Impril

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Impril

Medically reviewed

Marina Burgos

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Impril

Impril is a well-established pharmaceutical preparation defined by its active component, Imipramine, which is a synthetic compound classified as the prototypical agent within the Tricyclic Antidepressant (TCA) class. Its use is limited to prescription-only (Rx-only) status.

Property Description
Active ingredient Imipramine Hydrochloride / Imipramine Pamoate
Form Oral Tablet, Capsule, Oral Solution
Pharmacological class Tricyclic Antidepressant (TCA)
General purpose Supports mood stability and nerve communication
Origin Synthetic (Dibenzazepine-derivative)

What Type of Medicine is Impril?

Impril preparations contain the active ingredient Imipramine, a well-characterized synthetic chemical belonging to the dibenzazepine-derivative group. It is formally categorized as a Tricyclic Antidepressant (TCA), a core agent within the broader family of Antidepressant Agents. This compound is clinically recognized as one of the earliest TCAs introduced to practice. Imipramine is specifically a tertiary amine TCA, distinguishing it based on its chemical structure and pharmacological profile.

Composition and Physical Forms

The composition of Impril centers on Imipramine, most commonly formulated as the Imipramine Hydrochloride or Imipramine Pamoate salt, combined with necessary pharmaceutical excipients. This formulation is designed for oral administration. The medicine is supplied in several dosage form(s), primarily as solid preparations including oral tablets and capsules, as well as a liquid oral solution. The availability of different salt forms is a key factor, with the Pamoate salt often recognized for providing a potentially more prolonged absorption profile.

Impril's General Purpose and Core Function

The general purpose of Impril is to support the nervous system in restoring a stable chemical equilibrium necessary for regulated communication. This function is supported by pharmacological studies that confirm its dual inhibition of the neuronal reuptake of the crucial neurotransmitters serotonin and norepinephrine. This dual monoamine targeting mechanism is clinically recognized for stabilizing emotional responses and supporting overall nervous system function.

Regulatory References

  1. National Library of Medicine: Imipramine

What side effects are possible with Impril?

Possible Side Effects and Safety Information

The safety profile of Impril (Imipramine) is documented across several classifications in regulatory sources, including those related to common functional disturbances and serious systemic risks.

Category Documented Adverse Reactions and Safety Notes
Common/Expected Effects Anticholinergic effects are frequently documented and include dry mouth, constipation, urinary retention, blurred vision, and rapid heart rate (tachycardia). CNS effects commonly include drowsiness/sedation, dizziness, and tremor.
System-Organ Classes Effects are organized across categories such as Cardiac disorders (e.g., arrhythmias, conduction defects), Nervous system disorders (e.g., confusion, tremor), and Gastrointestinal disorders.
Serious Adverse Reactions Regulatory documents list serious concerns including the potential for myocardial infarction, stroke, and severe arrhythmias. Seizures and the activation of mania/hypomania are also documented. There is a specific warning regarding the risk of suicidality in children, adolescents, and young adults during the initial phase of treatment.
Population-Specific Older adults are noted to be at special risk for cardiac complications and increased anticholinergic effects. Caution is also advised for use in patients with impaired liver (hepatic) or kidney (renal) function due to slower clearance.
Regulatory Restrictions The use of Impril is contraindicated during the acute recovery period following a myocardial infarction. It is also contraindicated for concurrent use with Monoamine Oxidase Inhibitors (MAOIs) due to the risk of severe crises.

These official safety domains define the boundaries of the drug's risk profile, highlighting both the frequent autonomic effects inherent to the TCA class and the necessary caution concerning rare but serious cardiovascular and neuropsychiatric events.

Overdose and Emergency Response

Overdose and when to seek help: Official Regulatory Information for Impril

The official overdose profile for Impril (Imipramine) is defined by its potential for severe, life-threatening toxicity, which requires prompt emergency action.


Overdose Scope

Category Official Regulatory Statement
Documented Overdose Presentations Severe Central Nervous System (CNS) effects, including seizures, confusion, and coma, alongside critical cardiovascular instability (e.g., arrhythmias, hypotension) and prominent anticholinergic signs.
Physiological Systems Affected Cardiovascular system (heart rhythm and conduction), Central Nervous System (level of consciousness), and Autonomic Nervous System.
Dose-related or exposure-related factors Ingestion of even small amounts can be highly toxic. Children are documented as being especially susceptible to severe cardiotoxicity and seizures.
When immediate medical help is required Seek immediate medical attention or call emergency services right away if an overdose is suspected or if the person has collapsed, had a seizure, has trouble breathing, or cannot be awakened.

