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TCA·Psychiatry - Antidepressants
Major Depressive Disorder, Nocturnal enuresis (bedwetting)
Max Dose
200 mg/day
Half-life
10-20 h
Enuresis
PAEDS USE
Toxicity in OD
CRITICAL
Overview
The very first Tricyclic Antidepressant (TCA). A highly potent serotonin and noradrenaline reuptake inhibitor. Extremely toxic in overdose. Uniquely used in pediatrics for bedwetting.
Maximum Dose
Max 200 mg/day (Depression). Max 75 mg/day (Childhood enuresis).
Clinical Focus
As with all TCAs, a 10-day supply taken at once is a fatal cardiac overdose. Do not dispense large quantities to suicidal patients.
Bottom Line
Imipramine is a classic TCA for depression and nocturnal enuresis in children, but is cardiotoxic in overdose and has significant anticholinergic and sedative effects.
Brand Names
Tofranil
Oral Routes
Tablets (10, 25 mg).
Prescribing & PBS
Unrestricted General Benefit (S4).
Primary
Major Depressive Disorder, Nocturnal enuresis (bedwetting).
Clinical Place
Largely obsolete for depression due to SSRIs. Retains a niche in treatment-resistant childhood bedwetting due to its profound anticholinergic bladder-relaxing effect.