Published on 22 November 2021

Imipramine Vs Amitriptyline: Which One Is Effective?

Tofranil (Imipramine) imipramine-vs-amitriptyline
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Depressive disorder is a common but serious mood disorder. It is likely to cause severe symptoms affecting how you feel, think, and handle routine activities. Globally, an estimated 3.8% of the population is affected, including 5.0% among adults and 5.7% among adults older than 60.

Depression and pain are closely related. Sometimes depression and pain create a vicious cycle wherein pain worsens the depressive symptoms, and the resulting depression worsens the feelings of pain or discomfort.

Imipramine and Amitriptyline are the medications that aid depression and pain. Both medicines belong to the tricyclic antidepressant class. To know further, read more.

What Is Imipramine?

Imipramine (Tofranil) belongs to the tricyclic antidepressant class of drugs. Depression is treated with Imipramine pills and capsules. Imipramine pills are also used to keep children from wetting the bed. It was first approved in 1959 by the FDA for treating Major Depressive Disorder (MDD).

Indications:

Imipramine is used in the following:

  • Nocturnal enuresis
  • Panic disorder (off-label)
  • Depression (off-label)
  • Chronic pain (off-label)
  • Hyperactivity
  • Neuropathic pain

How Does Imipramine Work?

It works by raising the levels of certain natural chemicals in the brain that are necessary for mental equilibrium. There is potentiation of adrenergic synapses by blocking the uptake of norepinephrine at the nerve endings.

There isn't enough data to explain how Imipramine keeps you from peeing on the bed. You can buy Imipramine online from a certified online pharmacy, but it is advised to get a doctor's recommendation first.

What Is Amitriptyline?

Amitriptyline, a prescription-only medication, belongs to the tricyclic antidepressant class. This drug was first created to treat depression and Anxiety. But when it is taken at a lower dose, it is beneficial for treating pain, especially pain caused by damage to your nerves.

Amitriptyline hydrochloride, also known as Elavil, was initially approved by the FDA in 1977 and manufactured by Sandoz 11. It can treat nerve (neuralgia) and back pain and help avoid migraines.

Indications:

Amitriptyline is used in the following:

  • Nocturnal enuresis
  • Panic disorder (off-label)
  • Depression
  • Analgesia for chronic pain
  • Migraine prophylaxis (off-label)
  • Idiopathic musculoskeletal pain syndrome¬†

How Does Amitriptyline Work?

It works by raising the levels of certain natural chemicals in the brain that are necessary for mental equilibrium. It inhibits the membrane pump mechanism responsible for the uptake of serotonin and norepinephrine in adrenergic and serotonergic neurons. It is available in tablet form and as a drinkable liquid (Bryson, H.M. and Wilde, M.I., 1996).

Dosage Of Imipramines vs. Amitriptyline

It is essential to know the dosage for the condition to be cured. Whenever you are about to consume any medicine, you should get the exact dose and not consume more or less than recommended, as every dosage might differ according to the person's condition. Below mentioned are the general dosage that is given to people.

Frequently asked questions

Imipramine can make your skin photosensitive. Speak to your medical practitioner about the benefits and risks of taking Imipramine if you are 65 or older.
Amitriptyline may increase suicidal thoughts and behavior, especially in children, adolescents, and young adults. People taking antidepressant therapy should be closely monitored for signs of changes in behavior or worsening depression.
Through a direct toxic effect on the myocardium, Imipramine reduces myocardial contractility and cardiac output with resultant hypotension.

Imipramines

Initial Dosage: 100 mg/day in divided doses was started and eventually increased to 200 mg/day as required.
Maximum Dosage: Increase to 250 to 300 mg/day if there is no reaction after two weeks, however, under the physician's advice.
For Depression: Oral Imipramine 1.5 mg/kg/day thrice a day. The maximum dose is 5 mg/kg/day.
For Neuropathic pain: The initial recommended dose is 0.2 - 0.4 mg/kg/day. The maximum oral dose is 1 - 3 mg/kg at bedtime.

Amitriptyline

OUTPATIENTS:

  • Initial dose: 75 mg orally in divided doses per day; this can be increased to 150 mg per day (if needed)
  • Maximum dose: 150 mg/day -Maintenance dose: 40 to 100 mg orally each day

INPATIENTS:

An initial dose of 100 mg orally each day is recommended.

  • Maintenance dosage: 40 to 100 mg orally at bedtime in a single dose
  • Maximum daily dose: 300 mg

For Idiopathic musculoskeletal pain syndrome- 10 - 50 mg at bedtime
For Migraine prophylaxis- 0.25 mg/kg/day at rest; not to exceed 1 mg/kg/day

Side Effects Of Amitriptyline vs Imipramine

Side Effects are the common cause that you might suffer from. Side effects might happen to you because the medicine's active ingredient affects your body. If the person goes through common conditions, it can be cured as time goes off, but severe effects should be taken care of and informed to the doctor quickly.

Imipramine

While using Imipramine, if you are under the age of 24, you may develop suicidal thoughts. If this happens, contact your doctor.

Common side effects

Severe Side Effects

Drowsiness

Unexpected numbness or weakness

Dizziness

Vision Speech or balance issues

Constipation

Unusual bleeding

Nausea

Dizziness

Loss of appetite

Yellowing of the eyes or skin

Blurred vision

New or worsening chest discomfort

Amitriptyline

Amitriptyline for pain has lower doses than Amitriptyline for depression. This means that the most common side effects are milder and last only a few days. It rarely occurs. However, some people experience significant side effects after using Amitriptyline.

