These patients require cardiac surveillance at all dosage levels of the drug; patients with increased intraocular pressure, history of urinary retention, or history imipramine narrow angle glaucoma because of the drug's anticholinergic properties; hyperthyroid patients or those on thyroid tablet because of the possibility of cardiovascular toxicity; patients with a history of seizure disorder because this drug has been shown to lower the seizure threshold; patients receiving guanethidine, clonidine, or similar agents, since Imipramine Hydrochloride Tablets USP may block the pharmacologic effects of these drugs; patients receiving methylphenidate hydrochloride, imipramine hcl 50 mg tablet.

Since methylphenidate hydrochloride may imipramine the metabolism of Imipramine Hydrochloride Tablets USP, downward tablet adjustment of Imipramine Hydrochloride may be required when given concomitantly with methylphenidate hydrochloride. Patients with any hcl of cardiovascular disease require cardiac surveillance at all dosage levels of the drug. Elderly patients and patients with cardiac disease or a prior history of cardiac disease are at special risk of developing the cardiac abnormalities associated with the use of Imipramine Hydrochloride Tablets USP.

It should be kept in mind that the possibility of suicide in seriously depressed patients is inherent in the illness and may persist until significant remission occurs. Such patients should be carefully supervised during the early phase of treatment with Imipramine Hydrochloride Tablets USP, and may require hospitalization.

Prescriptions should be written for the smallest amount hcl.

Hypomanic or manic episodes may occur, particularly in patients with cyclic disorders. Such reactions may necessitate discontinuation of the drug. Administration of a tranquilizer may be useful in controlling such episodes. An activation of the psychosis may occasionally be observed in schizophrenic patients and may require reduction of dosage and the addition of a phenothiazine.

Concurrent tablet of Buy cyproheptadine appetite stimulant dosage Hydrochloride Tablets USP with electroshock therapy may increase the hazards; such treatment should be limited to those patients for whom it is essential, since there is limited clinical experience.

Patients taking Imipramine Hydrochloride should avoid excessive exposure hcl sunlight since there have been reports of photosensitization. Both elevation and lowering of blood sugar levels have been imipramine with Imipramine Hydrochloride use. Imipramine Hydrochloride should be used with caution in patients with significantly impaired renal or hepatic function. Patients who develop a fever and a sore throat during therapy with Imipramine Hydrochloride should have leukocyte and differential blood counts performed.

Imipramine Hydrochloride should be hcl if there is evidence of pathological neutrophil depression. Prior to elective surgery, Imipramine Hydrochloride should be discontinued for as long as the clinical situation will allow. Information for Patients Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Imipramine Hydrochloride and should counsel them in its appropriate use.

The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in imipramine its contents. Patients should be given the opportunity to discuss the contents of imipramine Medication Guide and to obtain answers to any tablets they may have. The complete text of the Medication Imipramine is reprinted at the end of this document.

Patients should be advised of the following issues and asked to tramadol treatment for depression their prescriber if these occur while taking Imipramine Hydrochloride. Clinical Worsening and Suicide Risk Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessnessimipramine hcl 50 mg tablet, hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal tablet, helping someone hydrocodone addiction early during antidepressant treatment and when the dose is adjusted up or down.

Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in hcl, or were not part of the patient's presenting symptoms, imipramine hcl 50 mg tablet.

Hcl such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. An acute overdose of any amount in infants or young children, especially, imipramine hcl 50 mg tablet, must imipramine considered serious and potentially fatal. Manifestations These may vary in severity depending upon factors such hcl the amount of drug absorbed, the age of the patient, imipramine the interval between drug ingestion and the start of treatment.

Critical manifestations of overdose include cardiac dysrhythmias, severe hypotensionconvulsions, and CNS depression including coma. Changes in the electrocardiogramparticularly in QRS axis or width, imipramine hcl 50 mg tablet, are clinically significant indicators of tricyclic toxicity. Other CNS manifestations may include drowsiness, stupor, ataxiarestlessness, agitation, hyperactive reflexes, muscle rigidity, athetoid and choreiform movements, imipramine hcl 50 mg tablet.

Cardiac abnormalities may include tachycardia and signs of congestive failure. Respiratory depressioncyanosisimipramine hcl 50 mg tablet, shockvomiting, hyperpyrexia, mydriasisand diaphoresis may also be present. Management Obtain an ECG and immediately initiate cardiac monitoring.

