View Full Version : Anyone else's child on imipramine?

Ms. Mango
11-03-09, 08:43 PM
My son is 6 1/2 and is on 75mg of imipramine along with 5mg of adderall that we're going to take him off of. Does anyone else have a child who is on imipramine? With another medication or alone?

The combination works pretty well but the dr. feels that we can get rid of the adderall and either maintain at this dose or go up to 100mg if necessary.

Just wanted to hear of anyone else's experience--if there is anyone--I know this is a med that isn't prescribed much.

11-04-09, 01:37 PM
Here is what wikipedia says abou imapramine;

Sometimes antidepressants are given with a stimulant. Ussually the more modern SSRI antidepressants are given. Why was your son given that Med? What is his diagnosis?

Ms. Mango
11-04-09, 11:38 PM
Thanks MGDAD, I'm familiar with that link. In this case imipramine is being used at a low dose (75mg) for ADHD.

He's been diagnosed with ADHD. We did a trial with Adderall XR alone for a month and it was o.k.--not great. At 5mg he was fine until the early afternoon. They he'd rebound and start using very threatening language. 10mg was too much--he talked for three hours non-stop. And he had the usual side effects like weight loss and insomnia.

After a month it was time to go back to the doc. He saw DS in action and noted the excessive talking and some anxiety. We discussed how the month had gone and considered a booster in the afternoon. This presented some problems--who would administer the med? I work, the adderall worked through the school day and the afterschool program (that he subsequently got kicked out of for using threatening language anyways) wasn't sure it wanted to be responsible for giving him the med. At that point my son wasn't able to swallow pills which just complicated things a bit more.

Of course there was the weight loss. He lost nearly 10% of his total weight in the first month. Also, he wasn't falling asleep until 11pm, due in part to the adderall and possibly because he became very hungry at 9-9:30pm. So we fed him! I was concerned about giving him an afternoon booster. Breakfast might be the most important meal of the day, but I was afraid it was going to be the only time he'd eat. We talked about adding clonidine at night to help him sleep, but I didn't like the idea of adding a medication whose sole purpose was to treat the side effect of the initial medication.

His doctor suggested imipramine. He felt that, at a low dose, there would be few side effects and we'd get 24-hour coverage once he titrated up. The doctor had seen him unmedicated so he told us to keep him on adderall because it would take at least three weeks to get up to the prescribed dose.

The downside is that he will need to have routine blood tests to rule out toxicity and EKGs to rule out cardiac changes.

On the plus side, it's worked well until late in the day or early evening. My son has had no side effects. An added benefit is that imipramine is mildly sedating so it has helped him get a good night's sleep.

I like that this doctor isn't afraid to think outside the box and he's been in practice long enough to keep every option open. I did do some research before giving my son the medicine, but haven't been able to find much information about children with ADHD being treated with imipramine. Most references I've come across are old, have to do with side effects seen at higher doses and with adults taking imipramine for migrains or panic attacks.

Although medication affects everyone differently, it would be nice to come across another parent to who can share some experiences.

11-05-09, 12:47 AM
All I can say is that imipramine is on the list of possible adhd meds from our neurologist. He went over all of them with me when we met and I think I remember him mentioning that imipramine was older and not commonly used anymore, but still can be beneficial and should be considered more than it is. He listed it as

"antidepressants that have positive effectson on ADHD"
* imipramine/desipramine
* wellbutrin
* strattera

My son is doing well with concerta so we haven't looked into it for him. This neurologist is very well respected with over 30 years of experience, specifically with adhd.

edit: I see you're in MA - the neurologist is Dr. William Singer in Wellesley.

Ms. Mango
11-05-09, 10:46 AM
Dr. Singer is my son's doctor as well. Small world!

11-05-09, 12:03 PM
I guess that doesn't help then! :)

11-20-09, 08:47 AM
My son has been on imipramine since 2003.