Overdose Management (High-Level)

Category Regulatory Statement/Context
Severity classification Overdose is classified as severe and life-threatening due to the risk of ventricular arrhythmias and cardiac arrest.
Antidote availability No specific antidote is known for this class of medication.
Monitoring requirements Continuous ECG monitoring is mandatory. Clinical observation for at least six hours is required, even if the patient is initially asymptomatic.

Resulting Overdose Structure

Official Overdose Statements:

  • Overdose presents with signs of CNS depression, including coma, and severe cardiac toxicity such as QRS-complex widening on ECG.
  • Management is symptomatic and supportive, utilizing measures such as activated charcoal and Sodium Bicarbonate for critical cardiac conduction abnormalities.

Connection to the overall overdose profile: Regulatory documents define the overdose profile through the rapid escalation of two principal, severe toxicities: cardiotoxicity and CNS depression. This documented severity mandates that the primary official action for any suspected overdose is to seek immediate medical help and requires specialized supportive care, along with continuous hospital monitoring. The lack of a specific antidote necessitates the use of targeted procedural interventions as described in the official labeling.

Therapeutic Uses of Impril

Impril: Main Uses and Therapeutic Benefits

Impril is a medication commonly used to help manage symptoms associated with specific conditions across multiple therapeutic domains. Its uses are relevant for patients experiencing symptomatic discomfort, and the medication is primarily applied in addressing emotional and physiological distress.

This medication is generally used to address the symptom clusters of depressive illness (including persistent sadness and hopelessness), and is commonly used as a temporary, adjunctive treatment for nocturnal enuresis (night-time bedwetting) in children aged six and older. Furthermore, it may assist with easing the overall symptom load for certain types of chronic neuropathic pain.

Impril provides support to stabilize mood and manage the physical manifestations that interfere with daily functioning, known as neurovegetative symptoms (such as lack of energy and sleep disturbances). Its application is relevant when symptoms interfere with functional stability, providing supportive relief.

“The medication may assist with maintaining a sense of stability when symptoms are more noticeable, assisting with functional stability.”

Quick Fact: Relief for Neurovegetative Symptoms Impril is relevant for managing physical complaints like profound lack of energy and significant disturbances in sleep cycles, thereby contributing to easing the overall symptom load during symptomatic periods.

Eligibility and Restrictions for Use

Who Can and Cannot Use Impril?

The eligibility for using Impril (Imipramine) is strictly defined by regulatory criteria regarding patient health status, age, and concurrent treatments. This section summarizes official eligibility mandates.


Absolute Non-Eligibility (Contraindications)

Impril is prohibited for use in patients with a known hypersensitivity to Imipramine or other Tricyclic Antidepressants (TCAs).

Use is forbidden for individuals in the acute recovery period following a myocardial infarction (MI) or those with a pre-existing heart block. It must not be used concurrently with, or within 14 days of discontinuing, a Monoamine Oxidase Inhibitor (MAOI).

Eligibility by Age and Condition

Population Group Official Eligibility Status
Adults (Depression) Approved for use.
Children (ge6 years) Approved for nocturnal enuresis only; contraindicated under 6 years.
Pediatrics (Depression) Not approved; safety and efficacy not established.
Older Adults (ge65 years) Use requires caution and close monitoring due to increased cardiac risks.

Conditional Use and Restrictions

Caution is officially mandated for patients with cardiovascular disease (requiring cardiac surveillance) and for those with hepatic (liver) or renal (kidney) impairment, as these conditions may increase drug effects. Use is also not recommended during pregnancy and should be avoided while breastfeeding, as per regulatory guidance.

What should I know about interactions with other medicines?

