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DRUGS & SUPPLEMENTS
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Antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Imipramine pamoate or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Imipramine pamoate is not approved for use in pediatric patients (see WARNINGS: Inactive Ingredients. corn starch, FD and C blue 1, FD and C red 40, FD and C yellow 6, D and C yellow 10 (in 100 mg and 125 mg capsules), gelatin, magnesium stearate, sodium lauryl sulphate, talc and titanium dioxide. Imipramine Pamoate Starting Imipramine pamoate in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome (see The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 1. 18 to 24 5 additional cases ≥65 6 fewer cases It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to healthcare providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for Imipramine pamoate should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose. Extreme caution should be used when this drug is given to patients with cardiovascular disease because of the possibility of conduction defects, arrhythmias, congestive heart failure, myocardial infarction, strokes, and tachycardia. These patients require cardiac surveillance at all dosage levels of the drug; patients with increased intraocular pressure, history of urinary retention, or history of narrow-angle glaucoma because of the drug's anticholinergic properties; hyperthyroid patients or those on thyroid medication because of the possibility of cardiovascular toxicity; patients with a history of seizure disorder because this drug has been shown to lower the seizure threshold; patients receiving guanethidine, clonidine, or similar agents, since Imipramine pamoate may block the pharmacologic effects of these drugs; patients receiving methylphenidate hydrochloride. Since methylphenidate hydrochloride may inhibit the metabolism of Imipramine pamoate, downward dosage adjustment of Imipramine pamoate may be required when given concomitantly with methylphenidate hydrochloride. Since Imipramine pamoate may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned accordingly. Imipramine pamoate may enhance the CNS depressant effects of alcohol. Therefore, it should be borne in mind that the dangers inherent in a suicide attempt or accidental overdosage with the drug may be increased for the patient who uses excessive amounts of alcohol (see Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular changes (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Patients should be monitored for the emergence of serotonin syndrome. The concomitant use of Imipramine pamoate with MAOIs intended to treat psychiatric disorders is contraindicated. Imipramine pamoate should also not be started in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. All reports with methylene blue that provided information on the route of administration involved intravenous administration in the dose range of 1 mg/kg to 8 mg/kg. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection) or at lower doses. There may be circumstances when it is necessary to initiate treatment with an MAOI such as linezolid or intravenous methylene blue in a patient taking Imipramine pamoate. Imipramine pamoate should be discontinued before initiating treatment with the MAOI (see If concomitant use of Imipramine pamoate with other serotonergic drugs, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John's Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases. Treatment with Imipramine pamoate and any concomitant serotonergic agents should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated. Hypomanic or manic episodes may occur, particularly in patients with cyclic disorders. Such reactions may necessitate discontinuation of the drug. If needed, Imipramine pamoate may be resumed in lower dosage when these episodes are relieved. Administration of a tranquilizer may be useful in controlling such episodes. An activation of the psychosis may occasionally be observed in schizophrenic patients and may require reduction of dosage and the addition of a phenothiazine. Concurrent administration of Imipramine pamoate with electroshock therapy may increase the hazards: such treatment should be limited to those patients for whom it is essential, since there is limited clinical experience. Patients taking Imipramine pamoate should avoid excessive exposure to sunlight since there have been reports of photosensitization. Both elevation and lowering of blood sugar levels have been reported with Imipramine pamoate use. Imipramine pamoate should be used with caution in patients with significantly impaired renal or hepatic function. Patients who develop a fever and a sore throat during therapy with Imipramine pamoate should have leukocyte and differential blood counts performed. Imipramine pamoate should be discontinued if there is evidence of pathological neutrophil depression. Prior to elective surgery, Imipramine pamoate should be discontinued for as long as the clinical situation will allow. