Imipramine for bed-wetting

Examples

Generic Name	Brand Name
imipramine hydrochloride	Tofranil

Imipramine medications come in tablet form and are usually taken in the evening. However, they may be taken midafternoon and at bedtime, which can help prevent accidental wetting that occurs early in the night.

How It Works

The exact way imipramine works to reduce bed-wetting is not known. It may affect the muscles of the bladder, or it may have some effect on the hormone that causes the kidneys to release urine (antidiuretic hormone, or ADH). It may work by causing the child to sleep more lightly.

Why It Is Used

Imipramine may help decrease bed-wetting for short periods of time for children 6 years and older. It most often is used with another form of treatment such as praise and encouragement (motivational therapy).

• Imipramine is most helpful for children who have normal-sized bladders. It also works well for children who had periods of bladder control before starting treatment.
• Imipramine works best for older children and children who do not have frequent daytime accidental wetting.

How Well It Works

When treated with imipramine, about 50% of children are able to control bed-wetting, at least for a short time. Once medication is stopped, only 25% of children who take imipramine for bed-wetting have long-term success.¹

Side Effects

Side effects that may occur with imipramine include:

• Constipation.
• Dry mouth.
• Nervousness.
• Anxiety.
• Difficulty sleeping (insomnia).
• Mood or personality changes.

Other side effects that are less common include:

• Headaches.
• Abdominal pain.
• Decreased appetite.
• Blurred vision.
• Uncontrollable crying.

If a child accidentally takes too much imipramine (accidental overdose), it can cause death. A child who has taken an overdose of imipramine may have:

• A very fast heartbeat.
• Seizures.
• Coma (cannot be awakened).
• Low blood pressure (hypotension).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Imipramine is being used less often because other medications have been more effective and have fewer risks. Because there have been rare reports of deaths associated with imipramine use, the benefits of using the medication need to outweigh the risks.

Imipramine usually is given for 3 to 4 months and then tapered off over 3 to 4 weeks until it is stopped altogether. It also may be used for shorter lengths of time such as for camps, overnight outings, or vacation.

Imipramine should not be used to treat children younger than 6 years of age.

Imipramine has not been shown to be helpful in stopping bed-wetting in older teens or children who have small bladders.

Imipramine is not recommended for long-term treatment of accidental wetting. Some children actually get worse the longer they take imipramine. The reason for this is not known.

If imipramine is stopped suddenly, without tapering off the dosage, accidental wetting usually begins again.

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Author:	Amy Fackler, MA Debby Golonka, MPH	Last Updated: November 14, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Peter Anderson, MD, FRCS(C) - Pediatric Urology
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