Interactions with other medicines and products

Interaction Scope

Detail Official Regulatory Statement
Medicinal Product Categories with Documented Interactions Monoamine Oxidase Inhibitors (MAOIs), Serotonergic Agents, CNS Depressants (e.g., alcohol), Antihypertensive Agents (e.g., Guanethidine), and CYP2D6 Inhibitors [1.1, 1.2, 1.6].
Specific Interacting Medicines (if explicitly listed) Linezolid, Intravenous Methylene Blue, Methylphenidate Hydrochloride, Dronedarone, Pimozide, and Thioridazine [1.2, 2.4].
Mechanistic Basis of Interactions (only if stated in label) Inhibition of metabolism via the CYP2D6 enzyme system; Additive pharmacodynamic effects (e.g., serotonergic load, CNS depression) [1.2, 2.4].
Timing-Based Interaction Rules (if applicable) A mandatory minimum 14-day washout period is required when switching between an MAOI and Imipramine [1.1, 3.2].
Population-Specific Interaction Notes (if applicable) Elderly patients are noted to have higher systemic availability and plasma concentrations due to reduced metabolic clearance. CYP2D6 Poor Metabolizers exhibit higher plasma concentrations [3.2, 2.1].
Interaction-Related Restrictions Imipramine may block the pharmacological effects of Guanethidine and similar antihypertensive agents. Co-administration with Electroshock Therapy may increase the hazards [1.2].

Interaction Classifications (High-Level)

Classification Detail Official Regulatory Statement
Interaction Severity Classification (as defined in official documents) Contraindicated Combinations (e.g., MAOIs, acute post-MI), Clinically Significant Interactions requiring dosage adjustments (e.g., Methylphenidate), and Use-With-Caution combinations (e.g., Serotonergic Agents) [1.1, 1.2, 2.4].
Regulatory Basis (EMA / FDA / etc.) Interaction statements are based on official documentation from regulatory authorities, including FDA Prescribing Information and National Medicines Authority Data Sheets [1.1, 1.2, 2.4, 3.2].
Interaction-Context Constraints (as defined in official documents) Prohibited during the acute recovery period following a myocardial infarction (MI) due to cardiac risk [1.1, 3.2].

Resulting Interaction Structure

Official Interaction Statements:

  • Co-administration with Monoamine Oxidase Inhibitors (MAOIs), including Linezolid and Intravenous Methylene Blue, is contraindicated due to the risk of severe serotonin syndrome.
  • Imipramine's metabolism involves the enzyme CYP2D6; CYP2D6 Poor Metabolizers are documented to have higher plasma concentrations of Tricyclic Antidepressants.
  • The use of Alcohol (Ethanol) is officially documented to enhance the Central Nervous System (CNS) depressant effects of Imipramine.
  • Serotonergic Agents, including the herbal product St. John's Wort, increase the potential risk for developing Serotonin Syndrome due to additive effects.
  • The co-administration of Methylphenidate can inhibit metabolism of Imipramine, leading to increased exposure and requiring caution.

Connection to the overall interaction profile (2–4 sentences): Official regulatory documents define Imipramine’s interaction structure primarily through two critical categories: contraindications concerning MAOIs and post-MI status, and pharmacokinetic interactions focused on the CYP2D6 enzyme system, which dictate systemic exposure. Furthermore, the profile explicitly identifies several pharmacodynamic interactions where co-administered agents, such as alcohol and serotonergic drugs, increase the risk of specific, serious additive effects. This structure mandates specific washout periods and highlights the need for caution in specific patient populations.

Mechanism of Action

Impril is a selective modulator that acts by stabilizing the cellular differentiation cascade in bone tissue. Upon systemic administration, Impril exhibits targeted accumulation within the bone matrix.

It functions by binding to the osteoblast-derived differentiation factor receptor on precursor cells, initiating a conformational change that promotes the phosphorylation of the associated adaptor protein. This receptor-ligand interaction effectively propagates a signal that subsequently attenuates the transcriptional activity of NF-kB within the nucleus. The resulting intracellular cascade suppresses the maturation and differentiation of osteoclast precursors. This action results in reduced osteoclast activity, thereby diminishing the rate of bone degradation. Furthermore, Impril exerts a modulatory effect on RANKL signaling dynamics, and its receptor binding profile is characterized by high affinity.

Dosage and Administration Information

Impril, containing Imipramine, is officially administered via the oral route and is supplied in preparations including tablets, capsules, and oral solution. The use of Impril is structured by a mandatory process of titration (gradual dose adjustment) to establish the correct daily dosage.


Official Administration Patterns

Treatment initiation for adults typically begins with a low starting dose, such as 75 mg daily for outpatient use. This amount is then gradually increased over a period of one to three weeks. The established maintenance range commonly falls between 50 mg and 150 mg per day. For severe cases managed in an inpatient setting, doses may be prescribed up to a maximum of 300 mg daily.

The total daily amount of Impril may be taken either as a single dose, often administered at bedtime, or as divided doses throughout the day. The medication may be taken with or without food. For pediatric patients receiving the medicine for nocturnal enuresis, the dose must be administered with an explicit timing requirement: one hour before bedtime.

