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Imipramine is a medication used in the treatment of depression and anxiety. It is a tertiary amine tricyclic antidepressant. This activity reviews the indications, contraindications, activity, adverse events, and other key elements of imipramine therapy in the clinical setting as continuous monitoring of the drug and the acute management of tricyclic overdose. These factors will be clinically relevant and essential for interprofessional team members in taking care of patients on imipramine therapy. Objectives: Describe common adverse effects associated with imipramine. Explain the need for monitoring of imipramine to ensure maintaining the therapeutic level and avoid the toxic effects of imipramine. Review the interventions for an imipramine overdose. Summarize how collaboration and effective communication among healthcare providers can promote patient care when monitoring the dose of imipramine and prompt treatment in imipramine overdose. Access free multiple choice questions on this topic.

The risk of developing toxicity from imipramine and other tricyclics is greater upon increasing the dose. An overdose of imipramine can result in serious side effects, mainly cardiac dysrhythmia, critical hypotension, convulsions, coma, confusion, hyperactive reflexes, and hypothermia. Imipramine has type 1 antiarrhythmic effects as it blocks the fast sodium channel on the myocardium. Therefore, this will lead to inhibition of depolarization of the heart action potential, which will result in QRS prolongation, which can lead to cardiac arrhythmia. Acute management must begin with an assessment of airway, breathing, and circulation in addition to ECG monitoring and vital signs. The initial management should primarily focus on the correction of hypoxia and acidosis if present. Treatment with sodium bicarbonate will reverse the fast sodium channel function on the myocardium, which will reverse the cardiotoxicity and will also help in increasing the pH, which can enhance the excretion of TCAs. Therefore, continuous monitoring of imipramine is important to prevent cardiotoxicity and to prevent morbidity and mortality. If patients develop seizures, the recommendation is to use benzodiazepines as first-line therapy. However, dose adjustment is necessary for certain medical conditions as hepatic or renal impairment.[9][10][11]

Patients should receive education about the possible side effects profile associated with imipramine and other tricyclics.; this will help patients make better decisions that fit their health. Before initiating imipramine, it is imperative to discuss with the patient regarding its clinical use and side effects of imipramine and other tricyclic antidepressants. Patient education about warning signs and symptoms that warrant a visit to the emergency department, such as suicidal thoughts, confusion, dizziness, severe palpitations, and vision changes, is vital before initiating therapy as well. Additionally, imipramine should be prescribed within the therapeutic dose with gradual titration as it can be fatal in overdose and require close monitoring. Special precautions merit consideration for anyone on this medication. Parents should be urged to keep the drug in a locked cabinet away from the reach of children.[10] Managing imipramine therapy requires the efforts of an interprofessional team that includes clinicians, specialists, mid-level practitioners, pharmacists, and psychology professionals, all collaborating and communicating as a cohesive unit and engaging the patient in their own care. Psychoeducation and good interprofessional communication skills between mental and other health providers and patients are of paramount importance for a better outcome. [Level 5]