Post-traumatic stress disorder
Laeth Sari Nasir, Arwa K Abdul-Haq in Caring for Arab Patients, 2018
Anti-depressant drugs — selective serotonin re-uptake inhibitors (SSRIs) such as sertraline (Zoloft) or paroxetine (Paxil) — are considered first-line treatments for PTSD owing to their efficacy, tolerability and safety. Other medications such as imipramine (Tofranil) and amitriptyline (Elatrol), two tricyclic drugs, may also be used in the treatment of PTSD. Dosages of imipramine and amitriptyline should be the same as those used to treat depressive disorders, and an adequate trial should last at least six to eight weeks. Patients who respond well should probably continue the pharmacotherapy for at least one year before an attempt is made to withdraw the medication. Some studies indicate that pharmacotherapy is more effective in treating the depression, anxiety and hyperarousal than in treating the avoidance, denial and emotional numbing.22 Other drugs that may be useful in the treatment of PTSD include buspirone (BuSpar) and trazodone (Desyrel), which are predominantly serotonergic in action, monoamine oxidase inhibitors such as phenelzine (Nardil), and some anticonvulsants such as carbamazipine (Tegretol) or valproate (Depakene). Use of clonidine (Catapres) and propranolol (Inderal), which are anti-adrenergic agents, might theoretically be effective given the noradrenergic hyperactivity in the disorder. There is little evidence that antipsychotic drugs are effective in this disorder. Therefore the use of medications such as haloperidol (Haldol) should be reserved for the short-term control of severe aggression and agitation.
Generalized Anxiety Disorder
Stephen M. Stahl, Bret A. Moore in Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy, 2013
In a subsequent study, Rickels et al. (2000) compared imipramine and bus-pirone in the management of BZD discontinuation in GAD patients who had been taking BZDs for an average of 8.5 years. There were several phases: a BZD stabilization phase, 4 weeks of imipramine (180 mg/day), buspirone (38 mg/day) or placebo with BZD maintenance, a 4-to 6-week BZD taper, and a 5-week post-taper phase with imipramine, buspirone, and placebo treatment continued for another 3 weeks, followed by 2 weeks of placebo. Of the 107 patients who entered the study, 32 did not complete the pre-taper phase. During that period, patients taking imipramine reported more adverse reactions than patients in the other two groups. During the actual taper phase, neither buspirone nor imipramine reduced the severity of the BZD discontinuation effects, and the patients receiving imipramine even reported significantly more severe symptoms. But at the 3-month follow-up, patients receiving imipramine had a significantly higher success rate of taper (82.6&) than those given placebo (37.5&), while the difference between these treatments and buspirone (67.9&) did not reach statistical significance. At 12 months, 80& of the patients BZD-free at 3 months were still free (32 out of 40). For 57 patients who provided data at 12 months, 39 (68.4&) were BZD-free and 18 (31.6&) were still taking BZDs. Most importantly, BZD-free patients reported significantly lower levels of anxiety and depression than those still taking the drugs.
Norepinephrine in Depression and Anxiety
Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen in Handbook of Depression and Anxiety, 2003
Since the early 1950s, when MAOIs and imipramine were coincidently discovered to have therapeutic effects in the treatment of depression [132], and imipramine was found to be effective for panic attacks in patients with agoraphobia [133], a steady stream of new medications for depression and anxiety became available for clinical use. The first of these drugs were simple modifications of the original tricyclic or MAOI compounds. However, as our understanding of the pharmacology of these compounds evolved, newer drugs were tailored to have specific neurochemical effects. The vast majority of newer compounds have been designed to potently enhance NA and/or 5HT neurotransmission without anticholinergic, antihistaminergic, or antiadrenergic properties. It was hoped that this would lead to drugs with fewer side effects and/or greater efficacy and faster onset of action.
Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children
Published in Expert Opinion on Pharmacotherapy, 2019
Tiernan Middleton, Pamela Ellsworth
Imipramine is one of the earliest medications used to treat bedwetting in children and is the most commonly used tricyclic antidepressant used for nocturnal enuresis. Initially it was thought that the beneficial effect was related to its anticholinergic effects, however, this has been questioned due to positive responses to imipramine in children who failed anticholinergic therapy [23,24]. Although effective, tricyclic antidepressants are not recommended as first-line pharmacologic therapy for nocturnal enuresis due to their risks. The International Children’s Continence Society guidelines suggest that imipramine use be limited to specialty centers dedicated to treating primary monosymptomatic nocturnal enuresis[25]. The recommended initial starting dose is 25mg/day in children 6 years of age and older 1 h before bed. If no significant response occurs within 1 week, the dose may be increased to 50 mg in children <12 years of age. In children >12 years of age, the dose may be increased to a maximum of 75 mg/day. Cessation of the medication should occur gradually via tapering the dosage compared to discontinuing abruptly to decrease the tendency to relapse. Those children who relapse when they discontinue the tricyclic may not always respond to a subsequent course. [25–27]
Inhibiting extracellular vesicles formation and release: a review of EV inhibitors
Published in Journal of Extracellular Vesicles, 2020
Mariadelva Catalano, Lorraine O’Driscoll
As outlined earlier, even if some of these drugs – that are already formulated and used as therapeutic agents – are found to reliably, robustly and reproducibly, inhibit release of EVs, substantial efforts would still be needed to investigate their influence on EV release from healthy cells. Approaches to selectively deliver them to cancer cells may be required. Of course, the drugs that are already approved for use in humans, for some indication(s), would likely have a more straightforward pathway to utility than those are molecules that have never been developed as therapeutics. Notwithstanding that, even for currently used as therapeutics, their side-effects (whether or not related to their influence on EVs) must also be considered. For example, known side-effects of imipramine include blood disorders/suppression of immune cells and associated infections, disorientation, dizziness, tiredness, nausea and vomiting, low blood pressure, among others. Side-effects of pantetheine include – but are not limited to – nausea, diarrhoea and possible impaired blood clotting. Similarly, side-effects of others of these drugs such as imatinib, glibenclamide, and indomethacin are well established. However, it must also be remembered that no drugs in clinical use are without some side-effects and so decisions must ultimately be made on the benefit/risk ratio to decide upon the appropriateness of use.
A systematic review of evidence based treatments for lichen simplex chronicus
Published in Journal of Dermatological Treatment, 2021
Michelle C. Juarez, Shawn G. Kwatra
Sanjana et al carried out a double-blind RCT to evaluate the efficacy of Chlorpheniramine and Imipramine in 24 patients with LSC (20). In this study, patients were divided into three groups and randomly allocated to receive placebo, 4 mg starting dose of chlorpheniramine, or 25 mg starting dose of imipramine in increasing doses weekly. Treatment with chlorpheniramine and imipramine resulted in a significant decrease in pruritus severity between baseline and at 2, 4, and 6 weeks of treatment, though a greater decrease was seen in the imipramine treated group. Based on these findings, the authors concluded that imipramine was superior to the other medications in treating pruritus in patients with LSC and may be considered in patients with recalcitrant pruritus who do not respond to conventional therapies.
Related Knowledge Centers
- Anxiety
- Dizziness
- Hypotension
- Panic Disorder
- Somnolence
- Tricyclic Antidepressant
- Xerostomia
- Depression
- Oral Administration
- Side Effect