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Imipramine pamoate. Patients should be advised that taking Imipramine pamoate can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle-closure glaucoma. Preexisting glaucoma is almost always open-angle glaucoma because angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy. Open-angle glaucoma is not a risk factor for angle-closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible. In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition. The extent to which SSRI-TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved. Nevertheless, caution is indicated in the co-administration of TCAs with any of the SSRIs and also in switching from one class to the other. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary). Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required. It is desirable to monitor TCA plasma levels whenever a TCA is going to be co-administered with another drug known to be an inhibitor of P450 2D6. The plasma concentration of Imipramine may increase when the drug is given concomitantly with hepatic enzyme inhibitors (e.g., cimetidine, fluoxetine) and decrease by concomitant administration with hepatic enzyme inducers (e.g., barbiturates, phenytoin), and adjustment of the dosage of Imipramine may therefore be necessary. In occasional susceptible patients or in those receiving anticholinergic drugs (including antiparkinsonism agents) in addition, the atropine-like effects may become more pronounced (e.g., paralytic ileus). Close supervision and careful adjustment of dosage is required when Imipramine pamoate is administered concomitantly with anticholinergic drugs. Avoid the use of preparations, such as decongestants and local anesthetics, that contain any sympathomimetic amine (e.g., epinephrine, norepinephrine), since it has been reported that tricyclic antidepressants can potentiate the effects of catecholamines. Caution should be exercised when Imipramine pamoate is used with agents that lower blood pressure. Imipramine pamoate may potentiate the effects of CNS depressant drugs. Patients should be warned that Imipramine pamoate may enhance the CNS depressant effects of alcohol (see There have been no well-controlled studies conducted with pregnant women to determine the effect of Imipramine on the fetus. However, there have been clinical reports of congenital malformations associated with the use of the drug. Although a causal relationship between these effects and the drug could not be established, the possibility of fetal risk from the maternal ingestion of Imipramine cannot be excluded. Therefore, Imipramine should be used in women who are or might become pregnant only if the clinical condition clearly justifies potential risk to the fetus. Safety and effectiveness in the pediatric population have not been established . It is generally recommended that Imipramine pamoate should not be used in children because of the increased potential for acute overdosage due to the high unit potency (75 mg, 100 mg, 125 mg, and 150 mg). Each capsule contains Imipramine pamoate equivalent to 75 mg, 100 mg, 125 mg, or 150 mg Imipramine hydrochloride. Anyone considering the use of Imipramine pamoate in a child or adolescent must balance the potential risks with the clinical need. Clinical studies of Tofranil™, brand of Imipramine hydrochloride tablets, in the original application did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Post-marketing clinical experience has not identified differences in responses between the elderly and younger subjects. In general, dose selection for the elderly should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. (see also DOSAGE AND ADMINISTRATION, (see also PRECAUTIONS, Cardiovascular: Orthostatic hypotension, hypertension, tachycardia, palpitation, myocardial infarction, arrhythmias, heart block, ECG changes, precipitation of congestive heart failure, stroke. Eye disorders Angle-closure glaucoma Children have been reported to be more sensitive than adults to an acute overdosage of Imipramine pamoate. An acute overdose of any amount in infants or young children, especially, must be considered serious and potentially fatal. Other CNS manifestations may include drowsiness, stupor, ataxia, restlessness, agitation, hyperactive reflexes, muscle rigidity, athetoid and choreiform movements. Cardiac abnormalities may include tachycardia, and signs of congestive failure. Respiratory depression, cyanosis, shock, vomiting, hyperpyrexia, mydriasis, and diaphoresis may also be present. Dysrhythmias unresponsive to sodium bicarbonate therapy/hyperventilation may respond to lidocaine, bretylium, or phenytoin. Type 1A and 1C antiarrhythmics are generally contraindicated. In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity. However, hemodialysis, peritoneal dialysis, exchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic poisoning. Therapy should be initiated at 75 mg/day. Dosage may be increased to 150 mg/day which is the dose level at which optimum response is usually obtained. If necessary, dosage may be increased to 200 mg/day. Dosage higher than 75 mg/day may also be administered on a once-a-day basis after the optimum dosage and tolerance have been determined. The daily dosage may be given at bedtime. In some patients it may be necessary to employ a divided-dose schedule. As with all tricyclics, the antidepressant effect of Imipramine may not be evident for one to three weeks in some patients. Hospitalized