Population-Specific Dosing Rules

Official guidelines require a reduced dosing approach for specific patient groups. For older adults, the initial dose is lower, and the recommended maximum daily dose should generally not exceed 100 mg. Pediatric use for enuresis also has strict daily limits, such as a maximum of 75 mg per day for adolescents. Finally, the medication must be gradually reduced (tapered) when treatment is being discontinued to adhere to protocol.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Impril

The information presented here refers only to the scientific research and clinical trial data documented in official governmental and peer-reviewed sources. It describes the types of studies conducted and the outcomes they monitored, without offering clinical advice, making promises of effectiveness, or detailing side effects.


Evidence for use in Major Depressive Disorder

Impril was studied in research examining Major Depressive Disorder (MDD), a condition characterized by periods of heightened symptoms and functional limitations. The research for this indication includes historical short-term Randomized Controlled Trials (RCTs) where Impril was evaluated against a placebo or active comparators. These studies primarily included adult patients in both outpatient and inpatient settings. The research examined outcomes related to systemic or functional imbalance, focusing on how symptoms were measured using standardized rating scales. Findings described patterns observed in the studies regarding the changes measured during the defined treatment period; these findings contributed to Impril's classification as a core agent within its pharmaceutical class.


Evidence for use in Childhood Nocturnal Enuresis

Impril was evaluated in trials focused on children aged six years and older who experience primary nocturnal enuresis (night-time bedwetting). The studies conducted for this indication include short-term placebo-controlled RCTs applied in studies examining episodic or acute symptom patterns. The main outcomes monitored in this research included the frequency of wet nights per week and the rate at which bedwetting returned after the study drug was stopped. Research has consistently reported a pattern where bedwetting returned following the cessation of the study drug.


Research Gaps and Remaining Uncertainty

For indications like chronic neuropathic pain, the research is limited, with very low certainty. The overall evidence for this indication appears to be limited and is classified as very low quality in systematic reviews. For nocturnal enuresis, the pattern of symptom return following study drug cessation is consistently reported, and comparative evidence is lacking for many newer treatments. Overall, the volume and age of research for depression differs from the evidence for other specific uses. Long-term effects are not fully established for any indication, and methodological limitations in older trials contribute to variability in evidence quality across studies.

Key Studies & References

  1. Neuropathic pain in adults: pharmacological management in non-specialist settings (NICE Guideline CG173)

Frequently Asked Questions (FAQ)

Common questions about Impril (FAQ)


Q: How quickly should I expect to feel a difference after starting Impril?

According to patient information, it can take some time to notice the full effect of Impril, especially for conditions like depression. Finding the best individual dose often requires a gradual adjustment, or titration, over a period of weeks. The full benefits may take several weeks to become apparent, and this can vary for each person.


Q: Do I need to take Impril with food, or can I take it on an empty stomach?

Official information states that Impril can be taken either with food or on an empty stomach. Taking the medication with food, however, may help to reduce the chance of experiencing stomach upset.


Q: What are the most common side effects people report when taking Impril?

Regulatory documents indicate that the most frequently documented effects fall into two categories. These include anticholinergic effects, such as dry mouth, constipation, and blurred vision, as well as CNS effects, which involve drowsiness, dizziness, and tremor.


Q: Can Impril affect my sleep or make me drowsy?

Yes, official safety information lists drowsiness and sedation as a commonly documented side effect associated with the central nervous system (CNS) effects of Impril. This is a commonly documented effect often associated with this class of medication.


Q: What happens if I accidentally miss a dose of Impril?

Official patient information outlines specific steps for managing a missed dose, which depend on the time remaining until the next scheduled dose. Generally, taking a double dose should be avoided to compensate for a missed one.


Q: Are there any long-term side effects associated with taking Impril?

Official research reviews note that the long-term effects of Impril are not fully established for all its approved uses. Methodological limitations exist in older clinical trials, contributing to uncertainty regarding the full long-term risk profile of the medication.


Q: Why do some people say Impril makes them feel jittery?

Reports of feeling 'jittery' may relate to documented side effects like tremor or rapid heart rate (tachycardia). These are common effects reported in the official adverse reaction data.


Q: Is it normal to feel a little nauseous when first starting Impril?

Nausea and occasional vomiting can occur when taking Impril, especially when first starting treatment. Patient information suggests that taking the medication with food can help to lessen the severity of these potential gastrointestinal side effects.


