Introduction
Depram is known as a tricyclic antidepressant. It is used to treat depression and bedwetting in children of age 6 years and above. It is also effective in treating depression that is unresponsive to other treatments.
Depram works by increasing the levels of chemical messengers in the brain that stabilizes and enhances the mood. It is better to take it before bedtime because it can make you feel drowsy. It can be taken with or without food, but you should take it at a fixed time each day for better efficacy. The dose and duration will be decided by your doctor so that you get the right amount to control your symptoms. If you have missed any dose, take it as soon as you remember it. Do not skip any dose and finish the full course of treatment even if you feel better. This medication must not be stopped suddenly without talking to the doctor. Your dose may be modified or gradually decreased before stopping the medication.
The most common side effects of this medicine include increased heart rate, blurred vision, dryness in the mouth, difficulty in urination and constipation. Initially, this medicine may also cause a sudden drop in blood pressure, especially when you change positions. It may even cause dizziness and sleepiness, do not drive or do anything that requires mental focus until you know how this medicine affects you. To lower the chances of dizziness, rise slowly if you have been sitting or lying down. It may also lead to weight gain in some people. Most of the common side effects tend to be mild and temporary. Your doctor may be able to suggest ways of preventing or reducing side effects if they bother you or do not go away. Serious side effects associated with this medicine are rare.
Before taking this medicine, it is important to tell your doctor if you are taking or have recently taken any other medicines for the same or any other diseases. Pregnant and breastfeeding women should take this medicine with proper consultation and caution. This medicine is not known to be addictive, but you can experience additional side effects (withdrawal symptoms) if you stop taking it suddenly. If you notice any sudden mood change or get suicidal or self-harm thoughts, you must consult the doctor without delay. Also, remember to take this medicine as advised by the doctor as an overdose of this medication may lead to a serious health emergency. Consumption of alcohol should be avoided as alcohol interacts with this medicine to cause serious health issues.
Side effects of Depram
Common
- Increased heart rate
- Blurred vision
- Dryness in mouth
- Difficulty in urination
- Constipation
- Orthostatic hypotension (sudden lowering of blood pressure on standing)
How to use Depram
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Depram may be taken with or without food, but it is better to take it at a fixed time.
How Depram works
Depram is a tricyclic antidepressant. It increases the levels of chemical messengers in the brain that help in regulating the mood and treat depression.
What if you forget to take Depram?
If you miss a dose of Depram, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Indication
Depression, Nocturnal enuresis
Administration
May be taken with or without food.
Adult Dose
Oral
Depression
Adult: Initially, 75 mg in divided doses, may gradually increase to 150-200 mg daily as necessary. Max: 300 mg/day. May give in divided doses or single dose HS
Maintenance dose: 50-100 mg PO qDay
Elderly: 10 mg daily, may gradually increase to 30-50 mg daily.
Hepatic impairment: Severe: Contraindicated.
Child Dose
Oral
Nocturnal enuresis
Child: 6-7 yr 20-25 kg: 25 mg;
8-11 yr 25-35 kg: 25-50 mg;
>11yr 35-54 kg: 50-75 mg.
Doses are given just before bedtime. Max treatment duration: 3 mth.
Contraindication
Any degree of heart block or cardiac arrhythmias, recent MI, porphyria, narrow-angle glaucoma, urine retention, mania. Severe hepatic impairment. Childn <6 yr. Concomitant use w/ MAOIs.
Mode of Action
Imipramine is believed to increase the synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibition of their reuptake by the presynaptic neuronal membrane. However, additional receptor effects have been found including desensitisation of adenyl cyclase, down regulation of β-adrenergic receptors, and down regulation of serotonin receptors.
Precaution
Imipramine should be used cautiously and with close physician supervision in people, especially the elderly, who have benign prostatic hypertrophy, urinary retention, and glaucoma, especially angle-closure glaucoma. The sedative effect is increased when imipramine is taken with other central nervous system depressants, such as alcoholic beverages, sleeping medications, other sedatives, or antihistamines. Imipramine may increase heart rate and stress on the heart. It may be dangerous for people with cardiovascular disease, especially those who have recently had a heart attack, to take this drug or other antidepressants in the same pharmacological class.
Older people and persons with a history of heart disease may develop heart arrhythmias, heart conduction abnormalities, congestive heart failure, heart attack, abnormally rapid heart rates and strokes. Until a therapeutic dosage has been determined, people starting imipramine should be closely watched for signs of suicide. The risk of suicide is increased when imipramine is taken in overdose or combined with alcohol. Manic episodes and the emergence of symptoms of pre-existing psychotic states have been reported when imipramine therapy is started.
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments
Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
Side Effect
Orthostatic hypotension, HTN, tachycardia, palpitation, MI, arrhythmias, heart block, ECG changes, precipitation of CHF, stroke; confusional states (esp in elderly) w/ hallucinations, disorientation, delusions; anxiety, restlessness, agitation, insomnia and nightmares, hypomania, exacerbation of psychosis; numbness, tingling, paraesthesias of extremities; incoordination, ataxia, tremors, peripheral neuropathy, extrapyramidal symptoms, seizures, altered EEG patterns, tinnitus; dry mouth; rarely, associated SL adenitis; blurred vision, accommodation disturbances, mydriasis, constipation, paralytic ileus, urinary retention, delayed micturition, dilated urinary tract; skin rash, petechiae, urticaria, itching, photosensitization, oedema, drug fever; bone marrow depression, agranulocytosis; eosinophilia, purpura, thrombocytopenia; nausea and vomiting, anorexia, epigastric distress, diarrhoea, peculiar taste, stomatitis, abdominal cramps, black tongue; gynaecomastia (male), breast enlargement and galactorrhea (female), increased/decreased libido, impotence, testicular swelling, increased/decreased blood sugar levels, inappropriate antidiuretic hormone secretion syndrome; jaundice, altered liver function, wt gain/loss, perspiration, flushing, urinary frequency, drowsiness, dizziness, weakness and fatigue, headache, parotid swelling, alopecia, proneness to falling.
Interaction
Increased plasma levels and effects with quinidine, cimetidine, SSRIs, propafenone, flecainide. Reduced plasma levels with barbiturates, phenytoin. May increase effects of anticholinergic drugs. Severe orthostatic hypotension with altretamine. Causes drowsiness and impaired performance in combination with alcohol.
Potentially Fatal: Severe hypertension with adrenaline, noradrenaline and methylphenidate. Reduces hypotensive effects of guanethidine, bethanidine, debrisoquine, bretylium, methyldopa and clonidine. Possible serotonin syndrome with MAOIs, separate admin by 3 wk.