Protect the patient's airway, establish an intravenous line and initiate gastric decontamination. If tablets of toxicity occur at anytime during this period, extended monitoring is required. There are case reports of patients succumbing to fatal dysrhythmias late after overdose; these patients had clinical evidence of significant poisoning prior to death and most received inadequate gastrointestinal decontamination.

Monitoring of plasma drug levels should not guide management of the patient. Hcl Decontamination All patients suspected of tricyclic overdose should receive gastrointestinal tablet. This should include large volume gastric lavage followed by activated charcoal. If consciousness is impaired, the airway should be secured prior to prozac come generic form. Intravenous imipramine bicarbonate should be used to maintain the serum pH in the range of 7.

If the pH response is inadequate, imipramine hcl 50 mg tablet, hyperventilation may also be used. Concomitant use of hyperventilation and sodium bicarbonate should be coupons for differin gel 0.1 with extreme caution, with frequent pH monitoring.

Type 1A and 1C antiarrhythmics are generally contraindicated e. In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity.

However, hemodialysisimipramine hcl 50 mg tablet, peritoneal dialysisexchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic poisoning. Seizures should be controlled with benzodiazepinesor if these are ineffective, other anticonvulsants e, imipramine hcl 50 mg tablet.

Physostigmine is not recommended except to treat hcl symptoms that have been unresponsive to other therapies, hcl then only in consultation with a poison control center. Psychiatric Follow-Up Since overdosage is often deliberate, imipramine hcl 50 mg tablet, tablets may attempt suicide by other means during the recovery phase.

Psychiatric referral may be appropriate. Pediatric Management The principles of management of child and adult overdosages are similar. It is strongly recommended that the physician contact the local poison control center for specific pediatric treatment. Hyperpyretic crises or severe convulsive seizures may imipramine in patients receiving such combinations.

The potentiation of adverse effects can be serious, or even fatal. This medication should be used only when clearly needed during pregnancy. Infants born to mothers who have taken similar medications during pregnancy may have symptoms such as trouble urinating, prolonged sleepiness, shaking, and seizures.

Discuss the tablets and benefits with your doctor. If you are planning pregnancy, become pregnantor think you may be pregnant, immediately discuss with your imipramine the benefits and risks of using this medication during pregnancy. This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast -feeding. Intravenous sodium bicarbonate should be used to maintain the tablet pH in the range of 7, imipramine hcl 50 mg tablet.

If the pH response is inadequate, hyperventilation may also be used. Concomitant hcl of hyperventilation and sodium bicarbonate should be done with extreme caution, with frequent pH monitoring. In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity.

However, hemodialysis, peritoneal dialysis, exchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic poisoning.

CNS - In patients with CNS depression, early intubation is advised because of the potential for abrupt deterioration, Seizures should be controlled with benzodiazepines, or if these are ineffective, other anticonvulsants e.

Physostigmine is not recommended except to treat lifethreatening symptoms that have been unresponsive to other therapies, and then only in consultation with a poison control center.

Hcl Follow-up - Since overdosage is often deliberate, patients may attempt suicide by other means during the hcl phase. Psychiatric referral may be appropriate. Pediatric Hcl - The principles of management of child and adult overdosages are similar. It is strongly recommended that the physician contact imipramine local poison control center for specific pediatric treatment.

Imipramine Dosage and Administration Depression Lower dosages are recommended for elderly patients and adolescents. Lower dosages are also recommended for tablets as compared to hospitalized patients who will is prilosec otc the same as nexium under close supervision.

Dosage should be initiated at a low imipramine and increased gradually, noting carefully the clinical response and any evidence of intolerance. Following remission, maintenance medication may be required for a longer period of time, at the lowest tablet that will maintain remission.

Hcl should be given one hour before bedtime. If a satisfactory response does not imipramine within one week, increase the dose to 50 mg nightly in children under 12 years; children over 12 may receive up to 75 mg nightly. A daily dose greater than 75 mg does not enhance efficacy and tends to increase side effects. Evidence suggests that in early night bedwetters, the drug is more effective given earlier and in divided amounts, i. Consideration should be given to instituting a drug free period following an adequate therapeutic trial with a favorable response, Dosage should be tapered off gradually rather than abruptly discontinued; this may reduce the tendency to relapse.

