IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

01 December 2021
Medically reviewed by
Sumayya Salam
Pharm D
CAN IMIPRAMINE BE TAKEN FOR SLEEP
Table of Contents

Imipramine is an antidepressant medication sold under the brand name Tofranil. It belongs to a class of drugs known as tricyclic antidepressants. It is used to treat depression, Anxiety, and panic disorders. It comes in the form of tablets and liquid oral medicine. 

Imipramine is used to treat depression, Anxiety, and bedwetting, but it has little to do with sleep issues. Relieving the symptoms of depression can better the quality of sleep, but Imipramine alone cannot alter any changes when it comes to sleep insomnia. 

Anomalies in the sleep-wake pattern, the hormone secretion rhythms, and other biological rhythms are typically present in depressive diseases. Rapid eye movement (REM) sleep has often been found to be suppressed by antidepressant medicines, notably tricyclic antidepressants, while some unusual antidepressants promote REM sleep. So, let us see in detail how Imipramine works in sleep problems in depression.

What Is Imipramine?

Imipramine is used to treat Anxiety and depression. It is a tricyclic antidepressant. Imipramine reduces depression and lethargy and improves mental and physical tone. The drug treats depression accompanied by motor clumsiness and enuresis in children and Parkinson's disease.  

How Does Imipramine Work?

Imipramine works by blocking the mechanism of the reuptake of biogenic amines. Imipramine inhibits the reuptake of norepinephrine and serotonin. It is a tertiary amine with a strong affinity for serotonin and higher anticholinergic adverse effects, thus making it an effective treatment for treating enuresis. 

Imipramine blocks D2 receptors. As a result of blocking antimuscarinic receptors, it has adverse effects on the cholinergic system. Additionally, it inhibits H1 and alpha 1 and 2 adrenergic receptors.

Indications of Imipramine

Due to its unfavorable side effects and toxicity in an overdose, while being FDA-approved for the treatment of depression, it is typically used as a second-line medication, particularly in cases of severe depression with melancholy and atypical symptoms. Imipramine is an adjunct treatment for nocturnal enuresis in children older than six. Imipramine has other off-label uses, including treating panic disorder and chronic neuropathic pain.

Dosage of Imipramine

Dosage refers to the quantity and frequency of drug administration. An ideal dosage form would be one that can provide the desired effect, has precise potency, reduces adverse effects, is simple to dose, and can be produced at affordable cost.

Both tablets and capsules of Imipramine are readily available. The pills come in 75, 100, 125, and 150 mg, while the tablets are available in 10, 25, and 50 mg.

Dosing for Depression

  • Outpatients-75 mg orally once daily initially; this may increase to 150 mg/day gradually. Do not exceed more than 200 mg/ day. Administer the doses in divided or single doses at night.
  • Inpatients- Initially, 100 mg/day in divided doses gradually increased to 200 mg/day as required. If there is no response after two weeks, increase it to 250 to 300 mg/day.

Nightly Bedwetting: 

Children only, to be taken at bedtime (for no longer than three months and up to a maximum of 75mg a day): 

  • Over 11 years (35-54kg) - 50-75mg once daily
  • 8-11 years (25-35kg) - 25-50mg once daily. 
  • 6-7 years (20-25kg) - 25mg once daily
  • Under six years - not recommended.

Can Imipramine Be Taken For Sleep?

Imipramine aids in the treatment of depression-related sleep issues. It cannot cure sleep issues on its own. The most effective antidepressant or antidepressant class for treating Insomnia in patients with depression is neither one nor the other. Imipramine use may benefit sleep physiology, but it does not appear to enhance subjective assessments of sleep quality.

How Does Imipramine Work To Treat Sleep Issues?

Studies on the effects of antidepressants on sleep-wake rhythm have discovered that Imipramine and many other antidepressants suppress REM (Rapid Eye Movement) sleep with prolonged Rapid Eye Movement Latency. It decreases the amount of REM sleep and increases Stage 1+2 sleep in healthy volunteers. Depressed patients also exhibit similar effects of Imipramine and other antidepressants on their sleep-wake rhythm. 

Therefore, one approach to treating sleep problems in individuals with depression involves choosing antidepressant medications that improve sleep continuity (i.e., uninterrupted sleep), extend REM latency, and reduce REM sleep.

Study On Imipramine Effectiveness For Sleep

The Department of Psychiatry and Behavioural Medicine, Eastern Virginia Medical School, Norfolk, conducted a double-blind study comparing Trimipramine to Imipramine in depressed insomniac patients. 

