Closely (1)terbinafine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)imipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, terbutaline. 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.tetrabenazineMonitor Closely (1)tetrabenazine and imipramine both increase QTc interval. Use Caution/Monitor.thioridazineContraindicated (1)thioridazine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Monitor Closely (1)thioridazine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)imipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. imipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.thiothixeneMonitor Closely (1)thiothixene and imipramine both increase sedation. Use Caution/Monitor.thyroid desiccatedMonitor Closely (1)thyroid desiccated increases effects of imipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.tiotropiumMonitor Closely (1)tiotropium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.tipranavirMonitor Closely (1)tipranavir will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tobacco useMonitor Closely (1)tobacco use will decrease the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tolazamideMinor (1)imipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.tolbutamideMinor (1)imipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.tolterodineMonitor Closely (1)tolterodine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.topiramateMonitor Closely (1)imipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.Minor (1)topiramate will decrease the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.toremifeneSerious - Use Alternative (1)imipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.tramadolMonitor Closely (2)imipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely. tramadol and imipramine both increase sedation. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine and imipramine both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (2)imipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor. imipramine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug. trazodone and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.triazolamMonitor Closely (1)triazolam and imipramine both increase sedation. Use Caution/Monitor.triclabendazoleMonitor Closely (1)triclabendazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole. triclofosMonitor Closely (1)triclofos and imipramine both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)imipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. imipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.trihexyphenidylMonitor Closely (1)trihexyphenidyl and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimMonitor Closely (1)imipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (2)imipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. imipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. imipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triprolidineMonitor Closely (1)triprolidine and imipramine both increase sedation. Use Caution/Monitor.tropisetronMonitor Closely (1)imipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (1)trospium chloride and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)imipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvalbenazineMonitor Closely (1)valbenazine and imipramine both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and imipramine both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)imipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vasopressinMinor (1)imipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.vecuroniumMonitor Closely (1)vecuronium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.venlafaxineMonitor Closely (2)venlafaxine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. imipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.verapamilMonitor Closely (2)verapamil will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. verapamil will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. TCA level may be increased.Minor (1)verapamil increases levels of imipramine by decreasing metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)imipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiatedvilazodoneSerious - Use Alternative (1)imipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vildagliptinMinor (1)imipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.voriconazoleMonitor Closely (2)voriconazole will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. imipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)voriconazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vortioxetineSerious - Use Alternative (1)imipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.xylometazolineMonitor Closely (1)imipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, xylometazoline. 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.yohimbeSerious - Use Alternative (1)yohimbe, imipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineMonitor Closely (1)imipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)imipramine, yohimbine. 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.zafirlukastMinor (1)zafirlukast will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ziconotideMonitor Closely (1)imipramine and ziconotide both increase sedation. Use Caution/Monitor.zileutonMonitor Closely (1)zileuton will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)imipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.zolpidemMinor (1)zolpidem, imipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. Frequency Not Defined Fatigue Lethargy Sedation Weakness Constipation Dry mouth Blurred vision Agitation Anxiety Headache Insomnia Nausea Vomiting Sweating ECG changes, orthostatic hypotension, tachycardia Confusion, extrapyramidal symptoms (EPS), dizziness, paresthesia, tinnitus Rash Increased LFTs Sexual dysfunction Seizure Agranulocytosis Eosinophilia Leukopenia Thrombocytopenia SIADH Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged over 24 years; a slight decrease in suicidal thinking was seen in adults aged over 65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patientsContraindications Hypersensitivity Acute recovery post-MI Coadministration with serotonergic drugs Concomitant with or within 14 days of MAOIs (serotonin syndrome) Starting imipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue imipramine immediately and monitor for CNS toxicity; may resume imipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Cautions Risk of anticholinergic effects; use caution in BPH, urinary/GI retention, hyperthyroidism, oseizure disorder, brain tumor, respiratory impairment Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Clinical worsening and suicidal ideation may occur despite medication Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue) May cause bone marrow suppression (rare) May cause orthostatic hypotension May cause sedation and impair physical or mental abilities Do not discontinue abruptly for prolonged high dosage Pregnancy category: D Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; inhibits reuptake by neuronal membrane; may also down-regulate beta-adrenergic and serotonin receptors Absorption Bioavailability: Completely absorbed Onset: After >2 weeks Peak plasma time: 1-2 hr Distribution Vd: 18 L/kg Protein bound: 90% Metabolism Hepatic CYP1A2, CYP2C19, CYP2D6 Metabolites: Desipramine Elimination Half-life: 6-18 hr Excretion: Urine BRAND FORM. UNIT PRICE PILL IMAGE imipramine oral- 25 mg tabletimipramine oral- 10 mg tabletimipramine oral- 50 mg tabletimipramine oral- 10 mg tabletimipramine oral- 25 mg tabletimipramine oral- 50 mg tabletimipramine oral- 10 mg tabletimipramine oral- 50 mg tabletimipramine oral- 25 mg tabletimipramine oral- 10 mg tabletimipramine oral- 25 mg tabletimipramine oral- 25 mg tabletimipramine oral- 50 mg tabletimipramine oral- 10 mg tabletimipramine oral- 50 mg tabletimipramine oral- 10 mg tabletimipramine oral- 10 mg tabletimipramine oral- 10 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationimipramine oral IMIPRAMINE - ORAL (ih-MIH-pra-meen) COMMON BRAND NAME(S): Tofranil WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability,