IMIPRAMINE

Drugs in Pregnancy and Lactation.

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Name: IMIPRAMINE
Class: Antidepressant
Risk Factor:    D

Fetal Risk Summary

Six animal reproductive studies using imipramine were reviewed by Shepard in 1989 (1). Some defects were observed in one investigation using rabbits, but other studies with mice, rats, rabbits, and monkeys revealed no evidence of drug-induced teratogenicity.

Bilateral amelia was reported in one child whose mother had ingested imipramine during pregnancy (2). An analysis of 546,505 births, 161 with 1st trimester exposure to imipramine, however, failed to find an association with limb reduction defects (3,4,5,6,7,8,9,10,11,12,13,14 and 15). Reported malformations other than limb reduction include (4,5 and 6): Defective abdominal muscles (1 case) Diaphragmatic hernia (2 cases) Exencephaly, cleft palate, adrenal hypoplasia (1 case) Cleft palate (2 cases) Renal cystic degeneration (1 case) These reports indicate that imipramine is not a major cause of congenital limb deformities (see also below).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 75 newborns had been exposed to imipramine during the 1st trimester (F. Rosa, personal communication, FDA, 1993). Six (8.0%) major birth defects were observed (three expected), including (observed/expected) 3/0.8 cardiovascular defects, 1/0.2 spina bifida, and 1/0.2 hypospadias. No anomalies were observed in three other defect categories (oral clefts, polydactyly, and limb reduction defects) for which specific data were available. Only with cardiovascular defects is there a suggestion of an association, but other factors, including the mother's disease, concurrent drug use, and chance, may be involved.

Neonatal withdrawal symptoms have been reported with the use of imipramine during pregnancy (16,17 and 18). Symptoms observed in the infants during the 1st month after birth were colic, cyanosis, rapid breathing, and irritability (16,17 and 18). Urinary retention in the neonate has been associated with maternal use of nortriptyline (chemically related to imipramine) (19).

Breast Feeding Summary

Imipramine and its metabolite, desipramine, enter breast milk in low concentrations (20,21). A milk:plasma ratio of 1 has been suggested (20). Assuming a therapeutic serum level of 200 ng/mL, an infant consuming 1000 mL of breast milk would ingest a daily dose of about 0.2 mg. The clinical significance of this amount is not known. The American Academy of Pediatrics classifies imipramine as an agent whose effect on the nursing infant is unknown but may be of concern (22).

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World’s leading meds delivered to your door – and you don’t even need a prescription! Only certified, first class drugs on offer! Buy more and spend less with our great discount system.

References

  1. Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD:Johns Hopkins University Press, 1989:345–6.
  2. McBride WG. Limb deformities associated with iminodibenzyl hydrochloride. Med J Aust 1972;1:492.
  3. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977:336–7.
  4. Kuenssberg EV, Knox JDE. Imipramine in pregnancy. Br Med J 1972;2:29.
  5. Barson AJ. Malformed infant. Br Med J 1972;2:45.
  6. Idanpaan-Heikkila J, Saxen L. Possible teratogenicity of imipramine/chloropyramine. Lancet 1973;2:282–3.
  7. Crombie DL, Pinsent R, Fleming D. Imipramine in pregnancy. Br Med J 1972; 1:745.
  8. Sim M. Imipramine and pregnancy. Br Med J 1972; 2:45.
  9. Scanlon FJ. Use of antidepressant drugs during the first trimester. Med J Aust 1969;2:1077.
  10. Rachelefsky GS, Flynt JW, Eggin AJ, Wilson MG. Possible teratogenicity of tricyclic antidepressants. Lancet 1972;1:838.
  11. Banister P, Dafoe C, Smith ESO, Miller J. Possible teratogenicity of tricyclic antidepressants. Lancet 1972; 1:838–9.
  12. Jacobs D. Imipramine (Tofranil). S Afr Med J 1972;46:1023.
  13. Australian Drug Evaluation Committee. Tricyclic antidepressant and limb reduction deformities. Med J Aust 1973;1:766–9.
  14. Morrow AW. Imipramine and congenital abnormalities. NZ Med J 1972;75:228–9.
  15. Wilson JG. Present status of drugs as teratogens in man. Teratology 1973;7:3–15.
  16. Hill RM. Will this drug harm the unborn infant? South Med J 1977;67:1476–80.
  17. Eggermont E. Withdrawal symptoms in neonate associated with maternal imipramine therapy. Lancet 1973;2:680.
  18. Shrand H. Agoraphobia and imipramine withdrawal? Pediatrics 1982;70:825.
  19. Shearer WT, Schreiner RL, Marshall RE. Urinary retention in a neonate secondary to maternal ingestion of nortriptyline. J Pediatr 1972;81:570–2.
  20. Sovner R, Orsulak PJ. Excretion of imipramine and desipramine in human breast milk. Am J Psychiatry 1979;136:451–2.
  21. Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry 1979;136:1483.
  22. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.

