Presentation
We report a 64-year-old female who presented with blue-gray discoloration on her face present for 4-5 years. The patient's medications included imipramine for depression for approximately 23 years. [ncbi.nlm.nih.gov]
Entire Body System
- Nightmare
See physician always: chest pain, difficulty urinating, nightmares, ringing in the ears, rapid heart rate excessive sedation or uncoordinated movements while taking this medication. [psyweb.com]
Central nervous system: dizziness, drowsiness, confusion, seizures, headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, extrapyramidal symptoms in geriatric patients, increased psychiatric symptoms, paresthesia Cardiovascular: orthostatic [en.wikipedia.org]
Less frequent side effects include: Seizures Ringing in the ears Abnormal movements and muscle rigidity Confusion Hallucinations Disorientation, delusions Anxiety Agitation Nightmares Memory loss Aggressiveness Heart rhythm problems, palpitations, fainting [anti-depressants.com]
Side Effects of Imipramine Common side effects include: nausea drowsiness weakness or tiredness excitement or anxiety confusion nightmares dry mouth sun sensitivity weight loss or gain constipation difficulty urinating frequent urination blurred vision [rxwiki.com]
- Congestive Heart Failure
Imipramine usage has been linked to both increases and decreases in blood pressure and heart rate. Heart attacks, congestive heart failure, and strokes have been reported. [minddisorders.com]
Contraindications: hypersensitivity, hepatic-renal failure, IHD, tachycardia, congestive heart failure, early post-infarction period, propensity to convulsions, schizophrenia, epilepsy, glaucoma, prostate adenoma, bladder atony, pregnancy, children's [order-rxpills.com]
Cardiovascular: Orthostatic hypotension, hypertension, tachycardia, palpitation, myocardial infarction, arrhythmias, heart block, ECG changes, precipitation of congestive heart failure, stroke. king, feeling, and acting with excitement and activity you [healthyplace.com]
[…] spells High blood pressure Congestive heart failure Heart attack or stroke Blood abnormalities Nausea/vomiting/loss of appetite/diarrhea/upset stomach/stomach cramps Black tongue Hepatitis Allergic reactions Sensitivity to sunlight or UV rays Swelling [anti-depressants.com]
- Unconsciousness
After a short period of time, she became unconscious and experienced hypotension and refractory arrhythmia, finally being diagnosed with imipramine poisoning. [ncbi.nlm.nih.gov]
Gastrointestinal
- Nausea
Common side effects include nausea, weakness and dry mouth. Imipramine can cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how it affects you. [rxwiki.com]
Do not suddenly stop taking this medication: you may get side effects like ( nausea, headaches, and fatigue ). Missed Dose: If you are taking more than 1 a day and miss a dose do not take it if it is almost time for the next dose. [psyweb.com]
Other symptoms include stiff muscles, seizures, nausea, vomiting, diarrhea, and tremors (uncontrollable movements in one part of your body). If you have any of these symptoms, call your doctor right away. [healthline.com]
If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away. [medlineplus.gov]
- Abdominal Pain
Improvements in bowel symptom severity rating for interference (P = 0.05) and distress (P = 0.02) were greater with imipramine versus placebo, but improvements in abdominal pain were not. [ncbi.nlm.nih.gov]
TCAs have been shown to improve abdominal pain in patients with IBS; however, there is insufficient evidence of global symptom relief. The search for an optimal treatment to improve symptoms and quality of life in IBS remains ongoing. [news-medical.net]
Too much colchicine in the body leads to toxicity such as fever, vomiting, diarrhea, abdominal pain and muscle pains. [worstpills.org]
Related Disease Conditions Irritable Bowel Syndrome (IBS) Irritable bowel syndrome (IBS) is a GI (gastrointestinal) disorder with signs and symptoms that include abdominal pain, bloating,... [medicinenet.com]
Cardiovascular
- Heart Disease
fast heart rate, palpitations, heart attack, abnormal heart rhythm, heart block, ECG changes, heart failure and stroke. • Psychiatric : Confusion, hallucinations, disorientation, anxiety, restlessness, agitation, sleeplessness, abnormal dreams and irritable [medindia.net]
Tell your doctor if you have ever had: heart disease, stroke, or seizures; bipolar disorder (manic-depression), schizophrenia or other mental illness; kidney or liver disease; overactive thyroid; narrow-angle glaucoma; or problems with urination. [drugs.com]
Older people and persons with a history of heart disease may develop heart arrhythmias (irregular heartbeat), heart conduction abnormalities, congestive heart failure, heart attack, abnormally rapid heart rates and strokes. [minddisorders.com]
- Tachycardia
Electrocardiography (ECG) showed tachycardia and widened QRS. He was immediately treated with bicarbonate infusion and made an uneventful recovery. This is the youngest and only reported case of symptomatic imipramine ingestion in our locality. [ncbi.nlm.nih.gov]
