Imipramine

The Basics

What is Imipramine?

Used to treat depression; also used to prevent bedwetting in children.

Brand names for Imipramine

Tofranil

How Imipramine is classified

Antidepressive Agents, Antidepressive Agents (Tricyclic)

Imipramine During Pregnancy

Imipramine pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Imipramine while pregnant

N/A

Taking Imipramine While Breastfeeding

What are recommendations for lactation if you're taking Imipramine?

Milk levels of imipramine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Imipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Some experts consider imipramine one of the antidepressants of choice for nursing mothers.[1][2] Other agents with may be preferred when large doses are required or while nursing a newborn or preterm infant.

Maternal / infant drug levels

Milk levels of imipramine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Imipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Some experts consider imipramine one of the antidepressants of choice for nursing mothers.[1][2] Other agents with may be preferred when large doses are required or while nursing a newborn or preterm infant.

Possible effects of Imipramine on milk supply

Imipramine has caused increased prolactin levels and gynecomastia in nonpregnant, nonnursing patients.[11][12] Galactorrhea has been reported rarely.[13][14] The clinical relevance of these findings in nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[15] The antidepressants used by the mothers were not specified.

A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[16] None of the mothers were taking imipramine.

Possible alternatives to Imipramine

Nortriptyline, Paroxetine, Sertraline.