Imipramine Hydrochloride

Imipramine hydrochloride (Tofranil) is a tricyclic antidepressant that facilitates urine storage by decreasing bladder contractility and increasing urethral sphincteric function. These effects result from the anticholinergic, antihista-minic, local anesthetic, and alpha-adrenergic properties of the drug. Patients with mixed incontinence often benefit from this drug. It can be very useful for OAB patients whose prior treatments have failed. We start at a dosage of 25 mg orally at bedtime, and may gradually increase the dose to 100 mg at night. We give the dosage at night, because nocturia is frequently a significant complaint, and somnolence is common after administration. Care must be taken in treating the elderly patient, because imipramine has a narrow side-effect profile, including potential cardiovascular toxic effects and orthostatic hypotension. Its effectiveness in enhancing sphincteric function is increased by concomitant administration of local estrogen cream. Thus, we frequently prescribe both medications together.

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