imipramine hydrochloride
Imipramine is a medication that's used to treat depression. It can also temporarily help with bedwetting in children at night. Imipramine belongs to a class of medications called tricyclic antidepressants (TCAs). There are two different forms of the medication: imipramine hydrochloride and imipramine pamoate. They used to be available under the brand name Tofranil but are now only sold as generic versions. The dosage generally depends on why you need imipramine, how severe your symptoms are, and your age. It's generally not a first-choice option because it can cause a lot of side effects, like sleepiness, dizziness, dry mouth, and changes in weight.
What is Imipramine?
What is Imipramine used for?
- Depression
- Bedwetting in children (imipramine hydrochloride only)
How Imipramine works
Imipramine is a tricyclic antidepressant (TCA). The exact way it works isn't known. For depression, imipramine is thought to work by raising the levels of serotonin and norepinephrine chemicals in your brain; these chemicals are involved with regulating mood. For bedwetting, the medication is thought to allow the bladder to hold more urine.
Drug facts
More on Imipramine essentials
Side effects of Imipramine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
In adults (with depression)
- Dry mouth
- Blurry vision
- Nausea
- Vomiting
- Constipation
- Sleepiness
- Dizziness
- Confusion
- Anxiety
- Restlessness
In children (with bedwetting problems)
- Nervousness
- Sleep problems
- Tiredness
- Stomach upset
Less Common Side Effects
In adults (with depression)
- Numbness or tingling
- Ringing in the ears
- Change in taste
- Weight gain or loss
- Sweating
- Changes in blood pressure
- Fast or irregular heartbeat
- Mood changes
In children (with bedwetting problems)
- Constipation
- Anxiety
- Fainting
Imipramine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Heart attack: chest pain, cold sweats, left arm pain, trouble breathing
- Stroke: sudden numbness, weakness, confusion, trouble talking
- Serious allergic reaction: difficulty breathing, hives, itching, fast heartbeat, tightness in the throat, dizziness, swelling in the face or tongue
More on Imipramine side effects
The following Imipramine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abdominal or stomach pain
agitation
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or discomfort
clay-colored stools
cold sweats
confusion about identity, place, and time
continuing ringing or buzzing or other unexplained noise in the ears
cough or hoarseness
dark urine
decrease in the frequency of urination
difficulty in passing urine (dribbling)
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
double vision
false beliefs that cannot be changed by facts
fast, pounding, or irregular heartbeat or pulse
feeling, seeing, or hearing things that are not there
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
fever with or without chills
flushed, dry skin
general feeling of tiredness or weakness
hearing loss
hostility
hyperventilation
inability to move the arms, legs, or facial muscles
irritability
itching or rash
lack of coordination
lethargy
loss of balance control
lower back or side pain
mood or mental changes
muscle spasm or jerking of all extremities
muscle trembling, jerking, or stiffness
nightmares
pain or discomfort in the arms, jaw, back, or neck
painful or difficult urination
pinpoint red or purple spots on the skin
rapid weight gain
redness of the face, neck, arms, and occasionally, upper chest
restlessness
seizures
shakiness and unsteady walk
slow speech
stiffness of the limbs
stupor
sweating
swelling of the face, ankles, legs, or hands
talking, feeling, and acting with excitement
trouble sleeping
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
unusual behavior
unusual tiredness or weakness
weakness in the arms, hands, legs, or feet
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Bluish color of fingernails, lips, skin, palms, or nail beds
cold, clammy skin
decreased awareness or responsiveness
difficult or troubled breathing
disorientation
fast, weak pulse
hallucinations
irregular, fast, slow, or shallow breathing
severe sleepiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Bigger, dilated, or enlarged pupils (black part of the eye)
black tongue
decreased interest or ability in sexual intercourse
difficulty having a bowel movement (stool)
enlargement of the breast
hives or welts
increase in sexual ability, desire, drive, or performance
increased sensitivity of the eyes to light
increased urge to urinate during the night
peculiar taste
redness or other discoloration of the skin
severe sunburn
swelling of the testicles
swelling of the breasts or breast soreness in both females and males
swollen, painful, or tender lymph glands on the side of the face or neck
unexpected or excess milk flow from the breasts
waking to urinate at night
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Imipramine
Pros
- Available as a lower-cost generic
- Can take with or without food
- Dose can be adjusted by your provider based on how well the medication is working for you
- For bedwetting, only needs to be taken right before bedtime
Cons
- Can cause a lot of side effects, including blurry vision, dry mouth, and eye pain
- Can cause withdrawal symptoms if you stop taking it too suddenly after long-term use
- Has a risk for suicidal thoughts and behavior
- Not a good option for people with a history of heart problems
Pharmacist tips for Imipramine
- You can take imipramine with or without food. But it can upset your stomach and sometimes cause nausea, vomiting, or diarrhea. Taking it with food can help lessen the severity of these side effects.
