Last update June 18, 2022

Imipramine-Hcl

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is a tricyclic antidepressant with actions and uses similar to those of amitriptyline. Imipramine is one of the least sedating tricyclics with moderate antimuscarinic activity.I Indicated in the treatment of depression, neuropathic pain and migraine prophylaxis. It is metabolized to nortriptyline (Weissmann 2004). Oral administration in one to three daily doses. .

It is excreted into breastmilk in a clinically non-significant amount. (Yoshida 1997, Ware 1990, Sovner 1979)

Plasma levels in the infant have been found very low. (Birnbaum 1999, Yoshida 1997)

No side effects have been observed in infants of mothers treated with imipramine. (Uguz 2016, Nulman 2002, Birnbaum 1999, Misri 1991)

Imipramine can produce galactorrhea with or without increased prolactin. (Mahasuar 2010, Nutt 1987, Cooper 1981, Klein 1964)

Expert authors consider the use of this medication safe during lactation. (LactMed, Hale, Uguz 2021, Schaefer 2015, Davanzo 2011, di Scalea 2009). Some authors consider other alternatives to be safer during the neonatal period and in case of prematurity. (Davanzo 2011)

Women suffering from depression during pregnancy need more breastfeeding support due to their increased risk of breastfeeding problems and early weaning. (Grzeskowiak 2018, Leggett 2017, Venkatesh 2017, Gorman 2012)


 


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Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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José María Paricio, founder of e-lactancia.

Other names

Imipramine-Hcl is also known as


Imipramine-Hcl in other languages or writings:

Tradenames

Main tradenames from several countries containing Imipramine-Hcl in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 29 - 77 %
Molecular weight 280 daltons
Protein Binding 60 - 95 %
VD 10 - 20 l/Kg
pKa 9.5 -
Tmax 1 - 2 hours
12. (desi: 22.5) hours
M/P ratio 0.5 - 1.5 -
Theoretical Dose 0.03 mg/Kg/d
Relative Dose 2.4 %
Ped.Relat.Dose 0.6 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  4. Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol. 2018 Jun;84(6):1373-1379. Abstract Full text (link to original source)
  5. Venkatesh KK, Castro VM, Perlis RH, Kaimal AJ. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017 Sep;37(9):1003-1009. Abstract
  6. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017 Nov;33(4):701-709. Abstract
  7. Uguz F, Aydin A, Ak M, Turgut K. Low-Dose Imipramine for the Treatment of Panic Disorder During Postpartum Period: A Retrospective Analysis of 6 Cases. J Clin Psychopharmacol. 2016 Jun;36(3):292-3. Abstract
  8. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015 Abstract
  9. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Abstract
  10. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  11. Mahasuar R, Majhi P, Ravan JR. Euprolactinemic galactorrhea associated with use of imipramine and escitalopram in a postmenopausal woman. Gen Hosp Psychiatry. 2010 May-Jun;32(3):341.e11-3. Abstract
  12. Acedo-Valenzuela MI, Mora-Díez N, Galeano-Díaz T, Silva-Rodríguez A. Determination of tricyclic antidepressants in human breast milk by capillary electrophoresis. Anal Sci. 2010 Abstract Full text (in our servers)
  13. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  14. Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Abstract Full text (link to original source) Full text (in our servers)
  15. Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002 Abstract
  16. Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics. 1999 Abstract Full text (link to original source)
  17. Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics and of possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. J Affect Disord. 1997 Abstract
  18. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991 Abstract
  19. Ware MR, DeVane CL. Imipramine treatment of panic disorder during pregnancy. J Clin Psychiatry. 1990 Nov;51(11):482-4. Abstract
  20. Nutt D, Middleton H, Franklin M. The neuroendocrine effects of oral imipramine. Psychoneuroendocrinology. 1987 Abstract
  21. Cooper DS, Gelenberg AJ, Wojcik JC, Saxe VC, Ridgway EC, Maloof F. The effect of amoxapine and imipramine on serum prolactin levels. Arch Intern Med. 1981 Abstract
  22. KLEIN JJ, SEGAL RL, WARNER RR. GALACTORRHEA DUE TO IMIPRAMINE. REPORT OF A CASE. N Engl J Med. 1964 Abstract

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