Patients Therapy should be initiated at 100 to 150 mg/day and may be increased to 200 mg/day. If there is no response after two weeks, dosage should be increased to 250 to 300 mg/day. Dosage higher than 150 mg/day may also be administered on a once-a-day basis after the optimum dosage and tolerance have been determined. The daily dosage may be given at bedtime. In some patients it may be necessary to employ a divided-dose schedule. As with all tricyclics, the antidepressant effect of Imipramine may not be evident for one to three weeks in some patients. The usual maintenance dosage is 75 to 150 mg/day. The total daily dosage can be administered on a once-a-day basis, preferably at bedtime. In some patients it may be necessary to employ a divided-dose schedule. In cases of relapse due to premature withdrawal of the drug, the effective dosage of Imipramine should be reinstituted. Adolescent and Geriatric Patients Therapy in these age groups should be initiated with Tofranil™, brand of Imipramine hydrochloride tablets, at a total daily dosage of 25 to 50 mg, since Imipramine pamoate capsules are not available in these strengths. Dosage may be increased according to response and tolerance, but it is generally unnecessary to exceed 100 mg/day in these patients. Imipramine pamoate capsules may be used when total daily dosage is established at 75 mg or higher. The total daily dosage can be administered on a once-a-day basis, preferably at bedtime. In some patients it may be necessary to employ a divided-dose schedule. As with all tricyclics, the antidepressant effect of Imipramine may not be evident for one to three weeks in some patients. Adolescent and geriatric patients can usually be maintained at lower dosage. Following remission, maintenance medication may be required for a longer period of time at the lowest dose that will maintain remission after which the dosage should gradually be decreased. The total daily maintenance dosage can be administered on a once-a-day basis, preferably at bedtime. In some patients it may be necessary to employ a divided-dose schedule. In cases of relapse due to premature withdrawal of the drug, the effective dosage of Imipramine should be reinstituted. In some cases, a patient already receiving Imipramine pamoate therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Imipramine pamoate should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for two weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Imipramine pamoate may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue (see The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Imipramine pamoate is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use (see They are supplied as follows: NDC 68180-314-06 Bottles of 30's NDC 68180-314-01 Bottles of 100's Imipramine Pamoate Capsules 100 mg are size "1" capsule with brown cap and dark yellow body, imprinted with "LU" in black ink on cap and "U02" in black ink on body, containing pale yellow to yellow granular powder. They are supplied as follows: NDC 68180-315-06 Bottles of 30's NDC 68180-315-01 Bottles of 100's Imipramine Pamoate Capsules 125 mg are size "1" capsule with brown cap and light yellow body, imprinted with "LU" in black ink on cap and "U03" in black ink on body, containing pale yellow to yellow granular powder. They are supplied as follows: NDC 68180-316-06 Bottles of 30's NDC 68180-316-01 Bottles of 100's Imipramine Pamoate Capsules 150 mg are size "0" capsule with brown cap and brown body, imprinted with "LU" in black ink on cap and "U04" in black ink on body, containing pale yellow to yellow granular powder. They are supplied as follows: NDC 68180-317-06 Bottles of 30's NDC 68180-317-01 Bottles of 100's Store at 20°C to 25°C (68° to 77°F). Dispense in tight container (USP) with a child-resistant closure. Mouse 2185 mg/kg Rat 1142 mg/kg (M) 1807 mg/kg Rabbit 1016 mg/kg Dog 693 mg/kg (Emesis ED50) B. Subacute: Two three-month studies in dogs gave evidence of an adverse drug effect on the testes, but only at the highest dose level employed, i.e., 90 mg/kg (10 times the maximum human dose). Depending on the histological section of the testes examined, the findings consisted of a range of degenerative changes up to and including complete atrophy of the seminiferous tubules, with spermatogenesis usually arrested. Human studies show no definitive effect on sperm count, sperm motility, sperm morphology or volume of ejaculate. Rat One three-month study was done in rats at dosage levels comparable to those of the dog studies. No adverse drug effect on the testes was noted in this study, as confirmed by histological examination. C. Reproduction/Teratogenic: Oral: Imipramine pamoate was fed to male and female albino rats for 28 weeks through two breeding cycles at dose levels of 15 mg/kg/day and 40 mg/kg/day (equivalent to 2 1/2 and 7 times the maximum human dose). No abnormalities which could be related to drug administration were noted in gross inspection. Autopsies performed on pups from the second breeding likewise revealed no pathological changes in organs or tissues; however, a decrease in mean litter size from both matings was noted in the drug-treated groups and significant growth suppression occurred in the nursing pups of both sexes in the high group as