may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.procainamideContraindicated (1)imipramine and procainamide both increase QTc interval. Contraindicated.procarbazineContraindicated (1)procarbazine and imipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.prochlorperazineMonitor Closely (2)prochlorperazine and imipramine both increase QTc interval. Use Caution/Monitor. prochlorperazine and imipramine both increase sedation. Use Caution/Monitor.Minor (2)imipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. imipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.progesterone micronizedMinor (1)progesterone micronized, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.promazineSerious - Use Alternative (1)promazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)imipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. imipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.promethazineMonitor Closely (2)promethazine and imipramine both increase QTc interval. Use Caution/Monitor. promethazine and imipramine both increase sedation. Use Caution/Monitor.Minor (2)imipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. imipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.propafenoneMonitor Closely (1)propafenone will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.propanthelineMonitor Closely (1)propantheline and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.propofolMonitor Closely (1)propofol and imipramine both increase sedation. Use Caution/Monitor.Minor (1)propofol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.propylhexedrineMonitor Closely (1)imipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.protriptylineMonitor Closely (2)imipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. imipramine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. imipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.pseudoephedrineSerious - Use Alternative (1)imipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.pyridostigmineMonitor Closely (1)pyridostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam and imipramine both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (1)quetiapine and imipramine both increase sedation. Use Caution/Monitor.quinacrineMonitor Closely (1)quinacrine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.quinidineContraindicated (1)quinidine and imipramine both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.quinupristin/dalfopristinMinor (1)quinupristin/dalfopristin will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ramelteonMonitor Closely (1)imipramine and ramelteon both increase sedation. Use Caution/Monitor.ranolazineMonitor Closely (2)ranolazine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. imipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.rapacuroniumMonitor Closely (1)rapacuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.rasagilineSerious - Use Alternative (1)rasagiline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.remifentanilMonitor Closely (1)imipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.remimazolamMonitor Closely (1)remimazolam, imipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.repaglinideMinor (1)imipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.ribociclibMonitor Closely (1)ribociclib will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinMonitor Closely (2)rifabutin decreases levels of imipramine by increasing metabolism. Use Caution/Monitor. rifabutin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinMonitor Closely (3)rifampin will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. rifampin will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. rifampin will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidoneMonitor Closely (2)imipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and imipramine both increase sedation. Use Caution/Monitor.ritonavirMonitor Closely (2)ritonavir will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ritonavir will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rizatriptanMonitor Closely (1)rizatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.rocuroniumMonitor Closely (1)rocuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.rolapitantMonitor Closely (1)rolapitant will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinMonitor Closely (1)imipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.rosiglitazoneMinor (1)imipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.rufinamideMinor (1)rufinamide will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.safinamideContraindicated (1)imipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.sageMinor (1)imipramine and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)imipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.SAMeMonitor Closely (1)imipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.saxagliptinMinor (1)imipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.scopolamineMonitor Closely (1)scopolamine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.scullcapMonitor Closely (1)imipramine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (4)secobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. secobarbital will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. secobarbital will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. secobarbital and imipramine both increase sedation. Use Caution/Monitor.Minor (1)secobarbital, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.selegilineContraindicated (1)selegiline and imipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicatedselegiline transdermalSerious - Use Alternative (1)selegiline transdermal and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.selinexorSerious - Use Alternative (1)selinexor, imipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.serdexmethylphenidate/dexmethylphenidateSerious - Use Alternative (1)imipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of imipramine by decreasing metabolism. Minor/Significance Unknown.sertralineMonitor Closely (1)sertraline will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and imipramine both increase QTc interval. Avoid or Use Alternate Drug.sevofluraneMonitor Closely (2)sevoflurane and imipramine both increase sedation. Use Caution/Monitor. sevoflurane and imipramine both increase QTc interval. Use Caution/Monitor.Minor (1)sevoflurane, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.shepherd's purseMonitor Closely (1)imipramine and shepherd's purse both increase sedation. Use Caution/Monitor.sitagliptinMinor (1)imipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.smokingMonitor Closely (1)smoking will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.sodium oxybateSerious - Use Alternative (1)imipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of imipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)imipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of imipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.solifenacinMonitor Closely (2)solifenacin and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. solifenacin and imipramine both increase QTc interval. Use Caution/Monitor.sotalolContraindicated (1)imipramine and sotalol both increase QTc interval. Contraindicated.sparsentanMonitor Closely (1)sparsentan will decrease the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates. St John's WortMonitor Closely (1)St John's Wort will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)imipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (2)stiripentol, imipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. stiripentol will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.succinylcholineMonitor Closely (1)succinylcholine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil and imipramine both increase sedation. Use Caution/Monitor.sufentanil SLMonitor Closely (1)sufentanil SL, imipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sulfamethoxazoleMonitor Closely (1)imipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of imipramine by unspecified interaction mechanism. Minor/Significance Unknown.sumatriptanMonitor Closely (1)sumatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.suvorexantMonitor Closely (1)suvorexant and imipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytacrolimusMonitor Closely (1)tacrolimus and imipramine both increase QTc interval. Use Caution/Monitor.tamsulosinMonitor Closely (1)imipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (2)imipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. tapentadol and imipramine both increase sedation. Use Caution/Monitor.tecovirimatMonitor Closely (1)tecovirimat will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.tedizolidSerious - Use Alternative (1)tedizolid, imipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (1)imipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam and imipramine both increase sedation. Use Caution/Monitor.terbinafineMonitor