Key points
- The label covers depression and, as temporary added therapy, bedwetting in children 6 and older.
- MedlinePlus says it is occasionally used for panic disorders and eating disorders. Those uses are off-label.
- The boxed warning covers suicidal thoughts and behavior in children, teens and young adults.
- It must not be combined with MAOIs, and heart disease calls for extreme caution.
- MedlinePlus says older adults should not usually take it.
What imipramine is
Imipramine is a tricyclic antidepressant, one of the older groups of these medicines. MedlinePlus says it comes as a tablet and a capsule. The tablets and capsules are different salts of the drug, and the bedwetting use applies to the tablets. It is sold under its generic name.
NIMH says older antidepressants such as tricyclics are associated with more side effects than those prescribed most often today, yet they can suit some people. A long history does not make a medicine right or wrong for you. It simply means there is a lot on its label to talk through.
What it is approved for, and off-label uses
The FDA label for imipramine tablets lists two uses. The first is relief of symptoms of depression, with what the label calls endogenous depression more likely to be relieved than other kinds. The second is temporary added treatment to reduce bedwetting in children 6 and older, after possible physical causes have been ruled out. The label notes this effect may fade with continued use.
MedlinePlus says imipramine is also used occasionally to treat panic disorders and eating disorders. These uses are off-label. NIMH describes panic disorder as a type of anxiety disorder, but the FDA labels do not list anxiety as an approved use. Outside bedwetting, the label says safety and effectiveness have not been established in children.
How it is thought to work
The label says the mechanism is not definitely known. Its working idea is that imipramine blocks the uptake of norepinephrine at nerve endings, which strengthens signaling between nerve cells. The label also says the way it reduces bedwetting is thought to be separate from its antidepressant effect, and MedlinePlus says there is not enough information to explain it.
What taking it can be like
The label says one to three weeks of treatment may be needed before the best effects show, and MedlinePlus says it may take that long or longer. During that wait, it helps to keep brief notes on sleep, energy and side effects so your prescriber can see the pattern.
Do not stop imipramine without talking to your prescriber, who will probably want to lower the amount gradually. MedlinePlus also says to keep taking it even if you feel well.
It can make you drowsy, so MedlinePlus says not to drive or use machinery until you know how it affects you. Your skin may become more sensitive to sunlight, and the label says it can strengthen the effects of alcohol. MedlinePlus also says cigarette smoking may make it less effective, so tell your prescriber if you use tobacco.
Side effects and warnings
Boxed warning: in short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, teens and young adults. No such increase appeared in adults over 24, and adults 65 and older had a lower risk. Watch closely for worsening mood or unusual behavior at any age, and tell the prescriber about changes. Anyone in crisis should call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page has more.
MedlinePlus lists effects that include nausea, drowsiness, tiredness, excitement or anxiety, nightmares, dry mouth, changes in appetite or weight, constipation, trouble urinating, changes in sex drive and heavy sweating. Fever, sore throat or other signs of infection, trouble swallowing, severe rash, yellow skin and irregular heartbeat need a call right away.
- MAOIs: combining them is contraindicated, and the label warns of very high fever, severe seizures and possibly fatal effects. It calls for at least 14 days between them.
- Heart: it is contraindicated during acute recovery after a heart attack. People with heart disease need extreme caution and heart monitoring at all dosage levels.
- The label also asks for extreme caution with a history of urinary retention, narrow-angle glaucoma or seizures, or with thyroid problems or thyroid medicine.
- Other medicines: it can block the effects of guanethidine and clonidine, and methylphenidate may raise its levels.
- Low sodium has occurred, with greater risk in older adults and people taking diuretics.
- Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.
Online care in Pennsylvania and New York
Imipramine is taken at home, and its label does not limit it to a certified healthcare setting. A video visit can cover your history, mood, side effects and questions. It cannot provide heart monitoring, so anyone with heart disease should ask how that would be handled. If this is about a child, ask us what ages our psychiatrist sees.
A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment and online anxiety treatment by secure video, for people physically located in Pennsylvania or New York during each visit. Our therapists do not prescribe. Read about medication management for what follow-up covers.
Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication contact form.
Common questions
Is imipramine FDA-approved for anxiety or panic disorder?
No. The FDA label for the tablets lists depression and childhood bedwetting. MedlinePlus says imipramine is occasionally used for panic disorders, and that use is off-label. NIMH counts panic disorder among the anxiety disorders, but the label does not list anxiety. Talk with your prescriber about the possible risks of using it for your condition.
Why is imipramine used for bedwetting in children?
The label says it may help as temporary added therapy for children 6 and older, after possible physical causes have been ruled out by tests. It says the effect may lessen with continued use, and safety for long-term use has not been established. The boxed warning still applies, so parents should talk through the risks with their child's doctor.
Is imipramine safe if I have heart problems?
The label asks for extreme caution in people with heart disease, because of possible rhythm problems, heart failure, heart attack and stroke, and says these patients need monitoring at all dosage levels. It should not be used during acute recovery after a heart attack. Tell your prescriber about any heart history, including recent events, before deciding anything together.
Sources
Published by Locascio Wellness. Published November 5, 2026. Clinically reviewed by Kenneth M. Levy, DO, Psychiatrist (Pennsylvania license OS007464L). This page is general information, not medical advice or a diagnosis.