well as in the females of the low-level group. Finally, the lactation index (pups weaned divided by number left to nurse) was significantly lower in the second litter of the high-level group. * The brands listed are trademarks of their respective owners and are not trademarks of Lupin Pharmaceuticals, Inc. The makers of these brands are not affiliated with and do not endorse Lupin Pharmaceuticals, Inc. or its products. Lupin Pharmaceuticals, Inc. Baltimore, Maryland 21202 United States MADE IN INDIA Revised: April 20, 2015 ID#: 241149 Imipramine Pamoate (ih-MIH-pra-meen pam-OH-ate) Capsules Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions Rx only Read the Medication Guide that comes with you or your family member's antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member's, healthcare provider about: - eye pain - changes in vision - swelling or redness in or around the eye Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are. Do not take Imipramine pamoate capsules if you: - take a monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid. You may also report side effects to Lupin Pharmaceuticals, Inc. AT 1-800-399-2561 This Medication Guide has been approved by the U.S. Food and Drug Administration. * The brands listed are trademarks of their respective owners and are not trademarks of Lupin Pharmaceuticals, Inc. The makers of these brands are not affiliated with and do not endorse Lupin Pharmaceuticals, Inc. or its products. Lupin Pharmaceuticals, Inc. Baltimore, Maryland 21202 United States MADE IN INDIA Revised: April 20, 2015 ID#: 241310 75 mg - Bottle of 30s NDC 68180-314-06 bottles of 30 100 mg - Bottle of 30s NDC 68180-315-06 bottles of 30 125 mg - Bottle of 30s NDC 68180-316-06 bottles of 30 150 mg - Bottle of 30s NDC 68180-317-06 bottles of 30
DESCRIPTION
CLINICAL PHARMACOLOGY
INDICATIONS AND USAGE
CONTRAINDICATIONS
Monoamine Oxidase Inhibitors
Myocardial Infarction
Hypersensitivity to Tricyclic Antidepressants
WARNINGS
Clinical Worsening and Suicide Risk
Age Range Drug - Placebo Difference in Number of Cases of Suicidality per 1000 Patients Treated Increases Compared to Placebo <18 14 additional cases Decreases Compared to Placebo 25 to 64 1 fewer case Screening Patients for Bipolar Disorder
Serotonin Syndrome
Angle-Closure Glaucoma
PRECAUTIONS
General
Information for Patients
Clinical Worsening and Suicide Risk
Drug Interactions
Monoamine Oxidase Inhibitors
Serotonergic Drugs
Pregnancy
Nursing Mothers
SPL UNCLASSIFIED SECTION
Geriatric Use
ADVERSE REACTIONS
Psychiatric
Neurological
Anticholinergic
Allergic
Hematologic
Gastrointestinal
Endocrine
Other
Withdrawal Symptoms
Postmarketing Experience
OVERDOSAGE
Manifestations
Management
DOSAGE AND ADMINISTRATION
Initial Adult Dosage
Adult Maintenance Dosage
Switching a Patient to or from a Monoamine Oxidase Inhibitor Intended to Treat Psychiatric Disorders
Use of Imipramine Pamoate with Other MAOIs, such as Linezolid or Methylene Blue
HOW SUPPLIED
ANIMAL PHARMACOLOGY AND TOXICOLOGY
SPL UNCLASSIFIED SECTION
SPL UNCLASSIFIED SECTION
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL
Imipramine pharmaceutical active ingredients containing related brand and generic drugs:
Imipramine available forms, composition, doses:
Price Apo-Imipramine 10 mg Tablet 0.14 USD Apo-Imipramine 25 mg Tablet 0.25 USD Apo-Imipramine 50 mg Tablet 0.4 USD Apo-Imipramine 75 mg Tablet 0.58 USD Apo-Trimip 100 mg Tablet 0.97 USD Apo-Trimip 12.5 mg Tablet 0.23 USD Apo-Trimip 25 mg Tablet 0.29 USD Apo-Trimip 50 mg Tablet 0.57 USD Apo-Trimip 75 mg Capsule 0.77 USD Capsules; Oral; Imipramine Pamoate 100 mg Capsules; Oral; Imipramine Pamoate 125 mg Capsules; Oral; Imipramine Pamoate 150 mg Capsules; Oral; Imipramine Pamoate 75 mg Cenestin 0.3 mg tablet 2.21 USD Cenestin 0.45 mg tablet 2.21 USD Cenestin 0.625 mg tablet 2.21 USD Cenestin 0.9 mg tablet 2.21 USD Cenestin 1.25 mg tablet 2.21 USD Imipramine hcl 10 mg tablet 0.46 USD Imipramine hcl 25 mg tablet 0.35 USD Imipramine hcl 50 mg tablet 0.44 USD Imipramine hcl powder 0.77 USD Imipramine pamoate 100 mg capsule 15.17 USD Imipramine pamoate 125 mg capsule 15.17 USD Imipramine pamoate 150 mg capsule 15.17 USD Imipramine pamoate 75 mg capsule 16.35 USD Surmontil 100 mg capsule 5.92 USD Surmontil 25 mg capsule 2.49 USD Surmontil 50 mg capsule 4.07 USD Tablets; Oral; Imipramine Hydrochloride 10 mg Tablets; Oral; Imipramine Hydrochloride 25 mg Tablets; Oral; Imipramine Hydrochloride 50 mg Tofranil 10 mg tablet 4.73 USD Tofranil 25 mg tablet 4.97 USD Tofranil 30 50 mg tablet Bottle 185.09 USD Tofranil 50 mg tablet 0.57 USD Tofranil-PM 30 125 mg capsule Bottle 588.33 USD Tofranil-PM 30 150 mg capsule Bottle 588.33 USD Tofranil-PM 30 75 mg capsule Bottle 588.33 USD Tofranil-pm 100 mg capsule 19.23 USD Tofranil-pm 125 mg capsule 18.68 USD Tofranil-pm 150 mg capsule 18.86 USD Tofranil-pm 75 mg capsule 18.86 USD Trimipramine 25 mg capsule 1.92 USD Trimipramine 50 mg capsule 3.14 USD Trimipramine Maleate 50 mg capsule 3.27 USD Trimipramine maleate powder 51.0 USD
Imipramine destination | category:
Depending on the reaction of the Imipramine after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Imipramine not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Imipramine addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology