lPATIENT AND CARER ADVICE
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. driving). Effects of
alcohol enhanced.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral suspension, oral solution
Capsule
CAUTIONARY AND ADVISORY LABELS 2
▶Doxepin (Non-proprietary)
Doxepin (as Doxepin hydrochloride) 25 mgDoxepin 25 mg capsules
| 28 capsuleP£ 97. 00 DT = £ 97. 00
Doxepin (as Doxepin hydrochloride) 50 mgDoxepin 50 mg capsules
| 28 capsuleP£ 154. 00 DT = £ 154. 00Imipramine hydrochloride
lINDICATIONS AND DOSE
Nocturnal enuresis
▶BY MOUTH
▶Child 6–7 years: 25 mg once daily, to be taken at
bedtime, initial period of treatment (including gradual
withdrawal) 3 months—full physical examination
before further course
▶Child 8–10 years: 25 – 50 mg once daily, to be taken at
bedtime, initial period of treatment (including gradual
withdrawal) 3 months—full physical examination
before further course
▶Child 11–17 years: 50 – 75 mg once daily, to be taken at
bedtime, initial period of treatment (including gradual
withdrawal) 3 months—full physical examination
before further course
Attention deficit hyperactivity disorder (under expert
supervision)
▶BY MOUTH
▶Child 6–17 years: 10 – 30 mg twice dailylUNLICENSED USENot licensed for use for attention deficit
hyperactivity disorder.
lCONTRA-INDICATIONSAcute porphyrias p. 603.
arrhythmia.during the manic phase of bipolar disorder.
heart block
lCAUTIONSCardiovascular disease.chronic constipation.
diabetes.epilepsy.history of bipolar disorder.history of
psychosis.hyperthyroidism (risk of arrhythmias).patients
with a significant risk of suicide.phaeochromocytoma
(risk of arrhythmias).susceptibility to angle-closure
glaucoma.urinary retention
CAUTIONS, FURTHER INFORMATIONTreatment should be
stopped if the patient enters a manic phase.
lINTERACTIONS→Appendix 1 : tricyclic antidepressants
lSIDE-EFFECTS
▶Common or very commonAnxiety.appetite decreased.
arrhythmias.asthenia.cardiac conduction disorders.
confusion.delirium.depression.dizziness.drowsiness.
epilepsy.hallucination.headache.hepatic disorders.
hypotension.mood altered.nausea.palpitations.
paraesthesia.sexual dysfunction.skin reactions.sleep
disorder.tremor.vomiting.weight changes
▶UncommonPsychosis
▶Rare or very rareAggression.agranulocytosis.alopecia.
bone marrow depression.enlarged mammary gland.
eosinophilia.fever.galactorrhoea.gastrointestinal
disorders.glaucoma.heart failure.leucopenia.
movement disorders.mydriasis.oedema.oral disorders.
peripheral vasospastic reaction.photosensitivity reaction.
respiratory disorders (frequency not known in neonate).
SIADH.speech disorder.thrombocytopenia▶Frequency not knownAnticholinergic syndrome.
cardiovascular effects.drug fever.hyponatraemia.
increased risk of fracture.neurological effects.paranoid
delusions exacerbated.psychiatric disorder.suicidal
tendencies.tinnitus.urinary disorder.withdrawal
symptoms
SIDE-EFFECTS, FURTHER INFORMATIONThe risk of side-
effect is reduced by titrating slowly to the minimum
effective dose (every 2 – 3 days).
OverdoseTricyclic and related antidepressants cause dry
mouth, coma of varying degree, hypotension,
hypothermia, hyperreflexia, extensor plantar responses,
convulsions, respiratory failure, cardiac conduction
defects, and arrhythmias. Dilated pupils and urinary
retention also occur. For details on the management of
poisoning see Tricyclic and related antidepressants under
Emergency treatment of poisoning p. 832.
lPREGNANCYColic, tachycardia, dyspnoea, irritability,
muscle spasms, respiratory depression and withdrawal
symptoms reported in neonates when used in the third
trimester.
lBREAST FEEDINGThe amount secreted into breast milk is
too small to be harmful.
lHEPATIC IMPAIRMENTSedative effects are increased in
hepatic impairment. Avoid in severe liver disease.
lRENAL IMPAIRMENTUse with caution in severe
impairment.
lTREATMENT CESSATIONWithdrawal effects may occur
within 5 days of stopping treatment with antidepressant
drugs; they are usually mild and self-limiting, but in some
cases may be severe. The risk of withdrawal symptoms is
increased if the antidepressant is stopped suddenly after
regular administration for 8 weeks or more. The dose
should preferably be reduced gradually over about 4 weeks,
or longer if withdrawal symptoms emerge ( 6 months in
patients who have been on long-term maintenance
treatment). If possible tricyclic antidepressants should be
withdrawn slowly.
lPRESCRIBING AND DISPENSING INFORMATIONLimited
quantities of tricyclic antidepressants should be prescribed
at any one time because their cardiovascular and
epileptogenic effects are dangerous in overdosage.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Imipramine
http://www.medicinesforchildren.org.uk/imipramine
Driving and skilled tasksDrowsiness may affect the
performance of skilled tasks (e.g. driving).
Effects of alcohol enhanced.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral solution
CAUTIONARY AND ADVISORY LABELS 2
▶Imipramine hydrochloride (Non-proprietary)
Imipramine hydrochloride 5 mg per 1 mlImipramine 25 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 42. 00 DT = £ 42. 00
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Imipramine hydrochloride (Non-proprietary)
Imipramine hydrochloride 10 mgImipramine 10 mg tablets|
28 tabletP£ 0. 81 DT = £ 0. 58
Imipramine hydrochloride 25 mgImipramine 25 mg tablets|
28 tabletP£ 0. 81 DT = £ 0. 61240 Mental health disorders BNFC 2018 – 2019
Nervous system4