Tofranil
Tofranil (Imipramine)Pharmacological action
Tofranil antidepressant. Concerns antidepressants with mainly stimulating action. Antidepressive and psychogogic an effect has.
The alpha-adrenoblokirujushchim action possesses also the strong central and peripheric anticholinergic. In therapeutic doses slows down ventricular conductivity (at an overdosage can cause serious intraventricular blockade).
The mechanism of antidepressive action of Imipraminum. At long application reduces functional activity of b-adrenoreceptors, normalises adrenergic, restores the balance of these systems broken at depressions.
Antidepressive action develops gradually; the optimum therapeutic effect comes through 1-3 (to 4) weeks after the therapy beginning.
Indications
- Depressions and depressions of a various aetiology (endogenous, organic, psychogenic), accompanied motor.
- Panic disorder;
Dosage regimen
In the first day of Tofranil treatment prescribe 25 mg of Melipraminum 3 times/days In need of the treatments subsequent days a preparation dose it is possible to enlarge. The maximum daily dose for parenteral introduction - 100 mg. Since 7th day of therapy the dose is reduced gradually by replacement of one injection by reception by 1 dragees inside. Since 13th day of treatment of the patient it is necessary to translate completely on peroral reception of a preparation in a dose of 25 mg 4 times/days In case of occurrence of relapse of disease probably repeated appointment of a preparation inside musc.
Persons of advanced age are recommended to begin treatment with smaller doses.
Tofranil Side effect
From party TSNS and peripheric nervous system: a headache, giddiness, an excessive sedation, paresthesias, a tremor, cramps, a dysarthtia, disorders of coordination, disturbance of a dream, hallucination, excitation, accommodation disturbance.
From the alimentary system: dryness in oral cavities, a stomatitis, a nausea, vomiting, constipations, intestinal impassability; seldom - a hepatitis.
From cardiovascular system: a tachycardia, an arrhythmia, an orthostatic hypotension.
From hemopoiesis system: a leukocytosis, an eosinophilia; seldom - a leukopenia, a thrombocytopenia, an agranulocytosis.
From endocrine system: a gynecomastia, a galactorrhea, a swelling of mammary glands, tolerance depression to a glucose, a hyperglycaemia.
Allergic reactions: an urticaria, an exanthema, a Quincke's disease.
The other: a photosensitization.
Contraindications
- The acute period of a myocardial infarction;
- A heart failure;
- Hepatic and-or renal insufficiency;
- A diabetes in a decompensation stage;
- A hyperthyroidism;
- A good-quality hyperplasia of a prostate;
- A bladder atony;
- An angle-closure glaucoma;
- Simultaneous reception of inhibitors MAO and the period till 14 days after their cancellation;
- Pregnancy;
- A lactemia (thoracal feeding);
- Children's age;
- A hypersensibility to a preparation.
With care it is necessary to prescribe a preparation at an epilepsy.
Pregnancy and lactemia
The preparation is contraindicative to application at pregnancy and in a lactemia.
Special indicatings
At appointment of Melipraminum with an epilepsy the careful control of a condition since the preparation can provoke an epileptic attack in the first days of treatment is necessary for patients.
At preparation application it is necessary to pay attention, that the therapeutic effect comes not earlier than in 1-3 weeks from the treatment beginning, the maintenance dose should be accepted not less than 3 months In an initial stage of therapy by Melipraminum constant medical observation over patients with suicidal tendencies is necessary.
At the sudden termination of reception of a preparation cancellation symptoms (a nausea, a headache, irritability, a sleeplessness, an arrhythmia and extrapyramidal disturbances) develop.
It is not necessary to use an electroshock therapy during Melipraminum application.
In case of bipolar depression the preparation can provoke transition of the patient in a maniacal phase.
If this condition does not pass for 2 weeks appointment of preparations of derivatives of benzodiazepine is expedient.
With care prescribe Melipraminum to patients with predilection to constipations.
Melipraminum should be prescribed cautiously at a pheochromocytoma or an acute porphyria because of threat of an exacerbation of diseases with crisis development.
In treatment by Melipraminum regular carrying out of the general analysis of blood, an estimation of indicators of function of a liver, the control of an electrocardiogram and BP level is recommended.
Against treatment by Melipraminum it is impossible to take alcohol.
Influence on ability to driving of motor transport and to management of mechanisms
In Melipraminum application driving of vehicles and performance of other potentially dangerous work demanding raised concentration of attention and speed of psychomotor reactions is forbidden.
Overdosage
Symptoms: psychomotor excitation, dryness in a mouth, a mydriasis, a tachycardia, an ischuria, confusion of consciousness, difficulty of breath, a cramp, a clod.
Treatment: it is necessary to watch function of cardiovascular and respiratory systems, spend symptomatic therapy. At cramps i.v. enter Diazepamum, Phenytoinum, phenobarbital.
Imipraminum is not exposed to a dialysis. The artificial diuresis also is noneffective.
Medicinal interaction
Simultaneous application of Melipraminum and inhibitors MAO considerably raises risk of development of excitation, cramps, fluctuations of a BP, a hyperthermia, a coma. After the termination of reception of inhibitors MAO it is necessary to make a break of 2-3 weeks before Melipraminum appointment (and on the contrary).
At simultaneous application of Melipraminum and hormonal preparations of a thyroid gland there is an intensifying of adrenergic effects that can cause tachyarrhythmias and development of attacks of a stenocardia.
At simultaneous application of Melipraminum with alpha adrenoblockers and stimulators of the central a-adrenoreceptors (Clonidinum, Methyldopum) the antihypertensive effect of the last decreases, that, probably, is caused by inhibition of their linkage with presynaptic a-adrenoreceptors.
Imipraminum reduces anticonvulsant effect of Phenytoinum.
Inductors of enzymes (ethanol, nicotine, Meprobamatum, barbiturates, antiepileptic agents) accelerate a metabolism of Imipraminum and reduce concentration of substance in a blood plasma and its antidepressive effect.
Conditions and periods of storage
The preparation should be stored in the protected place inaccessible to children from light at temperature from 15 C to 25 C. The Period of validity - 2 years.
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