Imipramine precautions

Precautions The tricyclic antidepressants should be used with caution in manic-depressive patients, since they may unmask manic behavior. The tricyclic antidepressants have a narrow therapeutic index for example, 5 to 6 times the maximal daily dose of imipramine can be lethal. Depressed patients who are suicidal should be given only limited quantities of these drugs and should be monitored closely. Drug interactions with the tricyclic antidepressants are shown in Figure 12.5. 

The manufacturer recommends caution when atomoxetine is given concurrently with other drugs that affect noradrenaline, because of the potential for additive or synergistic pharmacological effects. Examples they name are antidepressants such as imipramine, venlafaxine and mirtaza-pine, and the decongestants pseudoephedrine or phenylephrine. Until more is known, this would seem a sensible precaution. 

Fluoxetine 60 mg daily or imipramine 75 mg twice daily for 5 days had no clinically significant effect on the steady-state plasma levels of quetiapine 300 mg twice daily. No special precautions would therefore appear to be necessary if either of these drugs and quetiapine are used concurrently. 

In 18 healthy subjects the steady-state plasma levels of imipramine 25 mg three times daily were unaffected by vinpocetine 10 mg three times daily, taken concurrently for 10 days. No special precautions would seem to be necessary. There seems to be nothing documented about any of the other tricyclic antidepressants. 

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