Index

Q&A about Imipramine

NatNat
Imipramine??
I was on Fluoxetine (Prozac) for a month, but after severe loss of sex drive, my doctor has moved me onto Imipramine. I specifically asked for a drug that does NOT have weight gain as a side effect, yet after Googling this drug, it seems weight gain is a common side effect!?

Also, I took my first pill last night, and I swear that my heart has been beating faster today, and I've been quite hot.

Does anyone have any experience with this drug, and what are the effects over Fluoxetine?!
Miranda K
i have not taken that drug but i have been prescribed amitriptyline and it done 5-8 years worth of damage on my heart in 4 months because it speeded my heart rate up so much when i already had a murmur. It causes a sort of angina with intense chest pain and now i am at risk for a heart attack
bill w
what are the side effects of slowly reducing and then stopping intake of imipramine?
My doctor noticed heart skips, and talked to my psychiatrist. They agreed to reduce, and within the month, have me stop taking Imipramine. I was taking 300 mg a night. Last night I started taking 200 mg, and will for the next 7 days. Then down to 100 mg for 7 days. And finally down to 50 mg for 2 weeks. I'd like to know, based on this reducing regimen, what side effects I could expect. And as a side note...maybe you can suggest an antidepressant that works well for you. Thanks, Bill.
Serenity
Imipramine/Tofrinil can cause heart beat irregularities. Try one of the new SSRIs. I like Lexapro but I think there are even newer ones available out there. It sounds like you are doing it right though, being monitored by a psychiatrist. You should never stop taking prescription medication on your own.
g.rocks
has anyone heard of imipramine used to reverse retrograde ejaculation from TURP surgery?
so my husband can ejaculate normally to father a child? thanks.
drankurb...
imipramine a anti depressant drug causes difficulty in micturation sometimes. It is also used for nocturnal enuresis or bed wetting but retrogradi ejeculation is not a known indication for the use of this drug.
g.rocks
i heard that imipramine is used to reverse retrograde ejaculation.My husband hadTURP surgery.?
we are going to the doctor next week to check it out. Has anyone heard about this? thanks for your input.
jupakill...
ive never heard that
hippo
Is there a an alternative drug to Imipramine to help deal with anxiety and depression ?
a more recently developed drug with fewer side effects
Lise22
I take Buspar and have had no side effects. It is for anxiety. After a traumatic brain injury I developed a sleep disorder. I was given Trazadone which not only gets me to sleep but also helps with depression and again no ill effects. Plus the group therapy that I go to is also an alternative drug.
same104
is it okay to take ambien ativan and imipramine together?
The ativan is nonanxiety, the ambien is for sleep and the imipramine is for depression
bbrzt
If you got them all at the same pharmacy, they have already checked for you and would've told you.

There are many, many websites to check drug interactions. Check www.drugs.com.
bimboish...
Should I take the Tofranil (Imipramine) I was prescribed?
Today I was prescribed 10mg of Tofranil (Imipramine) on top on the 100mg of zoloft I take every day. I have Chronic Fatigue Sydrome and I am scared that this will make me even more drowsy and lethargic. I was prescribed it to calm me at night to get me to sleep. I was also wondering if I have to take it every night if I do take it. Please help me.
Fishboy
Can't comment on your medication, but I had CFS for 5 years and found Mickel Therapy really helpful. Totally different approach to treatment as it looks at symptoms as helpful communication from the body. It also empowers people to heal themselves rather than taking tablets (don't get me wrong, it's not a type of psychotherapy though)
sweet
Which of these Medication: Imipramine or Pamelor has stronger effects when taking it?
I would just like to know which of these medication has stronger effects while taking it Imipramine or Pamelor? Thanks....
W W D
There's very little difference, but nortriptyline (Pamelor) has more antihistamine effects, and is a bit more sedating.
brandy
My 10 year old son is taken 50 mg of imipramine every night for bedwetting how bad is to take it?
I don't know if this is very bad because at the end this is medication and don't know the consecuences later on, this has being the only thing that has work his being dry for 2 months but is this the right choice?
softball...
Tofranil (imipramine) is a rather safe medication for bedwetting. It is actually a tricyclic antidepressant but has an off-label use as a med for bladder control in kids. This being said, off-label doesn't mean it's not safe. This drug has been used in children for this purpose for a long time. If the doctor was concerned about this med having long-term consequences for you son, he would have him stop the mediation. Usually the worst part of this type of medication is the side effects, but if it is working well for your son without many side effects, I would tell you to keep using it. Eventually I am sure your son's doctor will wean him off of the medication. He should eventually outgrow the bedwetting problem, but if the medication is working and he's not having ill effects, then why stop. Again, this is a very safe medication and while there is a risk associated with using ANY medication, this medication is a safer one. Tylenol would be considered potentially more problematic in the long run due to the effects of it on the liver. If it were me, I would keep him on it, and talk with the doctor about trying to wean him at this point and see if the night-time wetting has stopped. Good luck with this decision. Decisions about your kids are never easy, but either way, it won't be a bad decision. Also, try talking to your son about it and see what he thinks. He's old enough to understand a little about what's going on so see what he feels confortable with. Again, Good Luck!