What is imipramine?

Imipramine is a tricyclic antidepressant used to treat symptoms of depression. Imipramine is sometimes used to treat bed-wetting in children ages 6 and older.

Imipramine may also be used for purposes not listed in this medication guide.

Imipramine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Imipramine may cause serious side effects. Call your doctor at once if you have:

• easy bruising, unusual bleeding, purple or red spots under your skin;
• tunnel vision, eye pain or swelling, or seeing halos around lights;
• a light-headed feeling, like you might pass out;
• new or worsening chest pain, pounding heartbeats or fluttering in your chest;
• sudden numbness or weakness, problems with vision, speech, or balance;
• fever, sore throat;
• confusion, hallucinations, unusual thoughts or behavior;
• painful or difficult urination;
• seizure (convulsions); or
• jaundice (yellowing of the skin or eyes).

Common side effects of imipramine may include:

• increased blood pressure;
• tingly feeling, weakness, lack of coordination;
• dry mouth, nausea, vomiting; or
• breast swelling (in men or women).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA .

Warnings

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Before taking this medicine

You should not use imipramine if you are allergic to it, or if:

• you recently had a heart attack; or
• you are allergic to other antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, nortriptyline, protriptyline, or trimipramine).

Do not use imipramine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.

Tell your doctor if you have used an “SSRI” antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

Tell your doctor if you have ever had:

• heart disease, stroke, or seizures;
• bipolar disorder (manic-depression), schizophrenia or other mental illness;
• kidney or liver disease;
• overactive thyroid;
• narrow-angle glaucoma; or
• problems with urination.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

It is not known whether imipramine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breastfeed while using imipramine.

Do not give this medicine to a child without medical advice. Imipramine is not approved to treat depression in anyone younger than 18 years old. Imipramine should not be used to treat bed-wetting in a child younger than 6 years old.

How should I take imipramine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Tell your doctor if you have a planned surgery.

Call your doctor if your symptoms do not improve, or if they get worse.

You should not stop using imipramine suddenly. Follow your doctor’s instructions about tapering your dose.

Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of imipramine can be fatal.

Overdose symptoms may include irregular heartbeats, feeling like you might pass out, seizures, or coma.

What should I avoid while taking imipramine?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with imipramine.

Avoid driving or hazardous activity until you know how imipramine will affect you. Your reactions could be impaired.

Avoid exposure to sunlight or tanning beds. Imipramine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

What other drugs will affect imipramine?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking imipramine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

What is nortriptyline?

Nortriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may be unbalanced in people with depression.

Nortriptyline is used to treat symptoms of depression.

Nortriptyline is not recommended for use in children.

Warnings

You should not use nortriptyline if you recently had a heart attack.

Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine and others.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Before taking this medicine

You should not use nortriptyline if:

• you are allergic to it or similar medicines (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, protriptyline, trimipramine);
• you are allergic to certain seizure medications (carbamazepine, eslicarbazepine, oxcarbazepine, rufinamide); or
• you recently had a heart attack.

Do not use nortriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, tranylcypromine, and others.

Tell your doctor if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with nortriptyline could cause a serious condition called serotonin syndrome.

Tell your doctor if you have used an “SSRI” antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

To make sure nortriptyline is safe for you, tell your doctor if you have ever had:

• unexplained fainting spells;
• a genetic heart condition called Brugada syndrome;
• a family history of unexplained death at younger than 45 years old;
• heart disease;
• a heart attack or stroke;
• a seizure;
• bipolar disorder (manic-depression);
• schizophrenia or other mental illness;
• a thyroid disorder;
• problems with urination;
• narrow-angle glaucoma; or
• if you are receiving electroshock treatment.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Tell your doctor if you are pregnant or breastfeeding.

Nortriptyline is not approved for use by anyone younger than 18 years old.

How should I take nortriptyline?

Take nortriptyline exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

If you need surgery, tell your surgeon you currently use nortriptyline. You may need to stop for a short time.

You may have unpleasant withdrawal symptoms if you stop using nortriptyline suddenly. Ask your doctor how to safely stop using this medicine.

It may take a few weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Dosing information

Usual Adult Dose for Depression:

25 mg orally 3 to 4 times per day
-Maximum dose: 150 mg/day

Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.
-When doses above 100 mg per day are given, plasma levels should be monitored and maintained in the optimum range of 50 to 150 ng/mL.

Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression:

30 to 50 mg orally per day, in divided doses

Comments:
-The total daily dosage may be given once a day.
-Patients should be started at lower doses, and the doses should be gradually increased.

