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A tertiary amine tricyclic antidepressant that is thoughtto exert its therapeutic effect by inhibiting the reuptake of serotoninand norepinephrine centrally. A major metabolite is N-desmethylimipramine(desipramine), also used as an antidepressantdrug. Desipramine differs from imipramine in being a betterblocker of norepinephrine, rather than serotonin, uptake. Sideeffects, including sedation and drowsiness, dry mouth, urinaryretention, constipation, and orthostatic hypotension, are probablydue to the anticholinergic, anti-α-adrenergic, and antihistaminergicreceptor-blocking properties. Imipramine should not be usedin conjunction with a monoamine oxidase inhibitor or othertreatment that increases catecholamine concentrations (e.g.,drugs containing sympathomimetic amines). Imipramine shouldbe avoided in patients with cardiovascular disease or seizure disorder,or in those who may abuse alcohol, as imipramine lowersseizure threshold, can produce cardiovascular toxicity and maypotentiate the effects of alcohol. Imipramine intoxication caninclude CNS abnormalities (e.g., drowsiness, stupor, coma, andextrapyramidal symptoms), cardiac arrhythmia, and respiratorydepression. Children appear to be particularly vulnerable to thecardiotoxic and seizure-inducing effects of high doses of imipramine.The oral LD50 in female rats is 305 mg/kg.
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