- It can take up to 1 to 2 months to feel the full benefits of imipramine for your depression symptoms. It also might take some time to find the dose that works best for you. Make sure to keep taking the medication unless your provider specifically told you to stop taking it.
- Don't change your dose or stop taking imipramine without talking to your provider first. Changing the dose can cause bothersome side effects or withdrawal symptoms like nausea, headache, and sleeping problems. Follow your provider's instructions to lower your dose slowly over a period of time to completely stop the medication.
- Antidepressant medications like imipramine can raise the risk of suicidal thoughts. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.
- Imipramine can make you sleepy, dizzy, or have blurry vision. Don't drive or do anything requiring concentration until you know how this medication affects you.
- Dry mouth can happen with imipramine. Ways to help with dry mouth include drinking water, chewing sugar-free gum, and sucking on ice or sugar-free hard candies. Also, make sure to have good oral care by brushing your teeth and flossing every day.
- Imipramine can make your skin more sensitive to the sun, which means you can get sunburned more easily. When you go outside, make sure that you're wearing sunscreen and protective clothing to avoid a serious sunburn.
- If you have diabetes, ask your provider whether you need to check your blood sugar more often while you're using imipramine. This medication can cause your blood sugar to get too high or too low.
- Make sure to tell your providers about all of the medications you're taking. Don't start any new medications without talking to your provider first. It's important for your providers to check for drug interactions because imipramine can interact with a lot of common medications. Some medications that interact with imipramine and raise your risk for side effects include sedatives, opioid medications, antihistamines, and monoamine oxidase inhibitors (MAOIs).
Common questions about Imipramine
Imipramine hydrochloride and imipramine pamoate are two different salt forms of imipramine. The imipramine pamoate salt form was designed so that the medication gets released a little slower and lasts longer than imipramine hydrochloride. Imipramine hydrochloride is a tablet that's approved for depression, as well as bedwetting at night in children. But imipramine pamoate comes in a capsule and is only approved for depression. The tablets and capsules are also available in different strengths.
You might start to feel improvements in your depression symptoms after about 1 to 3 weeks of starting imipramine. But keep in mind that it generally takes about 1 to 2 months of treatment for you to get the full benefits from antidepressants, including imipramine. You might feel some side effects, like sleepiness, dry mouth, dizziness, and nausea, before feeling any benefit from the medication. So don't get discouraged and continue taking imipramine regularly. Don't stop taking imipramine without talking to your provider first because you might get bothersome withdrawal symptoms, such as movement, sleeping, or stomach problems. Speak with your provider if you're not sure whether imipramine is working for you.
Suddenly stopping imipramine can cause withdrawal symptoms, such as nausea, headache, trouble sleeping, and anxiety or restlessness. Imipramine should be stopped slowly over time, especially if you've been taking a higher dose or have been taking the medication for a long time. Talk to your provider before you stop imipramine. They can create a safe plan for you to gradually lower your dose.
Yes, it's possible for imipramine to make you gain weight. But research isn't clear just how much weight you might gain. One study found that about 15% of people gained at least 10 pounds after at least 4 months of taking imipramine. But another study saw that people gained just about 1 to 4 pounds. The amount of weight you might gain can depend on your dose and how long you're taking the medication. To lower your risk for weight gain while taking imipramine, make sure to eat a healthy diet and follow a regular exercise routine. Contact your provider if you're uncomfortable with how much weight you've gained during treatment with imipramine. They can recommend more options to help you manage your weight or switch you to a different medication.
Yes, it's possible for imipramine to make you constipated. It's not clear how common constipation from imipramine is. But you can lower your risk by eating a high-fiber diet and staying hydrated. If you become constipated, there are also several over-the-counter medications you can consider taking.
Possibly. Tricyclic antidepressants like imipramine are known to potentially cause erectile dysfunction. Speak with your provider if this happens to you. You might need your imipramine dose lowered or you might consider trying a different antidepressant medication.
Imipramine isn't FDA-approved for migraines. According to the 2021 migraine treatment guidelines by the American Headache Society, other tricyclic antidepressants, such as amitriptyline and nortriptyline, might be helpful to use for preventing migraines. Studies specifically looking at imipramine show that it can help with lowering the severity of tension headaches, but more research is needed in this area. Talk with your provider if you have questions about imipramine and migraines.
