

Depression: Start PO 25-50 mg NOCTE. Titrate up to 100-200 mg/day. Nocturnal Enuresis (Children > 6 yrs): PO 10-75 mg NOCTE (Strictly weight/age based. Used only after bed alarms/desmopressin fail).

Best Uses

Imipramine is a classic TCA for depression and nocturnal enuresis in children, but is cardiotoxic in overdose and has significant anticholinergic and sedative effects.

Key Risks

Cardiovascular: QRS widening, arrhythmias, heart block, severe orthostatic hypotension. Gastrointestinal: Severe dry mouth, constipation, urinary retention (desired in enuresis, dangerous in adults). Neurological: Sedation, delirium in the elderly, lowers seizure threshold.

Key Interactions

MAOIs, Tramadol (Serotonin Syndrome). CYP2D6 inhibitors (Fluoxetine) spike Imipramine levels into the toxic range.

Monitoring

Baseline ECG before escalating doses. Keep medication locked away from children. A toddler ingesting a few adult tablets will suffer a fatal cardiac arrest.

Clinical Pearl

Imipramine stops bedwetting through three pathways: it paralyzes the bladder (anticholinergic), it makes sleep lighter so the child wakes to a full bladder (noradrenaline), and it alters ADH secretion.

Access

Tofranil25 mg tablet

Brand: Tofranil
Formulation: Tablets (10, 25 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

TCA·Psychiatry - Antidepressants

Imipramine

Major Depressive Disorder, Nocturnal enuresis (bedwetting)

PBSTCATofranil25 mg tabletS4+1

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

200 mg/day

Half-life

10-20 h

Enuresis

PAEDS USE

High risk: Toxicity in OD

CRITICAL

Cautions

Avoid / Cautions

Recent myocardial infarction, heart block, concurrent MAOIs, narrow-angle glaucoma.

Where it stands

Rapid Summary

Overview

The very first Tricyclic Antidepressant (TCA). A highly potent serotonin and noradrenaline reuptake inhibitor. Extremely toxic in overdose. Uniquely used in pediatrics for bedwetting.

Clinical Focus

As with all TCAs, a 10-day supply taken at once is a fatal cardiac overdose. Do not dispense large quantities to suicidal patients.

Bottom Line

Imipramine is a classic TCA for depression and nocturnal enuresis in children, but is cardiotoxic in overdose and has significant anticholinergic and sedative effects.

Formulation & Access

Brand Names

Tofranil

Oral Routes

Tablets (10, 25 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder, Nocturnal enuresis (bedwetting).

Clinical Place

Largely obsolete for depression due to SSRIs. Retains a niche in treatment-resistant childhood bedwetting due to its profound anticholinergic bladder-relaxing effect.

Quick reference

Class & Role

TCA — The very first Tricyclic Antidepressant (TCA).

Route / Formulation

Tablets (10, 25 mg). (Tofranil)

Usual Dose & Max

Start PO 25-50 mg NOCTE. Titrate up to 100-200 mg/day. Max 200 mg/day (Depression).

Key Indication Doses

Depression: Start PO 25-50 mg NOCTE. Titrate up to 100-200 mg/day. Nocturnal Enuresis (Children > 6 yrs): PO 10-75 mg NOCTE (Strictly weight/age based. Used only after bed alarms/desmopressin fail).

Best Uses

Imipramine is a classic TCA for depression and nocturnal enuresis in children, but is cardiotoxic in overdose and has significant anticholinergic and sedative effects.

Key Risks

Key Interactions

MAOIs, Tramadol (Serotonin Syndrome). CYP2D6 inhibitors (Fluoxetine) spike Imipramine levels into the toxic range.

Monitoring

Baseline ECG before escalating doses. Keep medication locked away from children. A toddler ingesting a few adult tablets will suffer a fatal cardiac arrest.

Clinical Pearl

Access

Tofranil25 mg tablet

Brand: Tofranil
Formulation: Tablets (10, 25 mg).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.