Imipramine: uses and side effects of this antidepressant
The first tricyclic antidepressant in history was imipramine, which appeared in 1951. Although this and other tricyclics were the drugs most commonly used to treat depression for many decades, they were gradually replaced by other more effective drugs, although imipramine it is still used in certain disorders, not just depressive ones.
In this article we will analyze in detail the therapeutic uses and the most important side effects of imipramine . We will also describe the key pharmacological properties of this medication and explain in which cases its use is contraindicated.
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What is imipramine?
Imipramine is a antidepressant drug of the class of tricyclics , to which clomipramine, amitriptyline, doxepin, nortriptyline or desipramine also belong. Imipramine was the first of these drugs to be developed; The initial purpose was its use as a sedative in cases of schizophrenia and as an antihistamine.
Tricyclic antidepressants were for a long time the pharmacological treatment of choice in cases of depression. However, at present they have been relegated to the background due to the emergence of selective serotonin reuptake inhibitors (SSRIs) and other drugs with higher degrees of specificity and tolerability.
The effects of imipramine are very broad, so it acts on different neurotransmitters; this explains both its therapeutic properties and the adverse reactions associated with its use. Their agonist effects on serotonin and noradrenaline , which take place through the inhibition of its reuptake.
Although imipramine has been marketed under different generic names, the best known of all is "Tofranil" since this brand was the one that popularized the product and continues to be sold in many countries today.
Therapeutic uses of this drug
Imipramine, like all other drugs in the tricyclic class, is used primarily to treat the symptoms of the depression spectrum. The research suggests that it is especially useful in cases in which depression is associated with symptoms of anxious type , particularly the psychomotor agitation.
In this sense, imipramine is sometimes prescribed to people with disorders such as major depression, dysthymia (chronic and mild depression with marked anxiety), bipolar disorder, panic disorder and agoraphobia. It has also been applied in cases of attention deficit hyperactivity disorder, better known by the abbreviation "ADHD".
It is also relatively common to use imipramine in the treatment of nocturnal enuresis . Its effectiveness in this disorder is due to the fact that this drug reduces the proportion of phases of slow wave sleep, and it is in these when episodes of involuntary urination take place normally.
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Adverse reactions and side effects
The most commonly associated adverse reactions to treatment with imipramine include drowsiness, sensations of dizziness, tachycardia, dry mouth , urinary retention and orthostatic hypotension (sudden decrease in blood pressure). There are also changes in brain electrical activity, such as those related to sleep.
Other signs that affect the central nervous system and have a somewhat lower frequency are anxiety, agitation, insomnia, nightmares, headaches, confusion or the appearance of tremors, seizures and other motor symptoms related especially to the extrapyramidal system.
Imipramine also causes other Side effects of a physiological nature . Among these we find cardiovascular alterations (hypertension, palpitations, dysrhythmias ...), blurred vision, nausea, vomiting, increased appetite, gastrointestinal discomfort (such as cramps), constipation, jaundice and pupillary dilation or mydriasis.
Overdose of imipramine or other tricyclic antidepressants causes the appearance of blurred vision, mydriasis, confusion, drowsiness and increased heart rate. The toxic dose is easier to reach for children, and sometimes death can occur due to cardiac arrest if the alterations are not resolved quickly.
Contraindications and precautions
Even in comparison with other tricyclic antidepressants, imipramine has a very strong pharmacological potency.Because of this and its interaction with the receptors of multiple types of neurotransmitter, the use of imipramine should be avoided in numerous and varied circumstances.
This drug is contraindicated in people with a history of disorders such as alcoholism, hyperthyroidism, diabetes , glaucoma, problems in the kidneys and liver, epilepsy and particularly alterations of the cardiac system.
Imipramine consumption is not recommended if drugs of different types are being taken simultaneously, including barbiturates, monoamine oxidase inhibitors (MAOIs), SSRIs, lithium, methylphenidate, anticholinergics, or buspirone, the drug of choice. Choice for generalized anxiety disorder.
Currently the use of imipramine it is discouraged to some extent because of its pharmacological profile , difficult to tolerate for many people and very unspecific in terms of its effects on relevant neurotransmitters. However, we must also take into account that SSRIs and other modern antidepressants also cause important adverse reactions.