Imipramine

Withdrawal symptoms in cbUdreu Two children with psychopathological conditions receiving high dose imipramine hydrochloride (4.8 and 4.4mg/kg/day, respectively), each abruptly stopped taking their medication and experienced symptoms similar to, but intensely greater than, one would expect during gradual tapering off. These included nausea, frequent vomiting, headache, lethargy, and irritability. In both cases, medication was restarted and the symptoms quickly subsided. These symptoms tend to appear to a lesser extent when drug dosage is slowly decreased at the end of therapy. They h.a ve been considered to be side effects to imipramine therapy. Clinicians are advised to check on treatment compliance when these symptoms manifest themselves suddenly. Petti, T.A. and Law, W., Journal or tile American Medical Association 246: 768 (14 Aug 1981)

Rebouod ardtK arrilytllmla to aD .dult A middle-aged woman with a 26-year history of depression had received imipramine for I J years (final dosage 150mg/day) as well as oxazepam JOmg qid pLus conjugated oestrogen. She was selected to enter a trial comparing bupropion with amilriptyllne and, to prepare for the pre-trial washout period, diazepam was substituted for oxazepam and gradually withdrawn over a 2-week period, and imipramine reduced to 7 Smgi day for I week. Both medications were then withdrawn and placebo given, After 5 days she experienced palpitations, nausea and vomiting. an ECG showed sinus tachycardia and frequent ventricular ectopic beats. Bupropion 300mg I day was started but by day J 9 she had tachycardia of I 25bpm and more frequent PVCs with bigeminy. All medications were stopped and imipramine 75mg/day restarted. Symptoms resolved in 5 days. Eight years previously she had complained of palpitations but these were considered to be related to her anxiety and were not treated, Imipramine may have suppressed a pte-existing arrhythmia but the authors consider that drug withdrawal induced an adverse cardiac reaction. The other drugs were unlikely causes: palpitations started before bupropion was given; diazepam 40mg on day 19 had no effect on ECG so that benzodiazepine withdrawll was discounted. Boisven, D. and ClIouinard, G,; American Journal of Psychiatry IJ8: 985(Ju119lltl

0157-7271/81/0918-0003/0$00.50/0 © ADIS Press Reactions 18 Sap 1981 3