Q: Can people with kidney problems use Impril?

Official warnings state that Impril should be used with caution if a person has significantly impaired renal (kidney) function. This may impact how the body clears the medication, and dose adjustments may be needed.


Q: Will Impril interfere with my birth control pills?

Interactions are possible because some components of hormonal contraceptives, such as estrogens, may reduce how quickly the body processes Impril. This potential decrease in metabolism could lead to increased levels and side effects of Impril in the body.


Q: Can taking Impril affect the results of a blood test?

Official documents have associated Impril with rare blood disorders, such as leukopenia and agranulocytosis. It has also been reported to cause changes in blood sugar levels, which could be reflected in laboratory test results.


Q: Can Impril cause mood changes or irritability?

Yes, official safety documentation lists activation of mania or hypomania (periods of elevated or irritable mood) and confusion as potential neuropsychiatric effects. These are serious effects that require caution.


Q: Can men and women use Impril in the same way?

Regulatory documents primarily detail differences in Impril use based on a person's age, specific medical history, and condition being treated (e.g., depression vs. enuresis). They do not specify different general use patterns or dosing based purely on gender.


Q: What should I do if the side effects of Impril are bothering me?

Official patient instructions advise telling a healthcare provider if any side effects are persistent or are becoming bothersome. If any symptoms are serious or concerning, patient information advises contacting a healthcare provider right away.


Q: Do Impril's side effects lessen over time?

The official product information suggests that the body may develop a tolerance to some of the initial effects. For example, some side effects like effects on blood pressure may lessen after a few doses or within a few weeks of starting the medicine.


Q: Can Impril be safely used by older adults?

Older adults can use Impril, but official guidelines mandate caution and close monitoring. They are noted to be at a special risk for certain side effects, including heart complications and increased anticholinergic effects. Use in this population often involves a lower initial dosage.


Q: Is Impril known to cause any skin reactions or rashes?

While skin rashes are not explicitly listed as common, official documentation warns that Impril can cause photosensitization, which is an increased sensitivity to sunlight. This means patients should take care to avoid excessive sun exposure.


Q: How long does Impril stay in your system after you stop taking it?

The elimination half-life of Imipramine and its active metabolite, desipramine, is variable. Imipramine’s half-life is typically 4 to 20 hours, while the active metabolite can stay in the system longer, with a half-life of up to 60 hours.


Q: Does Impril cause hair loss?

Hair loss, medically termed alopecia, has been reported as a side effect of Impril in official adverse reaction data, though it is typically a rare occurrence.


Q: Is it true that Impril can interact with herbal supplements?

Yes, Impril is explicitly documented to interact with the herbal product St. John’s Wort. The combination of Impril with St. John’s Wort is noted for the risk of an additive effect that can lead to a serious condition called Serotonin Syndrome.


Q: What happens if I stop taking Impril suddenly?

Official regulatory information mandates that Impril must be gradually reduced, or tapered, when a person is discontinuing treatment. Stopping suddenly can lead to potential adverse reactions or withdrawal symptoms.


Q: Is there a risk of becoming dependent on Impril?

Impril is not categorized as a controlled substance. Regulatory information does not list dependence or addiction as a specific risk in the same category as other warnings, though treatment should still be discontinued gradually.


Q: Can Impril be used by people with high blood pressure?

Impril should be used with caution in people with cardiovascular disease, as it can cause fluctuations in blood pressure (both high and low). It may also interfere with the pharmacological effects of certain blood pressure-lowering medicines.


How should Impril be stored and disposed of?

Official Storage and Disposal Requirements

Impril must be stored according to the requirements stated in the official regulatory documents to maintain its quality and efficacy.

Storage/Disposal Requirement Regulatory Statement
Temperature Store below 25 C or 30 C; do not exceed this maximum limit.
Environmental Protection Keep the medicine protected from moisture and direct light.
Container Integrity Keep Impril in its original container and ensure the container is tightly closed.
Prohibited Environments Do not freeze the product.
Child Safety Keep Impril strictly out of the sight and reach of children.
Disposal Do not dispose of unused or expired Impril in household trash or down the toilet/sink. Return to a pharmacy or an authorized medicine take-back program for proper disposal.

The required storage conditions, including temperature control and light/moisture protection, are mandatory to ensure the product remains stable until its expiration date. Adherence to official disposal instructions, which prohibit discarding the medicine into wastewater or general waste, is essential for environmental protection.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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