Imipramine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: May 31, 2023

Warnings

Imipramine Risks, Warnings, and Complications

Imipramine can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for depression if you are at an increased risk of adverse reactions or complications from this medication. Some of the risks of taking imipramine include:

SUICIDAL RISK: Taking antidepressant drugs such as imipramine can cause suicidal thoughts and behaviors. The risk of this happening is higher in people 24 years of age and younger. Family members should watch for new or worsening depression, suicidal thoughts or behavior, anxiety, agitation, restlessness, irritability, insomnia, panic attacks, or any changes in mood and behavior, especially during the first few months of treatment or after a dose adjustment (dose reduction or increase). Call your healthcare provider if you notice any such medication effects.
HEART PROBLEMS: Taking imipramine can lead to serious heart problems, such as an irregular heart rhythm, congestive heart failure, and heart attack. Before starting imipramine, tell your doctor if you have a history of heart problems. This medicine should be used with extreme caution in people with a history of heart disease. Older adults and those taking high doses of this medicine are at a higher risk of these complications. Your doctor will monitor you carefully during imipramine treatment if you have pre-existing heart conditions.
SEROTONIN SYNDROME: Rarely, imipramine can raise the level of a natural chemical called serotonin. Too much serotonin in the body can lead to a condition called serotonin syndrome. The risk of this happening is higher if you are also taking other medications that can raise serotonin levels (for example, other antidepressants, lithium, migraine medications, and opioid pain medications such as tramadol). Tell your doctor right away if you develop a fast heartbeat, excessive sweating, fever, shakiness, muscle spasms, nausea, vomiting, agitation, or hallucinations. If you are taking medications called MAOIs (monoamine oxidase inhibitors), make sure you stop taking this type of medicine at least 14 days before starting imipramine.
EYE PROBLEMS: Antidepressant drugs, including imipramine, can cause glaucoma, a condition in which there is increased pressure inside the eye. Tell your doctor if you have a history of eye problems or if imipramine causes eye discomfort, swelling, redness, or vision changes.
SEIZURES: Imipramine can lower seizure threshold, i.e., it can increase your risk of having seizures. Tell your doctor if you have a history of seizures or a medical condition that increases your risk of seizures.
BIPOLAR DISORDER: Bipolar disorder is characterized by alternating episodes of depression (sadness) and mania (abnormal excitement). A major depressive episode can be the initial presentation in people with bipolar disorder. Treating such an episode with an antidepressant drug like imipramine can precipitate a mixed or manic episode. Before starting treatment with imipramine for depressive symptoms, your doctor will screen you to determine if you are at risk for bipolar disorder. They will do this by obtaining a detailed personal and family psychiatric history, including a history of suicide, bipolar disorder, and depression. Note that imipramine is not approved for treating bipolar depression.
DROWSINESS: Imipramine can cause drowsiness, especially in older adults (age 65 plus). This can put you at risk of falls, accidents, and injuries. Avoid driving or doing any hazardous activities that require full alertness until you know how imipramine affects you. Taking imipramine with other medications that also cause drowsiness or drinking alcohol can increase the risk of this side effect.
ORTHOSTATIC HYPOTENSION: Imipramine can cause dizziness, lightheadedness, low blood pressure, and fainting when going from a sitting or lying position to standing. Make sure you get up slowly out of bed to avoid falls. Tell your doctor if you experience severe dizziness or if it continues after a few days of starting imipramine.

Precautions Before Starting Imipramine

Tell your doctor if you have ever had an allergic reaction to imipramine, any of the active or inactive ingredients in imipramine tablets and capsules, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions between your medications.

Give your doctor a complete medical history. Imipramine may not be right for people with certain medical conditions, such as a recent heart attack, electroshock therapy for mental illness, heart disease, liver disease, kidney disease, enlarged prostate, difficulty urinating, overactive thyroid gland, or seizures.

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Imipramine

Keep all your healthcare appointments during imipramine treatment. Your doctor may want to adjust your dose based on your response.

Imipramine can increase the sensitivity of your skin to sunlight. Avoid unnecessary sun exposure and use of tanning beds. Wear protective clothing and sunscreen to protect your skin.

Taking imipramine can make you drowsy. Do not drive or do anything that requires your full concentration until you know how it affects you. Alcohol can make this side effect worse. Avoid drinking alcoholic beverages while on imipramine.

Smoking can lower the effectiveness of imipramine. Tell your doctor if you smoke. Take steps to quit smoking.

If you are an older adult (age 65 plus), discuss alternative treatments for depression with your healthcare provider. There may be other safer treatments available.

Tell your doctor if you become pregnant while taking imipramine.

Tell all your healthcare providers you are on imipramine, especially before any procedure, including dental procedures.

Imipramine can cause glaucoma (increased eye pressure), which can lead to permanent loss of vision if left untreated. Tell your doctor without delay if you develop any eye symptoms such as pain, swelling, redness, blurred vision, or vision changes.

Imipramine Drug Interactions

Many drugs can affect how imipramine works. Possible interactions with other medicines can increase the risk of severe adverse effects.

Do not take imipramine within 14 days of taking monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), linezolid (Zyvox), selegiline (Eldepryl, Emsam, Zelapar), methylene blue, and tranylcypromine (Parnate).

The following medications can have interactions with imipramine:

Anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven)
Antihistamines used to treat allergies
H2 blockers for stomach acidity such as cimetidine (Tagamet)
Medications used to treat heart rhythm abnormalities such as flecainide (Tambocor), propafenone (Rythmol), and quinidine
Parkinson’s disease medications such as levodopa (Sinemet, Larodopa)
Psychiatric medications such as lithium (Eskalith, Lithobid)
ADHD medications such as methylphenidate (Ritalin)
Medications used to treat high blood pressure, nausea, seizures, mental health problems, allergies, colds, and asthma
Muscle relaxants, sedatives, sleeping pills, tranquilizers
Other antidepressants such as selective serotonin reuptake inhibitors (SSRIs), for example, sertraline (Zoloft), fluoxetine (Prozac, Sarafem), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), and paroxetine (Paxil)
Thyroid medications

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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