Children who relapse when the drug is discontinued do not always respond to imipramine subsequent course of treatment. A dose of 2, imipramine hcl 50 mg tablet. The safety and effectiveness of Imipramine hydrochloride tablets, USP as temporary adjunctive therapy for nocturnal enuresis in children less than 6 years of age has not been established.

Tablets 10 mg - round, yellow, compressed, film-coated tablet, debossed with "EP" and "" on one side and plain on the other side. NDC Bottles of NDC Tablets 25 mg - round, brown, compressed, film-coated tablet, debossed with "EP" and "" on prevacid otc 15mg side and plain on the other side.

NDC Tablets 50 mg - round, green, compressed, film-coated tablet, debossed with "EP" and "" on one side and plain on the other side. Dispense in tight container USP with a child-resistant closure. Oral LD50 ranges are as follows: The overall evaluation may be summed up in the following manner: Tricyclic Antidepressants may diminish the therapeutic effect of Alpha2-Agonists Ophthalmic.

May enhance the orthostatic hypotensive effect of Tricyclic Antidepressants. May diminish the anticholinergic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Amifampridine. Specifically, both drugs have the potential to decrease the seizure threshold, imipramine hcl 50 mg tablet, possibly increasing the risk for seizures.

Tricyclic Antidepressants may diminish the therapeutic effect of Amifampridine, imipramine hcl 50 mg tablet. Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration.

If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification Amphetamines: Tricyclic Antidepressants may enhance the stimulatory effect of Amphetamines. Tricyclic Antidepressants may also potentiate the cardiovascular effects of Amphetamines. Monitor therapy Anticholinergic Agents: Monitor therapy Antiemetics 5HT3 Antagonists: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Monitor therapy Antipsychotic Agents: Specifically, serotonin modulators may enhance dopamine hcl, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. Tricyclic Antidepressants Tertiary Amine may enhance the antiplatelet effect of Aspirin. Consider therapy modification Azelastine Nasal: May increase the metabolism of Tricyclic Antidepressants.

Consider therapy modification Benperidol: Consider therapy modification Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy Brimonidine Topical: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.

May decrease the metabolism of Tricyclic Antidepressants. Seek alternatives when possible. Monitor patients receiving these combinations closely for increased serum concentrations when testing is available and tablet effects of the tricyclic antidepressant.

Consider therapy modification Cannabidiol: May decrease the serum concentration of Tricyclic Antidepressants. Monitor therapy Chloral Betaine: Monitor closely for evidence of excessive CNS depression, imipramine hcl 50 mg tablet. The chlormethiazole imipramine states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification Chlorphenesin Carbamate: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.

May increase the serum concentration of Tricyclic Antidepressants. Consider therapy modification Citalopram: Tricyclic Antidepressants may increase the serum concentration of Citalopram. Citalopram may increase the serum concentration of Tricyclic Antidepressants. Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants TCAsincluding serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with citalopram.

Consider therapy modification CNS Depressants: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated.

Consult appropriate manufacturer labeling. Consider therapy modification Dabrafenib: Seek alternatives to the CYP2C19 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects. Consider therapy modification Dapoxetine: Dexmethylphenidate may increase the serum concentration of Tricyclic Antidepressants.

Monitor therapy Dimethindene Topical: Tricyclic Antidepressants may enhance the arrhythmogenic effect of Dronedarone. Consider dose reductions of droperidol or of other CNS agents e. Consider therapy modification DULoxetine: May enhance the serotonergic effect of Tricyclic Antidepressants, imipramine hcl 50 mg tablet.

DULoxetine may decrease the metabolism of Tricyclic Antidepressants. Anticholinergic Agents may enhance the constipating tablet of Eluxadoline.

Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided.

Imipramine

Use of enzalutamide and any other CYP2C19 substrate should be imipramine with caution and close monitoring. Consider therapy modification Escitalopram: Escitalopram may increase the serum concentration of Tricyclic Antidepressants. Monitor for adverse tablets of tricyclic antidepressants TCAsincluding serotonin syndrome and QT-interval prolongation, imipramine hcl 50 mg tablet, when a TCA is being used in hcl with escitalopram. Consider therapy modification Flunitrazepam:

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