[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Tricyclic antidepressants (TCAs)](https://durgical.com/en/pharmacology/classes/tricyclic-antidepressants/) › Imipramine

# Imipramine

## TCAs?

Tricyclic antidepressants (TCAs)

The first tricyclic antidepressant. Used for depression and, in children, for bedwetting; anticholinergic and dangerous in overdose.

Updated Nov 12, 2026

## Quick facts

**Group**
[Tricyclic antidepressants (TCAs)](https://durgical.com/en/pharmacology/classes/tricyclic-antidepressants/)

**Target**
Serotonin transporter (SERT) and noradrenaline transporter (NET)

**Used for**
Depression · Bedwetting in children · Off-label

**Key effects**
Dry mouth · Drowsiness · Dizziness on standing

**Monitor**
Mood · Pulse · Eye examination before starting

**ATC**
N06AA02

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

⇄**Serotonin transporter (SERT) and noradrenaline transporter (NET)**Imipramine

ⓘ The figure shows imipramine bound to the human serotonin transporter (cryo-EM; vilazodone and an antibody fragment are also present).

**Target in 3D:** Serotonin transporter (SERT) and noradrenaline transporter (NET). PDB structure 7LWD (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7LWD) · Drag to rotate · pinch to zoom

Imipramine, a tertiary-amine tricyclic, blocks the reuptake of both serotonin and noradrenaline; it also has an active metabolite that lasts longer than the parent drug. More transmitter stays in the synapse and receptors adapt over weeks, which relieves depression. It also blocks muscarinic, histamine H1 and alpha-1 receptors and cardiac sodium channels: dry mouth, sedation, orthostatic hypotension and, in overdose, arrhythmias. How it reduces bedwetting is not fully explained.

- Blocks serotonin and noradrenaline reuptake
- An active metabolite prolongs the effect
- Receptor adaptation over weeks relieves depression
- Off-target: muscarinic, H1, alpha-1 block and Na+ channels

## Indications

- Depression [Major depressive disorder →](https://durgical.com/en/conditions/major-depressive-disorder/)
- Bedwetting in children (tablets only) [Nocturnal enuresis →](https://durgical.com/en/conditions/nocturnal-enuresis/)
- Off-label: panic disorder [Panic disorder →](https://durgical.com/en/conditions/panic-disorder/)

## Adverse effects

### Common

- Dry mouth, constipation and difficulty passing urine
- Drowsiness, tiredness, nightmares
- Dizziness on standing
- Sweating; appetite or weight change
- Changes in sex drive or ability

### Serious (rare, important)

- Suicidal thoughts in children, teens and young adults (boxed warning)
- Irregular heartbeat
- Angle-closure glaucoma
- Fever, sore throat or other signs of infection; yellow skin or eyes

## Contraindications

- MAO inhibitors now or within the previous two weeks
- Recent heart attack
- Generally avoided in people aged 65 or older

## Key interactions

**MAO inhibitors, linezolid, methylene blue**
Serotonin syndrome and severe reactions; not combined.

**Cimetidine**
Raises imipramine levels.

**Alcohol**
More drowsiness.

**Tobacco smoking**
May reduce its effect.

## What is monitored

- Mood, agitation and suicidal thoughts, especially early
- Pulse, blood pressure and ECG when there is heart disease
- Eye examination before starting
- Signs of infection or jaundice

## Administration and safety

- Oral; for bedwetting it is given about an hour before bedtime.
- Started low and raised gradually; not stopped suddenly.
- Kept out of children's reach: a small number of tablets can be fatal.

## Pregnancy and breastfeeding

Pregnancy or plans for pregnancy are discussed with the prescriber; it is used only when the benefit justifies the possible risk.

## Nursing care

- Before: screen for heart disease, glaucoma, urinary retention, seizures and MAOI use.
- During: ask about mood and suicidal thoughts; tell families what to watch for.
- Check lying and standing blood pressure; teach to rise slowly.
- Teach sun protection and to avoid alcohol.

## Pharmacokinetics

**Absorption**
Oral.

**Metabolism**
Liver, to an active metabolite with a longer half-life.

**Onset and duration**
Benefit in depression may take one to three weeks or longer.

## Memory aid

IMIPRAMINE: the first tricyclic, the bedwetting one ("I'M dry at night").

## Test yourself

Think of the answer, then tap the question to see it.

## Which two transporters does imipramine block?

The serotonin transporter (SERT) and the noradrenaline transporter (NET).

## Which childhood condition can imipramine tablets treat?

Bedwetting (nocturnal enuresis).

## Why is imipramine generally avoided in older adults?

Anticholinergic effects, sedation and orthostatic hypotension raise the risk of confusion and falls; safer options exist.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/imipramine/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Amitriptyline](https://durgical.com/en/pharmacology/amitriptyline/)
- [Clomipramine](https://durgical.com/en/pharmacology/clomipramine/)
- [Nortriptyline](https://durgical.com/en/pharmacology/nortriptyline/)

## Related conditions 3

- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Nocturnal enuresis](https://durgical.com/en/conditions/nocturnal-enuresis/)
- [Panic disorder](https://durgical.com/en/conditions/panic-disorder/)

[← Back to the class: Tricyclic antidepressants (TCAs)](https://durgical.com/en/pharmacology/classes/tricyclic-antidepressants/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Imipramine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682389.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Cryo-EM structure of the wild-type human serotonin transporter complexed with vilazodone, imipramine and 15B8 Fab](https://www.rcsb.org/structure/7LWD) (RCSB Protein Data Bank, 2021); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N06AA02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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