Imipramine isn't FDA-approved for anxiety. But there's some research showing that imipramine can help with certain types of anxiety problems, like panic attacks or generalized anxiety disorder. Your provider might consider imipramine to treat anxiety when other first-choice medications aren't working well enough. Discuss with your provider about whether imipramine is right for you if you have anxiety.
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Risks and warnings for Imipramine
Imipramine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening depression, suicidal thoughts, and unusual behavior
- Risk factors: Age 24 years and younger | History of depression or other mental health conditions | Heavy alcohol use
Taking imipramine can make your depression worse and cause you to have thoughts of suicide or harming yourself. The risk is highest if you're 24 years of age or younger, during the first few weeks of taking the medication, and when your dose changes. Get medical help right away if you or anyone around you notices that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while you're taking imipramine.
Not for use alone in bipolar disorder
Depression can be the first sign of bipolar disorder. If you're at risk for bipolar disorder, taking antidepressants, like imipramine, by themselves can trigger a bipolar manic episode. Before starting imipramine, your provider will check to see whether you have or are at risk for bipolar disorder. Imipramine isn't used to treat bipolar depression. Talk to your provider right away if you or your loved ones notice unusual changes in your behavior, such as racing thoughts, restlessness, getting easily distracted, or unusual talkativeness.
Risk of heart problems, heart attack, or stroke
- Risk factors: History of heart problems | Taking high doses of imipramine
It's possible for imipramine to affect your heart rhythm and cause a fast or irregular heart beat (e.g., arrhythmia). In addition, some people taking medications like imipramine have had a heart attack or stroke during treatment. If you have any heart problems or had a stroke before, talk to your provider before starting imipramine to see whether this medication is right for you.
Glaucoma
- Risk factors: History of angle-closure glaucoma
Imipramine can lead to or worsen angle-closure glaucoma. You might need to see your optometrist regularly and get eye exams to check your eyes and make sure your vision isn't worsening. Contact your provider if you notice changes in your vision after starting imipramine.
Higher risk of falls
- Risk factors: Age 65 years or older | Low blood pressure | Taking medications that lower blood pressure | History of medical conditions that can lower blood pressure
Imipramine can make you feel tired. It can also lower your blood pressure, which can make you feel dizzy or lose your balance. These can all lead to accidental falls and injuries. When standing from a sitting or lying position, make sure to get up slowly and hold onto something. Contact your provider if you still feel dizzy after a couple weeks of starting the medication or experience a fall while taking imipramine. They might recommend that you switch to a different medication.
Seizures
- Risk factors: History of seizures | Taking high doses of imipramine
Imipramine might raise your risk for seizures, especially when it's used at higher doses. If you've had a seizure before, discuss with your provider to see whether imipramine is right for you.
Imipramine dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mg | 30 tablets | $7.38 | $0.25 |
| 25mg | 90 tablets | $18.79 | $0.21 |
| 50mg | 90 tablets | $26.16 | $0.29 |
Typical dosage for Imipramine
The total daily dose is either split up into several smaller doses throughout the day or taken as a single dose before bedtime. Your provider will adjust your dosage based on how well it's helping your symptoms and whether you're having side effects.
Imipramine hydrochloride tablet
- Depression:
- Adults ages 18 to 64 years old: The typical starting dose is 75 mg to 100 mg by mouth daily.
- Adolescents and adults ages 65 years and older: The typical starting dose is 30 mg to 40 mg by mouth daily. Doses higher than 100 mg per day are generally not needed.
- Bedwetting at night:
- Children ages 6 years and older: The typical starting dose is 25 mg by mouth one hour before bedtime. Your provider might raise the dose to up to 75 mg, depending on your child's age and how well the medication works for them.
- Depression:
- Adults ages 18 to 64 years old: The typical starting dose is 75 mg to 150 mg by mouth daily.
- Adolescents and adults ages 65 years and older: You typically first start treatment with imipramine hydrochloride tablets at a dose of 25 mg to 50 mg by mouth daily. Once the total daily dose gets raised to 75 mg or higher, then you can switch to imipramine pamoate capsules. Doses higher than 100 mg per day are generally not needed.