He now takes 100mg per day - 2 in morning and 2 at night

Also takes dexamphetamine sulfate 25mg per day spaced out throughout the day

Imipramine is used a lot in Australia. Yeah it is an old medication. So is dexamphetamine. Australia tends to go with the tried but true meds rather than the newer ones.

You don't need to have routine EKG tests. The people that had heart problems after taking the medication already had heart defects before they started. You only need to have one before you start on the meds and then not worry about it again.

Ms. Mango
11-24-09, 06:26 PM
Thanks tudorose. Since my last post we've been back to the dr. and had the blood test (and the EKG, but I'll post that separately) and upped his dose to 100mg in the evening. He's been on this dose for a week now and we're going to try taking him off the 5mg Adderall XR starting tomorrow. We didn't give him the Adderall on Sunday and he had a very good day; I'd like to see how this works on a school day.

Tomorrow he has a 1/2 day at school and then we have a long weekend for our Thanksgiving holiday so it seems like a good time to give it a try.

Another option the dr. suggested is giving 25mg am and 75mg pm if he has a rough afternoon or evening off the Adderall. Do you have any experience with imipramine for an am dose with no stimulant med given at the same time? Do you think a dose that small would be sedating?

Thanks again!

Ms. Mango
11-24-09, 06:59 PM
Hmmm...about that EKG. We had the blood work done and that came back fine. My DH took DS for the blood test and forgot to ask for the EKG. I decided not to worry about it and step up to the higher dose. That was last Monday (11/16).

Friday he had a great day from start to finish with a little meltdown after dinner--great; looks like we're seeing positive results from the increase.

I give him his pills and within 10 minutes he's doubled up in his chair yelling that his stomach hurts. Then he sits up and says he's o.k. Then doubles over again. I ask him to show me where it hurts and he straightens up and puts his hand on his chest. Trying not to panic I ask him to describe the pain. Well, he's 6--I just got more of "it hurts".

He took his pills with just a sip of water so I get him a glass and have him drink some more. He says that helps, but again starts crying. I get DH. We carry him up to his bed where he's rolling around and crying in pain. This kid has a pretty high threshold for pain, so I turn to DH and tell him we're going to the ER. We get him dressed and head over there.

Ds gets very quiet in the car, he says he's still in pain, but it's evident that the meds are kicking in and he's groggy.

The nurse had never heard of imipramine, so I spelled it for her and told her why we gave it to him. Because he was complaining of chest pains they immediately gave him an EKG.

Two hours later we're seen by the doc who is familiar with imipramine and agrees that 100mg is a safe dose that shouldn't cause cardiac problems. He checks ds's lungs (by this point the kid's asleep) and goes to check the EKG. The EKG is fine.

The doc says this type of pain, if not cardiac, could be from a collapsed lung but probably not in this case because he was able to fall asleep after about an hour, he wasn't coughing prior to the onset of pain and his lungs sounded clear. But we could wake him up for an x-ray if we wanted (we declined).

The other possibility (most likely) was a spasm of the esophagus. The pills may have lodged along the windpipe and caused the spasm. Or not--just like any cramp there may not be a trigger for it that can be identified. His reaction was not unusual as this is extremely painful and adults who have this are often convinced they're having a heart attack.

Relieved, we pulled the EKG leads off ds--who didn't wake up--and were free to go home.

So, better safe than sorry, but a h*ll of a way to spend a Friday night/get that EKG!

11-27-09, 08:16 AM
Another option the dr. suggested is giving 25mg am and 75mg pm if he has a rough afternoon or evening off the Adderall. Do you have any experience with imipramine for an am dose with no stimulant med given at the same time? Do you think a dose that small would be sedating?

My son takes 50mg in the morning and 50mg at night. The doctor said that it helped the ADD as it aids in concentration so he wasn't on stimulants for about a year after he started taking it.

I'm a big believer in spacing out medication as much as possible to try and keep everything on an even keel.