IMIPRAMINE
(Tofranil)Standard Prescription
imipramine__mg PO__(frequency) (__mg/kg/24hr)
Dosages
Enuresis
Children (> 6 years old):
Initial: 10-25 mg QHS (1 hr prior to bedtime). Increase by 10-25 increments Q1-2 weeks until effect or maximum dose is achieved (see Comments). Continue optimal dose for 2-3 months, then taper
Maximum:
6-12 years: 50 mg/24 hr
Depression/ADHD:
Children:
Initial: 10 mg PO QHS. Increase gradually by 10-25 mg increments Q4-7 days.
Maximum: 2.5 mg/kg/24 hr (depression) or 4 mg/kg/24 hr (ADHD) (up to 100 mg/24 hr).
Adolescent:
Initial: 25 mg PO QHS. Increase gradually by 25 mg increments Q4-7 days.
Maximum: 2.5 mg/kg/24 hr (depression) or 4 mg/kg/24 hr (ADHD) (up to 200 mg/24 hr).
Children (> 6 years old):
Initial: 10-25 mg QHS (1 hr prior to bedtime). Increase by 10-25 increments Q1-2 weeks until effect or maximum dose is achieved (see Comments). Continue optimal dose for 2-3 months, then taper
Maximum:
6-12 years: 50 mg/24 hr
> 12 years: 75 mg/24 hr
Children:
Initial: 10 mg PO QHS. Increase gradually by 10-25 mg increments Q4-7 days.
Maximum: 2.5 mg/kg/24 hr (depression) or 4 mg/kg/24 hr (ADHD) (up to 100 mg/24 hr).
Adolescent:
Initial: 25 mg PO QHS. Increase gradually by 25 mg increments Q4-7 days.
Maximum: 2.5 mg/kg/24 hr (depression) or 4 mg/kg/24 hr (ADHD) (up to 200 mg/24 hr).
Mechanism of Action
Tricyclic Antidepressant.
Forms Supplied
tablet: 10 mg, 25 mg
(12.5 mg, 50 mg, 75 mg, 100 mg not stocked at BCCH)
Comments
HS dosing during first weeks of therapy will decrease sedation. Less sedation and anticholinergic effects than with amitriptyline.
Maximum antidepressant effects usually seen after 2 weeks.
Half life of imipramine is shorter in children than in adults. Larger daily dosages may be given in divided doses up to TID.
Tricyclics have limited efficacy for treatment of depression in children and adolescents.
ECG recommended at baseline, and once effective dose reached.
Steady state serum level monitoring recommended for doses above 2 mg/kg/24 hr. Serum level (imipramine plus active metabolite desmethylimipramine) not to exceed 1070 nmol/L in adults and children.
Maximum antidepressant effects usually seen after 2 weeks.
Half life of imipramine is shorter in children than in adults. Larger daily dosages may be given in divided doses up to TID.
A discontinuation syndrome is documented for tricyclics (flu-like symptoms, dizziness, mood changes, seizures). Do not suddenly stop longterm/high-dose treatment. Recommend tapering dose by ~25%/week.
Many CYP drug interactions. Contraindicated if MAO inhibitors used within 14 days.
Tricyclics have limited efficacy for treatment of depression in children and adolescents.
ECG recommended at baseline, and once effective dose reached.
Steady state serum level monitoring recommended for doses above 2 mg/kg/24 hr. Serum level (imipramine plus active metabolite desmethylimipramine) not to exceed 1070 nmol/L in adults and children.
Assess patient carefully and limit prescribed quantities if necessary; potential for significant toxicity of tricyclics in overdose.
Prescribers must be aware of warnings issued by Health Canada regarding the use of antidepressants in pediatric patients. Refer to the Health Canada website
References
32, 44, 83, 101, 112
Last Edited
2021-08-02 00:43:19