“Since imipramine acts on various receptors in the body, it can cause adverse effects on some organs and systems. In the central and autonomic nervous system, the antihistaminic effects of imipramine can lead to dizziness, sedation, confusion, delirium, seizures, increased appetite, and weight gain.
The anticholinergic properties of imipramine can produce undesired side effects such as blurred vision, constipation, tachycardia, confusion, dry mouth, urinary retention, delirium, and narrow-angle glaucoma. Therefore, it is crucial to use imipramine cautiously in patients with acute angle glaucoma, paralytic ileus, urinary retention, and benign prostatic hypertrophy. The cardiovascular side effects include cardiac arrhythmia, which is the leading cause of death in tricyclic antidepressant overdose. Other adverse effects include GI upset, mild elevation of liver enzymes, sexual dysfunction, and diaphoresis. TCAs may rarely cause bone marrow suppression. Diaphoresis and orthostatic hypotension are mainly caused by noradrenergic receptor manipulation, while sexual dysfunction is due to serotonergic effects such as impaired arousal and orgasms.
Serotonin syndrome is a life-threatening condition, and it occurs with concurrent use of other serotonergic drugs as SSRI, triptans, tramadol, lithium, St John's wort, and tryptophan. Patients will present with altered mental state, autonomic changes as tachycardia, and neuromuscular changes as tremor, rigidity, and myoclonus. Imipramine can worsen suicidal ideation during the initial period of taking this medication in patients under the age of 24. Imipramine and other antidepressants can lead to the precipitation of a manic or mixed episode in a bipolar patient.[7][8] Therefore, it is essential to obtain pertinent history to rule out bipolar disorder in patients with a history of depression before prescribing imipramine.”
“Avoid sunlamps and tanning beds. This medicine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are drowsy or not alert.”
