Patient/caregiver was educated on contraindications for using Imipramine as follows:
- 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. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on imipramine, by observing a window period of atleast 2 weeks, before the transition to imipramine is made. Using imipramine with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome, which can contribute to nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations.
- Imipramine has significant anticholinergic activity (atropine-like) and so, must be avoided using along with any other medications that can have similar spectrum of activity. Many inhaler medications used in treating breathing disorders and medications used to manage Parkinson’s disease can contain atropine and thus, can potentiate the side-effects of imipramine intake. So, imipramine must be avoided/used with extreme caution in individuals with history of asthma, COPD, and Parkinson’s disease, to prevent extreme side-effects of paralytic ileus with bowel obstruction, constipation, and urinary retention from developing.