Imipramine and Trimipramine are sedating tricyclic antidepressants. It was a four-week-long study conducted on patients with Insomnia and Anxiety. Trimipramine eliminated the signs of Insomnia, but the same can't be said for Imipramine. Although depression improved in both the medicine groups, the subject's sleep appeared to be unchanged or more disturbed.

For Trimipramine, significant changes in sleep were seen in the first week of the study, but Since then, the quality of changes gradually did not remain constant. Trimipramine did not improve the REM cycle in patients.

Imipramine can cause weight gain because Some antidepressants seem to have a higher risk of causing weight gain than others. Some tricyclic antidepressants, including amitriptyline, imipramine (Tofranil), and doxepin, fall under this category.
Pain relief could take anywhere between 2 and 4 weeks to begin. It may take longer (up to 2 months) to get to the correct dose and allow the medicine to build up in your body.
75 mg once daily initially. If necessary, your doctor might change your dose. However, unless you are in the hospital, it should not exceed not more than 200 mg per day.

Through this study, we can conclude that:

  • Antidepressants' effect on sleep can vary even though they have the same impact on depression.
  • Reports of sleep by patients were different; they changed after the first week, stating that these two medications have almost no effect on rest.

Possible Side Effects Of Imipramine

Side effects occur as unwanted effects after taking the drug. It can be mild to moderate or severe. Imipramine can have a few side effects. Consult a doctor before taking it and after taking it if any side effects prevail:

Common Side Effects Serious Side Effects
Dry mouth Unusual bleeding
Nausea Eye swelling
Vomiting Lightheadedness
Increased blood pressure Worsening chest pain
Lack of coordination Sudden numbness
Weakness Sore throat, fever
Headache Confusion
Drowsiness Hallucination
Constipation, diarrhea Difficult urination
Tingly feelings Seizure
Decreased sex drive Problems with vision, speech, or balance

Precautions Before Taking Imipramine

Precautions are necessary before administering Imipramine to avoid undesired effects. These are steps taken before giving any drug to the patient.

Before you take Imipramine-

  • Inform your doctor if you are allergic to Imipramine
  • Take Imipramine as directed by your physician. 
  • Tell your doctor about your prescription and OTC medications before starting Imipramine.

Before taking Imipramine, tell your doctor if you have any of the following-

  • irregular heartbeats or a heart attack
  • Episodes of mania
  • severe liver disease

Avoid Drinking Alcohol While You Are On Imipramine

Do not take Imipramine if you are pregnant or nursing. Babies born to mothers who used imipramine tablets within the previous three months may have respiratory issues, drowsiness, colic, irritability, changes in blood pressure, tremors, and spasms. 

Interactions

Drug interactions can increase or decrease the effect of drugs. These interactions can be minor, or sometimes severe reactions can occur. Always check for interactions before administering the medications.

Some Drug Interactions With Imipramine

  • If you have used an MAO inhibitor within the previous 14 days, avoid taking Imipramine. There may be a dangerous drug interaction.
  • Use caution when using blood pressure-lowering medications with Imipramine.
  • Co-administration of SSRIs may have cumulative effects on the serotonergic system.
  • Imipramine may intensify the depressing effects of alcohol as well as other central nervous system depressants such as barbiturates, benzodiazepines, and general anesthetics.
  • Combining quinidine-type antiarrhythmic medications with tricyclic antidepressants is not advised.
  • Tricyclic antidepressants may enhance the anticoagulant impact of coumarin medications. Therefore, monitor plasma prothrombin.
  • Co-medication with neuroleptics may cause seizures, a reduced convulsion threshold, and elevated plasma levels of tricyclic antidepressants. Serious cardiac arrhythmias may result from the use of thioridazine in combination.

Bottom Line From Practical Anxiety Solutions

Imipramine is a conventional tricyclic antidepressant that inhibits the reuptake of noradrenaline and serotonin. There is limited research on antidepressants' impact on subjective sleep scores.

 Imipramine inhibits REM sleep. Imipramine dramatically reduces REM sleep, although it has no statistically significant impact on Slow Wave Sleep. 

Studies have repeatedly shown that objective and subjective sleep metrics differ among antidepressant-using patients. There is limited research examining how antidepressants affect subjective sleep assessments. Despite a minor improvement in sleep patterns, Imipramine alone cannot treat sleep disorders.

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