Patient/caregiver was educated on the side effects of using Imipramine as follows:

Serotonin syndrome

• Imipramine use, especially along with a few other antidepressants, such as, citalopram, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Individuals can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea.

Central nervous system side effects

• Imipramine can induce some dizziness and make one drowsy. Starting the medication at a low dose, watching for the response, and gradually changing the dose, to help optimum control of your symptoms, can contribute to controlling/reducing the risk for drowsiness and dizziness due to the medication. If the dizziness becomes bothersome, report it to your physician and other health care personnel, for any change in plan of care to be considered. Stay away from activities, such as, driving and operating heavy machinery, until you are used to the side effects caused by imipramine intake.
• Continue taking imipramine, as recommended, even if your mood feels better. Discontinuing the medication abruptly, without your physician’s recommendation, can result in disruption of chemical balance in the brain, resulting in worsening of mood disorder.  Individuals can present with severe withdrawal symptoms, such as, listlessness, lack of energy, exacerbation of depressive symptoms, anxiety, sleep disturbances, appetite changes, hallucinations, and mania.
• Imipramine use carries risk of deterioration of mood disorders and worsening of clinical symptoms of mood disorders. Individuals can present with complaints such as, feeling low, anxiety, panic attacks, trouble sleeping, gross appetite changes, impulsiveness, agitation, aggression, and suicidal thoughts.