CV: orthostatic hypotension, tachycardia, ECG changes, hypertension, MI, arrhythmias, heart block, precipitation of heart failure. EENT: blurred vision, tinnitus, mydriasis. [glowm.com]
On the part of the cardiovascular system and blood system (hematopoiesis, hemostasis): tachycardia, arrhythmia, orthostatic hypotension, leukocytosis or leukopenia, agranulocytosis. [order-rxpills.com]
Cardiac abnormalities may include arrhythmia, tachycardia (fast or irregular heartbeat), ECG evidence of impaired conduction, and signs of congestive failure. [healthyplace.com]
- Cyanosis
This is followed by CNS depressant effects, including hypothermia, decreased or absent reflexes, sedation, hypotension, cyanosis, and cardiac irregularities, including tachycardia, conduction disturbances, and quinidine-like effects on the ECG. [glowm.com]
Respiratory depression, cyanosis, hypotension, shock, vomiting, hyperpyrexia, mydriasis, and diaphoresis may also be present. Other symptoms of overdose may include flushing, dry mouth, drowsiness, confusion, agitation, enlarged pupils, seizures. [healthyplace.com]
Eyes
- Eye Pain
Imipramine is furthermore used with great success in the treatment of chronic pain syndromes (neck and back pain, amongst others) and migraine. It has also been used to treat nerve pain such as that accompanied by shingles. [health24.com]
Call your doctor at once if you have: easy bruising, unusual bleeding, purple or red spots under your skin; tunnel vision, eye pain or swelling, or seeing halos around lights; a light-headed feeling, like you might pass out; new or worsening chest pain [drugs.com]
Migraine Headache Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on... [medicinenet.com]
Ears
- Tinnitus
A chart review of 475 patients treated with tricyclic antidepressants indicated that tinnitus occurred in about 1% of the patients. The case vignettes of 5 patients who developed tinnitus in the course of imipramine therapy are presented. [ncbi.nlm.nih.gov]
[…] nightmares, extrapyramidal symptoms in geriatric patients, increased psychiatric symptoms, paresthesia Cardiovascular: orthostatic hypotension, ECG changes, tachycardia, hypertension, palpitations, dysrhythmias Eyes, ears, nose and throat: blurred vision, tinnitus [en.wikipedia.org]
EENT: blurred vision, tinnitus, mydriasis. GI: dry mouth, constipation, nausea, vomiting, anorexia, paralytic ileus, abdominal cramps. GU: urine retention, testicular swelling, impotence. [glowm.com]
Neurological: Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures, alterations in EEG patterns; tinnitus. [healthyplace.com]
Skin
- Sweating
I sweat ALOT and VERY easily since I started this as well. Report [everydayhealth.com]
Anticholinergic effects, increased sensitivity to the sun, postural hypotension, weight gain, sleepiness, sweating. Dosages Recommended by Investigators. [anxieties.com]
[…] difficulty breathing, dilated pupils, drowsiness, heart failure, high fever, involuntary writhing or jerky movements, irregular or rapid heartbeat, lack of coordination, low blood pressure, overactive reflexes, restlessness, rigid muscles, shock, stupor, sweating [generalhlthnews.org]
Sweating a lot. Flushing. Feeling tired or weak. Headache. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. [drugs.com]
- Pruritus
[…] increased appetite, cramps, epigastric distress, jaundice, hepatitis, stomatitis, constipation, taste change Genitourinary: urinary retention Hematological: agranulocytosis, thrombocytopenia, eosinophilia, leukopenia Skin: rash, urticaria, diaphoresis, pruritus [en.wikipedia.org]
Skin: diaphoresis, rash, urticaria, photosensitivity, pruritus. Other: gynecomastia, galactorrhea and breast enlargement, altered libido, SIADH, hypersensitivity reaction. [glowm.com]
Psychiatrical
- Aggressive Behavior
Gilles de la Tourette's syndrome (GTS) is a chronic neuropsychiatric disorder characterized by multiple involuntary motor and phonic tics associated with behavioural disturbances including obsessive-compulsive and aggressive behavior, depression and, [ncbi.nlm.nih.gov]
behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. [medlineplus.gov]
- Loss of Libido
Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. [nature.com]
Naunyn-Schmiedeberg’s Arch Pharmacol 374:215–222 CrossRef Google Scholar Pierce JR Jr (1983) Cimetidine-associated depression and loss of libido in a woman. [doi.org]
Urogenital
- Hot Flushes
The most commonly reported side effects when taking Tofranil tablets 25mg include: weight gain, anorexia, tremor, tachycardia (rapid heart beat), vasodilation (hot flushes), orthostatic hypotension or dizzy spell (low blood pressure when standing up), [inhousepharmacy.vu]
Anticholinergic side effects: Dry mouth, blurred vision or double vision, constipation, sweating, hot flushes, difficulty urinating or urinary retention, pupil dilation, glaucoma and intestinal paralysis. [medizzine.com]
Neurologic
- Insomnia
In addition, this child experienced initial insomnia and nocturnal enuresis, problems not previously reported with fragile X. [ncbi.nlm.nih.gov]
