| Imipramine, Janimine, Tipramine, Tofranil
Imipramine is a tricyclic antidepressant that has a variety of effects on the lower urinary tract and is the tricyclic antidepressant most commonly used for urgency incontinence.
Imipramine has a variety of effects on the lower urinary tract and is the tricyclic antidepressant most commonly used for urgency incontinence. It increases the closure of the bladder neck and proximal urethra by stimulating alpha-receptors, suppresses bladder overactivity by a direct anticholinergic effect, and relaxes the dome of the bladder through beta-receptor stimulation. Because of this combination of effects, imipramine is perceived as an excellent choice for the treatment of mixed urinary incontinence, and it can be added to standard anticholinergics in the treatment of OAB. Imipramine is approved by the FDA only for treatment of enuresis in children. It has significant adverse effects, including typical anticholinergic effects, as well as cardiotoxicity and arrhythmogenicity, sedation, and orthostatic hypotension.
* Usual adult dose for bladder control: 12.5-25 mg PO qhs
* Elderly patients: 25 mg PO hs initially; may increase by 25-mg increments q3d until 75 mg achieved
* Half-life: 11-25 hours
abdominal pain, adynamic ileus, agranulocytosis, anorexia, anxiety, blurred vision, breast enlargement, confusion, constipation, cycloplegia, diarrhea, dizziness, drowsiness, EEG changes, ejaculation dysfunction, eosinophilia, erythema, fever, galactorrhea, gynecomastia, heart failure, hypertension, impotence, increased intraocular pressure, jaundice, leukopenia, libido decrease, mydriasis, myocardial infarction, nausea/vomiting, orgasm dysfunction, orthostatic hypotension, palpitations, parkinsonism, photosensitivity, PR prolongation, pruritus, purpura, QT prolongation, sedation, seizures, SIADH, stroke, testicular swelling, thrombocytopenia, tremor, urinary retention, urticaria, vasculitis, ventricular tachycardia, withdrawal, xerostomia,
Sedative herbs: Kava, Passionflower, Hops, Ashwagandha, Calendula, Catnip, LadyÕs Slipper, Lemon Balm, Sassafras, Skullcap, and Yerba mansa.
Sedative herbs may cause excess sedation when used with tricyclic antidepressants.
St JohnÕs Wort and Dong quai
St JohnÕs Wort and Dong quai may cause sensitivity to sunlight, adding to side effect of tricyclic antidepressants.
5-HTP increases levels of serotonin, which increases the risk of serotonin syndrome.
SAMe increases levels of serotonin, which increases the risk of serotonin syndrome.
St JohnÕs Wort
St JohnÕs Wort may increase levels of serotonin, which increases the risk of serotonin syndrome.
Grapefruit Juice slows breakdown of several drugs, including tricyclic clomipramine.
Tricyclic antidepressants may interfere with enzymes containing CoQ10.
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