Interactions between Imipramine and other drugs
More on Imipramine interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Furazolidone
- Grepafloxacin
- Iproniazid
- Isocarboxazid
- Levomethadyl
- Linezolid
- Mesoridazine
- Methylene Blue
- Metoclopramide
- Moclobemide
- Pargyline
- Phenelzine
- Pimozide
- Piperaquine
- Procarbazine
- Ranolazine
- Rasagiline
- Safinamide
- Saquinavir
- Selegiline
- Sparfloxacin
- Terfenadine
- Thioridazine
- Tranylcypromine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Aceclofenac
- Acemetacin
- Albuterol
- Alfentanil
- Alfuzosin
- Almotriptan
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Apomorphine
- Aprindine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Aspirin
- Astemizole
- Atazanavir
- Azimilide
- Azithromycin
- Benzhydrocodone
- Benzphetamine
- Bretylium
- Bromfenac
- Bufexamac
- Buprenorphine
- Bupropion
- Buserelin
- Celecoxib
- Ceritinib
- Chloral Hydrate
- Chloroquine
- Chlorpromazine
- Choline Salicylate
- Ciprofloxacin
- Clarithromycin
- Clofazimine
- Clomipramine
- Clonidine
- Clonixin
- Clozapine
- Codeine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Darifenacin
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Diflunisal
- Dihydrocodeine
- Dipyrone
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Droxicam
- Efavirenz
- Encorafenib
- Enflurane
- Entrectinib
- Epinephrine
- Erythromycin
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Fingolimod
- Flecainide
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Foscarnet
- Fostemsavir
- Frovatriptan
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Halothane
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Ibuprofen
- Ibutilide
- Iloperidone
- Indomethacin
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Isoflurane
- Isradipine
- Ivabradine
- Ivosidenib
- Ketoprofen
- Ketorolac
- Lapatinib
- Lasmiditan
- Lefamulin
- Lenvatinib
- Levalbuterol
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lidoflazine
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lorcainide
- Lorcaserin
- Lornoxicam
- Loxapine
- Loxoprofen
- Lumefantrine
- Lumiracoxib
- Macimorelin
- Meclofenamate
- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Metronidazole
- Mifepristone
- Mirtazapine
- Moricizine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nabumetone
- Nafarelin
- Nalbuphine
- Naproxen
- Naratriptan
- Nefopam
- Nepafenac
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Norepinephrine
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxaprozin
- Oxycodone
- Oxymetazoline
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Paliperidone
- Palonosetron
- Panobinostat
- Parecoxib
- Paroxetine
- Pasireotide
- Pazopanib
- Peginterferon Alfa-2b
- Pentamidine
- Pentazocine
- Phenylbutazone
- Piketoprofen
- Pimavanserin
- Piroxicam
- Pitolisant
- Pixantrone
- Ponesimod
- Posaconazole
- Pranoprofen
- Procainamide
- Prochlorperazine
- Proglumetacin
- Promethazine
- Propafenone
- Propyphenazone
- Proquazone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Remifentanil
- Revefenacin
- Ribociclib
- Risperidone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Scopolamine
- Secretin Human
- Selpercatinib
- Sematilide
- Sertindole
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- Solifenacin
- Sorafenib
- Sotalol
- Spiramycin
- Sufentanil
- Sulfamethoxazole
- Sulindac
- Sulpiride
- Sultopride
- Sumatriptan
- Sunitinib
- Tacrolimus
- Tapentadol
- Tedisamil
- Telavancin
- Telithromycin
- Tenoxicam
- Tetrabenazine
- Tiaprofenic Acid
- Tiotropium
- Tolfenamic Acid
- Tolmetin
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimethoprim
- Triptorelin
- Tryptophan
- Valdecoxib
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Vilanterol
- Vilazodone
- Vinflunine
- Voclosporin
- Voriconazole
- Vortioxetine
- Zolmitriptan
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Arbutamine
- Atomoxetine
- Cannabis
- Carbamazepine
- Cimetidine
- Citalopram
- Desogestrel
- Dicumarol
- Dienogest
- Drospirenone
- Ethinyl Estradiol
- Ethynodiol
- Fluvoxamine
- Fosphenytoin
- Gestodene
- Levonorgestrel
- Mestranol
- Mibefradil
- Nomegestrol
- Norethindrone
- Norgestimate
- Norgestrel
- Phenindione
- Phenprocoumon
- Phenytoin
- Ritonavir
- S-Adenosylmethionine
How much does Imipramine cost?
$7.38
Imipramine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Imipramine will not be safe for you to take.
- Currently taking or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days
- Recent heart attack
What are alternatives to Imipramine?
News about Imipramine
Imipramine images