A tricyclic drug, C 19 H 24 N 2, used in the form of its salts to treat depression and enuresis. imipramine Neuropharmacology A dibenzazepine class tricyclic antidepressant used for depression, enuresis Adverse effects Insomnia, numbness, tingling, tremors [medical-dictionary.thefreedictionary.com]
The most common side effects are headaches, drowsiness, dry mouth, constipation and insomnia. [anxieties.com]
Physical Symptoms of Depression in Pictures Depression can cause physical problems such as insomnia, chest pain, fatigue, headaches, and more. Learn the signs of depression... [medicinenet.com]
- Paresthesia
Side effects On the part of the nervous system and sensory organs: headache, dizziness, excessive sedation, paresthesia, tremor, convulsions, dysarthria, impaired coordination of movements, sleep disturbance, agitation, hallucinations, disruption of accommodation [order-rxpills.com]
Central nervous system: dizziness, drowsiness, confusion, seizures, headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, extrapyramidal symptoms in geriatric patients, increased psychiatric symptoms, paresthesia Cardiovascular: orthostatic [en.wikipedia.org]
Adverse reactions CNS: drowsiness, dizziness, excitation, tremor, confusion, hallucinations, anxiety, ataxia, paresthesia, nervousness, EEG changes, seizures, extrapyramidal reactions, CVA. [glowm.com]
Neurological: Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures, alterations in EEG patterns; tinnitus. [healthyplace.com]
- Vertigo
Nervous side effects: disorientation, vertigo, tiredness, weakness, headache, difficulty concentrating, confusion, agitation, mood changes, aggressiveness, difficulty sleeping, hallucinations, anxiety, restlessness, pricking sensation, tremor, muscle [medizzine.com]
Workup
Rhythm
- Torsades De Pointes
Zeltser, Torsade de pointes induced by psychotropic drugs and the prevalence of its risk factors, Acta Psychiatrica Scandinavica, 111, 3, (171-176), (2005). [doi.org]
Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence [reference.medscape.com]
Other ECG Findings
- Electrocardiogram Change
Common side effects of imipramine include dry mouth, drowsiness, dizziness, low blood pressure, rapid heart rate, urinary retention, and electrocardiogram changes. Overdose can result in death. [en.wikipedia.org]
Treatment
RESULTS: Endogenous depressed patients in remission and currently receiving treatment with imipramine (mean length of treatment 145 days, SD=27) presented significantly lower buspirone responses to ACTH and cortisol than in the pre-treatment condition [ncbi.nlm.nih.gov]
Prognosis
Despite a good prognosis and the beneficial effect of reassurance for many patients, most continue to have chest pain that may result in visits to the emergency room, admission to the coronary care unit, and even repeat cardiac catheterization 1-5,7-9 [nejm.org]
Etiology
The rapid resolution of intraventricular conduction delay and normalization of the QRS-T complexes after gastric lavage, installation of activated charcoal and alkalinization of the blood strongly implicates imipramine intoxication in the etiology of [ncbi.nlm.nih.gov]
Within the group of depressions, few etiologic principles have been substantiated and little agreement exists on subgroups. Consequently, differential drug responses are not clearly understood. [pharmrev.aspetjournals.org]
It is assigned for depressive states of various etiologies, including: asthenodepressive syndrome, depression (endogenous, involutional, climacteric, reactive, alcoholic), depressive states in psychopathy and neuroses, panic disorder, functional enuresis [order-rxpills.com]
Genitourinary: urinary retention Hematological: agranulocytosis, thrombocytopenia, eosinophilia, leukopenia Skin: rash, urticaria, diaphoresis, pruritus, photosensitivity Imipramine affects numerous neurotransmitter systems known to be involved in the etiology [en.wikipedia.org]
Epidemiology
The literature pertaining to etiology, epidemiology, pathophysiology and management of TCA-induced lung injury has been reviewed. In one series of severe TCA overdose, an ARDS rate of 9% was reported. [ncbi.nlm.nih.gov]
Epidemiology 3: 434–440. View Article Google Scholar 56. Lanevskij K, Japertas P, Didziapetris R, Petrauskas A (2009) Ionization-specific prediction of blood-brain permeability. J Pharm Sci 98: 122–134. View Article Google Scholar 57. [doi.org]
Pathophysiology
Both the clinical features and the pathophysiology of the serotonin syndrome are discussed. [ncbi.nlm.nih.gov]
The pathophysiology of functional dyspepsia is not fully understood and the correlation of those proposed mechanisms with the clinical characteristics and treatment response is poor. [clinicaltrials.gov]
When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am. J. Psychiatry 160, 1554–1565 (2003). 60. Gourley, S. L. et al. [doi.org]
Prevention
To try to prevent this complication, early intubation should be considered to avoid aspiration, and cautious volume loading, plus judicious use of alpha-adrenergic agonists, is indicated to prevent protracted hypotension. [ncbi.nlm.nih.gov]
Imipramine Overview Reviewed: September 18, 2013 Updated: July 21, 2016 Imipramine is a prescription medication used to treat the symptoms of depression and to prevent bedwetting in children. [rxwiki.com]