Depram 25 mg

Description

Indications
Depram is prescribed for the treatment of:

• Depressive illness
• Nocturnal enuresis in children.
  Use as per the advice of a registered medical professional.

Description
Depram is a tricyclic antidepressant belonging to the dibenzazepine class of compounds. While its exact mechanism of action is not fully understood, it is thought that Depram does not act primarily by stimulating the central nervous system. Its clinical effects are believed to stem from potentiating adrenergic synapses by inhibiting the reuptake of norepinephrine at nerve endings. When used for treating nocturnal enuresis in children, its action is considered separate from its antidepressant effect.

Pharmacology
Imipramine, the active ingredient in Depram, works by inhibiting the reuptake of two key neurotransmitters, norepinephrine and serotonin, by neurons. It binds to sodium-dependent transporters for serotonin and norepinephrine, reducing their reuptake, thereby increasing their concentration in the synaptic cleft. This process is thought to enhance neurotransmission and improve brain function, which helps alleviate symptoms of depression.

Dosage & Administration

• For Depression:
  • Start with 75 mg daily, divided into several doses. Gradually increase the dose to 150-200 mg per day (up to 300 mg in hospital settings).
  • In some cases, 150 mg may be administered as a single dose before bedtime.
  • For elderly patients, start with 10 mg daily, gradually increasing to 30-50 mg daily.
  • Not recommended for children for the treatment of depression.
• For Nocturnal Enuresis:
  • Children (7-8 years): 25 mg
  • Children (8-11 years): 25-50 mg
  • Children over 11 years: 50-75 mg before bedtime (maximum dose)
  • The treatment period, including gradual discontinuation, should not exceed 3 months, with full physical examinations before further courses.

Use as per the advice of a registered medical professional.

Interaction

• Methylphenidate can enhance the effects of imipramine, which may require dose adjustment.
• Depram may increase the sedative effects of alcohol.
• Combining imipramine with monoamine oxidase (MAO) inhibitors can result in dangerous hypertension. A 14-day gap is required before starting or stopping imipramine when transitioning from MAO inhibitors.
• Concomitant use with anticholinergic drugs (e.g., benztropine) or antihistamines may increase the drying effects of Depram.

Contraindications

• Depram should not be used together with or within 14 days of treatment with an MAO inhibitor due to the risk of severe interactions, including hypertensive crises, convulsions, or even death.
• Contraindicated in patients with severe hepatic or renal impairment, blood dyscrasias, or those who have shown hypersensitivity to imipramine or other dibenzazepine-related antidepressants.
• Should not be used in the acute recovery phase following a myocardial infarction.
• Contraindicated in patients with seizure disorders or glaucoma.

Side Effects
Common side effects may include:

• Dry mouth, constipation, urinary retention
• Increased heart rate, sedation, dizziness, and decreased coordination
• Irritability, confusion, and disorientation
• Skin issues such as rashes, numbness, and itching
• Abdominal issues, including nausea, vomiting, and cramping

Severe but rare side effects may include:

• Heart attacks, heart failure, strokes
• Seizures, ringing in the ears (tinnitus)
• Delusions, anxiety, and insomnia

Pregnancy & Lactation
Depram is classified as Pregnancy Category D, indicating a known risk to the fetus. It should only be used during pregnancy if the potential benefits outweigh the risks. Imipramine may be excreted in breast milk, so breastfeeding is not recommended during treatment.

Precautions & Warnings

• Use with caution in patients with a history of benign prostatic hypertrophy, urinary retention, or glaucoma, especially angle-closure glaucoma.
• The sedative effects may be enhanced when combined with central nervous system depressants like alcohol, sleeping aids, or sedatives.
• Depram may increase the heart rate and place stress on the cardiovascular system, so it should be used with caution in patients with cardiovascular disease or those who have recently experienced a heart attack.
• Close monitoring is necessary when starting treatment, particularly for elderly patients, due to an increased risk of arrhythmias, heart failure, and strokes.
• Patients should be closely monitored for signs of suicide, especially during the initial stages of treatment or in cases of overdose.

Overdose Effects

• Children are particularly sensitive to imipramine overdose, which can be severe and potentially fatal.
• In case of overdose, immediate medical attention is required.

Therapeutic Class
Tricyclic antidepressants & related antidepressant drugs.

Storage Conditions
Store below 30°C, away from light and moisture. Keep out of the reach of children.