Use: Relief of symptoms of depression

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of nortriptyline can be fatal.

Overdose symptoms may include irregular heartbeats, severe drowsiness, vision problems, confusion, hallucinations, agitation, stiff muscles, overactive reflexes, vomiting, feeling hot or cold, feeling like you might pass out, seizures, or coma.

What to avoid

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how nortriptyline will affect you. Your reactions could be impaired.

Nortriptyline could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Nortriptyline side effects

Get emergency medical help if you have signs of an allergic reaction to nortriptyline: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• restless muscle movements in your eyes, tongue, jaw, or neck;
• a light-headed feeling, like you might pass out;
• seizure (convulsions);
• new or worsening chest pain, pounding heartbeats or fluttering in your chest;
• sudden numbness or weakness, problems with vision, speech, or balance;
• fever, sore throat, easy bruising, unusual bleeding;
• painful or difficult urination; or
• jaundice (yellowing of the skin or eyes).

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common nortriptyline side effects may include:

• increased blood pressure;
• numbness or tingling in your hands or feet;
• dry mouth, nausea, vomiting, loss of appetite;
• blurred vision;
• rash, itching; or
• breast swelling (in men or women).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA .

What other drugs will affect nortriptyline?

Using nortriptyline with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

• medicine to treat depression, anxiety, mood disorders, or mental illness;
• cold or allergy medicine (Benadryl, Sudafed, and others);
• a stimulant medicine, such as diet pills or ADHD medicine;
• medicine to treat Parkinson’s disease;
• medicine to treat stomach problems, motion sickness, or irritable bowel syndrome;
• medicine to treat overactive bladder; or
• bronchodilator asthma medication.

What is amitriptyline?

Amitriptyline is a tricyclic antidepressant used to treat symptoms of depression (FDA approved), and amitriptyline is used off-label for insomnia, migraine prevention, ADHD, eating disorders, bipolar disorder, anxiety, psychotic disorders, and some types of pain. Amitriptyline may work by increasing chemical messengers (neurotransmitters) serotonin and norepinephrine that communicate between brain cells and help regulate mood.

The first amitriptyline brand was Elavil, which was FDA-approved on April 7, 1961, and has since been discontinued. Other amitriptyline brand names include Vanatrip and Endep, which have also been discontinued. Amitriptyline is now available as a generic medication. Amitriptyline is from the drug class tricyclic antidepressants (TCA).

Amitriptyline is available in combination with chlordiazepoxide for the treatment of patients with moderate to severe depression associated with moderate to severe anxiety. Amitriptyline, in combination with perphenazine, is FDA-approved for types of severe anxiety and/or agitation.

Amitriptyline side effects

Common amitriptyline side effects

Common amitriptyline side effects may include dry mouth, vision changes, sleepiness (sedation), tiredness, appetite or weight changes, constipation, diarrhea, nausea, vomiting, upset stomach, mouth pain, unusual taste, black tongue, urinating less than usual, breast swelling (in men or women), lower sex drive, impotence, or difficulty having an orgasm.

Serious amitriptyline side effects

Allergic reactions: Get emergency medical help if you have signs of an allergic reaction to amitriptyline, including difficulty breathing, hives, or swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• signs of a blood clot – sudden numbness or weakness, problems with vision or speech, swelling or redness in an arm or leg;
• unusual thoughts or behavior;
• a light-headed feeling, like you might pass out;
• chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
• pounding heartbeats or fluttering in your chest;
• confusion, hallucinations;
• a seizure (convulsions);
• painful or difficult urination;
• severe constipation;
• easy bruising, unusual bleeding, or
• fever, chills, sore throat, mouth sores.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA .

Warnings

You should not use amitriptyline if you have recently had a heart attack.

Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

You may have thoughts about suicide when you first start taking an antidepressant such as amitriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Amitriptyline may trigger an angle closure glaucoma attack in a patient with anatomically narrow angles who does not have a patent iridectomy.

Before taking this medicine

You should not use this medicine if you are allergic to amitriptyline or any of the inactive ingredients or:

• if you have recently had a heart attack.

Do not use amitriptyline if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Tell your doctor if you have used an “SSRI” antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

To make sure amitriptyline is safe for you, tell your doctor if you have ever had:

• bipolar disorder (manic-depression) or schizophrenia;
• mental illness or psychosis;
• liver disease;
• heart disease;
• a heart attack, stroke, or seizures;
• diabetes (amitriptyline may raise or lower blood sugar);
• glaucoma; or
• problems with urination.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.