Reactions 662 - 2 Aug 1997

★Imipramine

First report of diarrhoea: case reportA 32-year-old HIV-positive man with chronic hepatitis B

infection developed severe diarrhoea during treatment withimipramine.

The man had a history of bipolar disorder and he washospitalised because of a depressive episode with suicidalideation. He was treated with imipramine, increased from 25to 75 mg/day during the first week of therapy; he hadpreviously taken this agent without experiencing anysignificant complications.

After 10 days of imipramine therapy, the man started todevelop severe diarrhoea (approximately 7–8 stools/day).Treatment with loperamide and diphenoxylate wasunsuccessful. Stool specimens did not show an infectivecause. Imipramine was continued; however, after 3 weeks’treatment, he was still experiencing diarrhoea.

Imipramine was discontinued and, 2 weeks later, thediarrhoea resolved. The man was subsequently treated withdesipramine, without experiencing any further diarrhoea.

Author comment: Imipramine was probably responsible forthe diarrhoea in this patient. However, the diarrhoea cannot beattributed entirely to imipramine, the man’s chronic liverdysfunction may have been a contributing factor. ‘This casereport has to be added to the already existing observations inthe literature concerning the particular susceptibility of HIV-infected patients to develop rare, severe or even paradoxicaladverse effects when administered psychotropic agents,particularly antidepressants.’Grassi B, et al. Severe diarrhoea in an HIV-infected patient with chronic hepatitisB treated with imipramine. Human Psychopharmacology: Clinical andExperimental 12: 280-282, May-Jun 1997 - Italy 800550149

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous reports of diarrhoea with imipramine.

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Reactions 2 Aug 1997 No. 6620114-9954/10/0662-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved