Pramin
Generic Name
Imipramine Hydrochloride
Manufacturer
General Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| pramin 25 mg tablet | ৳ 4.00 | ৳ 40.00 |
Description
Overview of the medicine
Imipramine is a tricyclic antidepressant used to treat depression, certain anxiety disorders, and nocturnal enuresis in children. It helps restore the balance of certain natural substances (neurotransmitters) in the brain.
Uses & Indications
Dosage
Adults
Depression: Initially 25-50 mg daily in divided doses or as a single bedtime dose, gradually increased to 75-150 mg daily; max 300 mg/day for hospitalized patients.
Elderly
Initially 10-25 mg daily, gradually increased under close supervision; max 75 mg/day.
Renal_impairment
Use with caution. Dose adjustment may be necessary in severe renal impairment.
How to Take
Oral administration. Can be taken with or without food. To minimize stomach upset, take with food. For depression, a single bedtime dose is often preferred due to sedative effects.
Mechanism of Action
Imipramine inhibits the reuptake of norepinephrine and serotonin at the presynaptic neuronal membrane, increasing their concentration in the synaptic cleft. It also has anticholinergic and sedative properties.
Pharmacokinetics
Onset
Antidepressant effects typically begin after 1-2 weeks, full therapeutic effect within 4-6 weeks.
Excretion
Primarily renal (urine) as metabolites, with some fecal excretion.
Half life
Imipramine: 10-20 hours; Active metabolite (Desipramine): 17-30 hours.
Absorption
Well absorbed from the gastrointestinal tract, but undergoes extensive first-pass metabolism.
Metabolism
Extensively metabolized in the liver by cytochrome P450 enzymes (primarily CYP2D6) into active metabolite desipramine and other inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to imipramine or other tricyclic antidepressants.
- Concurrent use with Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy.
- During the acute recovery phase after myocardial infarction.
- Severe liver disease.
- Narrow-angle glaucoma (relative contraindication).
Drug Interactions
MAOIs
Concurrent use can lead to serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes).
SSRIs
Can increase plasma levels of imipramine due to CYP2D6 inhibition.
Warfarin
May increase the anticoagulant effect of warfarin by inhibiting its metabolism.
CNS Depressants (e.g., alcohol, sedatives, hypnotics)
Increased central nervous system depression, drowsiness, and sedation.
Anticholinergic agents (e.g., atropine, antihistamines)
Potentiation of anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention).
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include agitation, confusion, hallucinations, severe drowsiness, dilated pupils, fast/irregular heartbeat, seizures, and coma. Management involves supportive care, gastric lavage, activated charcoal, and careful monitoring of cardiac function and vital signs.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Imipramine is excreted in breast milk; therefore, use with caution during lactation, or consider an alternative.
Side Effects
Contraindications
- Hypersensitivity to imipramine or other tricyclic antidepressants.
- Concurrent use with Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy.
- During the acute recovery phase after myocardial infarction.
- Severe liver disease.
- Narrow-angle glaucoma (relative contraindication).
Drug Interactions
MAOIs
Concurrent use can lead to serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes).
SSRIs
Can increase plasma levels of imipramine due to CYP2D6 inhibition.
Warfarin
May increase the anticoagulant effect of warfarin by inhibiting its metabolism.
CNS Depressants (e.g., alcohol, sedatives, hypnotics)
Increased central nervous system depression, drowsiness, and sedation.
Anticholinergic agents (e.g., atropine, antihistamines)
Potentiation of anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention).
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include agitation, confusion, hallucinations, severe drowsiness, dilated pupils, fast/irregular heartbeat, seizures, and coma. Management involves supportive care, gastric lavage, activated charcoal, and careful monitoring of cardiac function and vital signs.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Imipramine is excreted in breast milk; therefore, use with caution during lactation, or consider an alternative.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture, depending on manufacturer specifications.
Availability
Pharmacies, Hospitals
Approval Status
DGDA approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Imipramine has been extensively studied since its introduction in the late 1950s, with numerous clinical trials demonstrating its efficacy in treating major depressive disorder, panic disorder, and nocturnal enuresis. Ongoing research explores its long-term effects and comparative efficacy.
Lab Monitoring
- ECG (especially at baseline and for cardiac risk patients)
- Liver function tests (periodically)
- Complete blood counts (periodically, especially with signs of infection)
- Plasma drug levels (if therapeutic monitoring is required or toxicity suspected)
Doctor Notes
- Monitor patients for signs of suicidal ideation and behavior, especially during initial therapy or dose adjustments, particularly in young adults.
- Perform baseline ECG, especially in elderly patients or those with pre-existing cardiac conditions, and periodically during treatment.
- Educate patients about anticholinergic side effects and measures to manage them.
- Start with a low dose and titrate slowly to minimize side effects.
Patient Guidelines
- Do not stop taking this medicine abruptly without consulting your doctor, as withdrawal symptoms may occur.
- Avoid alcohol consumption while on this medication.
- Report any unusual mood changes, agitation, or suicidal thoughts to your doctor immediately.
- Be aware of potential drowsiness and blurred vision, especially when starting treatment.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.
Driving Precautions
This medicine may cause drowsiness, dizziness, or blurred vision. Avoid driving or operating machinery until you know how this medication affects you.
Lifestyle Advice
- Maintain a healthy and balanced diet.
- Regular physical activity can complement antidepressant therapy.
- Practice good sleep hygiene to help manage mood and energy levels.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.