Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (214 page)
(im-ip′ra-meen)
Tofranil, Tofranil PM
Func. class.:
Antidepressant, tricyclic
Chem. class.:
Dibenzazepine, tertiary amine
Do not confuse:
imipramine
/desipramine
Blocks reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine, serotonin in nerve cells
Depression, enuresis in children
Unlabeled uses:
Chronic pain, migraine headaches, cluster headaches as adjunct, incontinence, ADHD, neuralgia, bulimia, neuropathic pain, social phobia
Pregnancy (D), hypersensitivity to tricyclics, AV block, bundle branch block, ileus, QT prolongation, acute MI
Precautions:
Breastfeeding, geriatric patients, suicidal patients, severe depression, increased intraocular pressure, closed-angle glaucoma, urinary retention, cardiac/hepatic disease, hyperthyroidism, electroshock therapy, elective surgery, seizure disorders, prostatic hypertrophy, MI
Black Box Warning:
Children other than for enuresis; suicidal ideation
Calculator
• Adult: PO
75-100 mg/day in divided doses, may increase by 25-50 mg to 200 mg/day (outpatients), 300 mg/day (inpatients); may give daily dose at bedtime
• Geriatric: PO
25-50 mg at bedtime, may increase to 100 mg/day in divided doses
• Child ≥6 yr (unlabeled): PO
1.5 mg/kg/day in divided doses, max 2.5 mg/kg/day
• Child 6-12 yr: PO
10-25 mg at bedtime, max 50 mg
• Adult: PO
10-150 mg/day
• Adult: PO
10 mg at bedtime, titrate q2-4days to 100-200 mg/day
• Adult: PO
10-50 mg daily, may titrate to 150 mg/day
Available forms:
Tabs 10, 25, 50 mg; caps 75, 100, 125, 150 mg
•
Not to break, crush, or chew caps
•
With food or milk for GI symptoms
•
Dosage at bedtime if oversedation occurs during day; may take entire dose at bedtime; geriatric patients may not tolerate once daily dosing
•
Sugarless gum, hard candy, or frequent sips of water for dry mouth
CNS:
Dizziness, drowsiness
, confusion,
seizures,
headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, EPS (geriatric patients), increased psychiatric symptoms, paresthesia
CV:
Orthostatic hypotension, ECG changes, tachycardia
, hypertension, palpitations,
dysrhythmias
EENT:
Blurred vision, tinnitus, mydriasis
GI:
Diarrhea, dry mouth
, nausea, vomiting,
paralytic ileus;
increased appetite; cramps, epigastric distress, jaundice,
hepatitis,
stomatitis, constipation, taste change
GU:
Retention
,
acute renal failure
HEMA:
Agranulocytosis, thrombocytopenia, eosinophilia, leukopenia
INTEG:
Rash, urticaria, sweating, pruritus, photosensitivity; hyperpigmentation (rare)
Steady state 2-5 days; metabolized to desipramine by liver; excreted in urine, breast milk, feces; crosses placenta; half-life 6-20 hr
Hyperpyretic crisis, seizures, hypertensive episode: MAOIs, cloNIDine
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists; avoid concurrent use, linezolid, methylene blue IV
Increase:
QT interval—class IA/III antidysrhythmics, tricyclics, gatifloxacin, levofloxacin, moxifloxacin, ziprasidone
Increase:
effects of direct-acting sympathomimetics (EPINEPHrine), alcohol, barbiturates, benzodiazepines, CNS depressants
Decrease:
effects of guanethidine, cloNIDine, indirect-acting sympathomimetics (ePHEDrine)
Increase:
serotonin syndrome—SAM-e, St. John’s wort
Increase:
serum bilirubin, alk phos, blood glucose
Decrease:
5-HIAA, VMA, urinary catecholamines
•
B/P (lying, standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take vital signs q4hr in patients with CV disease
•
Blood studies: CBC, leukocytes, differential, cardiac enzymes, serum imipramine levels (125-250 ng/ml) if patient is receiving long-term therapy
•
Hepatic studies: AST, ALT, bilirubin
•
Weight weekly; appetite may increase with product
QT prolongation:
ECG for flattening of T wave, bundle branch block, AV block, dysrhythmias in cardiac patients
•
EPS primarily in geriatric patients: rigidity, dystonia, akathisia
•
Mental status: mood, sensorium, affect,
suicidal tendencies;
increase in psychiatric symptoms: depression, panic
•
Urinary retention, constipation; constipation is more likely to occur in children, geriatric patients; increase fluids, bulk in diet
Withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness, diarrhea, insomnia, restlessness; not usual unless product is discontinued abruptly
•
Serotonin syndrome, hypertensive episodes, identify drug interactions before use of product
•
Alcohol consumption; if alcohol is consumed, hold dose until morning
•
Storage in tight container at room temp; do not freeze
•
Assistance with ambulation during beginning therapy because drowsiness, dizziness, orthostatic hypotension occurs
•
Safety measures, primarily for geriatric patients
•
Therapeutic response: decreased depression, enuresis, pain
•
That therapeutic effects may take 2-3 wk
•
That product is dispensed in small amounts because of suicide potential, especially at beginning of therapy
•
To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
•
To report urinary retention immediately
•
To avoid alcohol, other CNS depressants during treatment
•
Not to discontinue medication abruptly after long-term use; may cause nausea, headache, malaise
•
To wear sunscreen or large hat because photosensitivity occurs
•
To rise slowly, orthostatic hypotension may occur
ECG monitoring; lavage, activated charcoal; administer anticonvulsant
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert