Buy Melipramine

The dose and frequency of reception are determined individually, depending on the nature and severity of the symptoms. As with other antidepressants, at least 2-4 weeks are required to achieve a therapeutic effect (possibly 6-8 weeks). Treatment should begin with low doses with a gradual increase in them to select the lowest effective maintenance dose. Dose titration before achieving efficacy requires extreme caution in the elderly and in patients younger than 18 years.

Depression

Out-patient patients aged 18-60 years:
The standard dose is 25 mg 1-3 times a day, the dose can be gradually increased to a daily dose of 150-200 mg by the end of the first week of therapy. The standard maintenance dose is 50-100 mg per day.
Hospital patients 18-60 years of age:
In a hospital in very severe cases, the initial dose is 75 mg per day, the dose may be increased by 25 mg per day to a daily dose of 200 mg (in exceptional cases, the daily dose may reach 300 mg).

Patients over 60 years of age

In these age groups, a marked response to the above doses may be noted, therefore, treatment should be started with the lowest possible doses. The initial dose may gradually increase to a total daily dose of 50-75 mg.
It is recommended to reach the optimum dose within 10 days and maintain this dose throughout the treatment period.

Panic disorders

Since this group of patients has an increased incidence of drug side effects, treatment should begin with the lowest possible dose. The transient worsening of anxiety at the onset of antidepressant medication can be prevented or cured by benzodiazepines, the dose of which gradually decreases as the symptoms of anxiety improve. The dose of Melipramin® can gradually increase to 75-100 mg per day (in exceptional cases up to 200 mg). The minimum duration of treatment is 6 months. Upon completion of treatment, it is recommended to cancel Melipramine® gradually.
Children:
The drug should be administered only to children over 6 years of age solely as a temporary adjuvant therapy for nocturnal enuresis with the exception of organic pathology.
Recommended doses are:
6-8 years (with a body weight of 20-25 kg): 25 mg / day.
9-12 years (with body weight 25-35 kg): 25-50 mg / day.
Older than 12 years and body weight above 35 kg: 50-75 mg / day.
Exceeding the recommended doses is justified only in those cases when there is no satisfactory response to therapy after 1 week of treatment with the drug in lower doses.
The daily dose in children should not exceed 2.5 mg / kg of body weight.
It is recommended to use the lowest dose from the above range of doses.
The daily dose is recommended to be taken only once after eating before going to bed. If nocturnal enuresis is noted in the early evening hours, it is recommended to divide the daily dose into two doses: one by day and one by night. Duration of treatment should not exceed 3 months. Depending on the changes in the clinical picture of the disease, the maintenance dose may be reduced. Upon completion of therapy, Melipramine® should be discontinued gradually.

MAO inhibitors: combinations with MAO inhibitors should be avoided, since these two types of drugs have a synergistic effect and their peripheral noradrenergic effects can reach toxic levels (hypertensive crisis, hyperpyrexia, myoclonus, agitation, convulsions, delirium, coma).
For safety reasons, imipramine should not be started earlier than 3 weeks after the end of therapy with MAO inhibitors (with the exception of moclobemide, a reversible MAO inhibitor, which requires a 24 hour break). The period without drug therapy lasting three weeks should also be observed when transferring the patient from imipramine to MAO inhibitors. Treatment with MAO inhibitors or imipramine should begin with small doses with a gradual increase in them with careful monitoring of clinical effects.

Inhibitors of microsomal liver enzymes: when combined with imipramine, inhibitors of the isoenzyme 2D6 cytochrome P-450 can lead to a decrease in the metabolism of the drug and, thus, lead to an increase in the concentration of imipramine in the blood plasma. Inhibitors of this type include preparations that are not substrates for the isoenzyme 2D6 cytochrome P-450 (cimetidine, methylphenidate), as well as drugs that are metabolized by this isoenzyme (i.e., many other antidepressants, phenothiazines, antiarrhythmics of class I (propafenone, flecainide)). All antidepressants related to selective serotonin reuptake inhibitors are inhibitors of the 2D6 cytochrome P-450 isoenzyme of various capacities. Accordingly, caution is required when combining imipramine with these drugs, and when transferring the patient from antidepressants that are selective serotonin reuptake inhibitors to imipramine (and vice versa), especially in cases of fluoxetine (given the long half-life of the drug). Tricyclic antidepressants can lead to an increase in plasma concentrations of antipsychotic drugs (competition at the level of hepatic enzymes).

Oral contraceptives, estrogens: a decrease in the effectiveness of antidepressants and the development of toxic effects of antidepressants sporadically observed in women taking oral contraceptives or preparations of estrogens and tricyclic antidepressants. Thus, the joint use of these drugs requires caution, and with the development of toxic effects, the dose of one of the drugs should be reduced.

Inductors of microsomal liver enzymes (alcohol, nicotine, meprobamate, barbiturates, antiepileptic drugs, etc.) increase the metabolism of imipramine and reduce its concentration in the blood plasma and antidepressant effects.

Preparations with m-cholin-blocking properties (for example, phenothiazines, preparations for the treatment of parkinsonism, H1-histamine receptor blockers, atropine, biperidine) when combined with imipramine are characterized by an increase in antimuscarinic effects and side effects (eg, paralytic ileus). Combination therapy with these drugs requires careful monitoring of the patient and careful selection of doses.

Drugs that depress the central nervous system: a combination of imipramine with drugs that cause depression of the central nervous system (eg, narcotic analgesics, benzodiazepines, barbiturates, drugs for general anesthesia) and alcohol leads to a marked increase in the effects and side effects of these drugs.

Antipsychotic drugs can increase the concentration in the blood plasma of tricyclic antidepressants, thus increasing the side effects. A dose reduction may be required. Combined use with thioridazine can cause severe arrhythmia.

Preparations of thyroid hormones can increase the antidepressant effect of imipramine, as well as its side effect on the heart, so their joint application requires special care.

Sympatholytics: imipramine may lead to a decrease in the antihypertensive effect of the adrenergic neuron blockers used together (guanethidine, betanidine, reserpine, clonidine, methyldopa). Thus, in patients requiring the joint use of drugs for the treatment of hypertension, it is necessary to use antihypertensive drugs of a different type (for example, diuretics, vasodilators or (β-blockers)).

Sympathomimetics: cardiovascular effects of sympathomimetics (mainly epinephrine, norepinephrine, isoprenaline, ephedrine, phenylephrine) are increased by imipramine.

Phenytoin: Imipramine reduces the anticonvulsant effect of phenytoin.

Quinidine: To avoid the risk of conduction disorders and arrhythmias, tricyclic antidepressants should not be used in combination with class I antiarrhythmics.

Indirect anticoagulants: tricyclic antidepressants inhibit the metabolism of indirect anticoagulants and increase their half-life. This leads to an increased risk of bleeding, so careful medical supervision and monitoring of prothrombin content is recommended.

Hypoglycemic drugs: the concentration of glucose in blood plasma with imipramine may change, therefore, at the beginning of treatment, at the end of it, as well as when changing the dose, it is recommended to monitor the concentration of glucose in the blood.