Common side effects

Severe Side Effects

Constipation

Headache

Difficulty urinating

Feeling confused

Blurred vision

Muscular cramps

Nightmares

Swelling or redness in or around your eye

Headaches

Irregular Heartbeat

Drowsiness

Change in vision

Contraindications of Amitriptyline Vs. Imipramine

People should be careful while they are consuming any medicine. You should know priorly about all the Ins and Outs of the drug as per the initial conditions you are being gone through and the drugs you have been consuming. It would be best if you did not take medication while you are going through situations such as:

Imipramine

  1. Allergic to Imipramine or any of its ingredients.
  2. Hepatic impairment and cardiovascular disease.
  3. This drug is not recommended during the acute recovery phase following myocardial infarction.
  4. The concomitant use of MAO oxidase inhibiting compounds is contraindicated as it can cause serious adverse effects and even be fatal.
  5. have Bipolar disorder, mania, schizophrenia
  6. have hepatic or thyroid disease
  7. Patients should avoid excessive exposure to sunlight while using Imipramine due to the possibility of photosensitization.

Amitriptyline:

  1. Allergic to Amitriptyline or any of its ingredients.
  2. Acute porphyria, hepatic impairment, and cardiovascular disease.
  3. It should not be given concomitantly with MAO inhibitors
  4. Amitriptyline hydrochloride should not be prescribed with Cisapride due to the increased risk of arrhythmia.
  5. A minimum period of 14 days should be allowed after the discontinuation of an MAO inhibitor when it is desired to replace it with Amitriptyline hydrochloride.
  6. This drug is not recommended during the acute recovery phase following myocardial infarction.

Which One Is Effective, Imipramine vs. Amitriptyline?

In four-week double-blind research, fifty-seven neurotically depressed outpatients with sleep disturbances were randomly assigned to therapy with either Imipramine pamoate or Amitriptyline administered in a single dose at bedtime.

Imipramine and Amitriptyline are equally helpful in treating neurotic depression, according to the findings. This study refuted the clinical belief that Imipramine is more beneficial for retarded depression and Amitriptyline is more effective for anxious, agitated depression.

The fact that the imipramine pamoate group had much earlier rising times and a trend toward higher sleep quality is particularly intriguing. In this population, the side effect profiles of the two medicines were likewise very similar; however, more patients complained of amitriptyline-related side effects than imipramine-related side effects.

Study: Imipramine vs. Amitriptyline

The Polish Academy of Sciences studied the Institute of Pharmacology, Krakw, Poland, to know how Amitriptyline and Imipramine have different effects on the pharmacokinetics and metabolism of Perazine in rats.

After the experimentation, the results detected that the interactions between phenothiazines and tricyclic antidepressants could go both ways. It's best to take lower doses of the neuroleptic and the antidepressant when they're brought together.

User Reviews

Imipramine possesses an average rating of 6.5 out of 10 from 29 ratings for the treatment of depression. A positive experience was reported by 48% of reviewers, while 24% reported a negative experience.

Amitriptyline possesses an average rating of 8.1 out of 10 from 114 ratings for the treatment of depression. A positive experience was reported by 75% of reviewers, while 12% reported a negative experience.

Interactions of Medications

Drug interactions may change the pharmacodynamics of your medicine. It is advised not to start, stop or alter the dosage of any medication without your doctor's approval. Speak to your doctor about all products you use (including prescription/non-prescription drugs, supplements, or herbal products) for better treatment and guidance.

Some medicines that might interact with Imipramine or Amitriptyline include-

Imipramine Interactions:

  • Hypotensives, sedatives, drugs that prolong QT interval- increased effects of these drugs
  • Anti-coagulants, Rifampicin- decreased plasma concentration of Imipramine
  • MAO Inhibitors- severe convulsions, hyperpyretic crises, and deaths have occurred with this combination.
  • Calcium-channel blockers, SSRIs, Cimetidine, OCPs, Phenothiazines- plasma concentration of Imipramine increased.

Amitriptyline Interactions:

  • Hypotensives, sedatives, drugs that prolong QT interval- increased effects of these drugs
  • Anti-coagulants, Rifampicin- plasma concentration of Amitriptyline is decreased.
  • MAO Inhibitors- severe convulsions and deaths have occurred with this combination.
  • Calcium-channel blockers, SSRIs, Cimetidine- plasma concentration of Imipramine increased.
  • Anticholinergic agents or with neuroleptic drugs- Hyperpyrexia usually occurs.

Also Read:

Bottom Line From Practical Anxiety Solutions

A person suffering from any disease, such as Anxiety, stress, or depression, needs medication to get relief. Seek consultation with the concerned healthcare professional for better treatment. The medical practitioner would recommend the best-suited drug based on the person's age, medical history, body composition, and other factors.

Imipramine and Amitriptyline are the medications that aid depression and pain. Both medicines belong to the tricyclic antidepressant class. Imipramine pamoate and Amitriptyline are equally helpful in treating neurotic depression and work with similar mechanisms on the body.

In either approach, seek consultation with your healthcare professional to ensure the treatment is tailored to your needs.

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