Pramin 25

Indications

Pramin is indicated for:

• Treatment of depressive illnesses.
• Management of nocturnal enuresis in children.

Always consult a registered healthcare professional before using this medication.

Description

Pramin is a unique tricyclic antidepressant belonging to the dibenzazepine class. Although its precise mechanism of action is not fully understood, it does not primarily stimulate the central nervous system. The therapeutic effect is believed to arise from enhancing adrenergic synapses by inhibiting norepinephrine reuptake at nerve endings. Its effectiveness in treating childhood enuresis is thought to be distinct from its antidepressant properties.

Pharmacology

Imipramine, the active ingredient in Pramin, works by blocking the reuptake of neurotransmitters norepinephrine and serotonin. It binds to the sodium-dependent serotonin transporter and norepinephrine transporter, increasing the availability of these neurotransmitters in the synaptic cleft. This action is thought to alleviate depressive symptoms by promoting changes in neurotransmission and brain physiology.

Dosage & Administration

For Depression:

• Adults: Start with up to 75 mg daily in divided doses, gradually increasing to 150-200 mg (up to 300 mg for hospitalized patients).
• Elderly: Begin with 10 mg daily, increasing to 30-50 mg daily as needed.
• Children: Not recommended for depressive disorders.

For Nocturnal Enuresis:

• Children (7-8 years): 25 mg.
• Children (8-11 years): 25-50 mg.
• Children (over 11 years): 50-75 mg at bedtime (maximum dosage).

Treatment duration, including gradual withdrawal, should not exceed 3 months without a full physical examination.
Always consult a registered healthcare professional before using this medication.

Interactions

Methylphenidate may enhance the effects of imipramine; dosage adjustment may be necessary. Pramin can increase the sedative effects of alcohol. Serious interactions, including dangerously high blood pressure, can occur if imipramine is combined with monoamine oxidase inhibitors (MAOIs). Patients on MAOIs must discontinue them at least 14 days before starting imipramine and vice versa. The anticholinergic effects of imipramine may be intensified when used with other anticholinergic medications.

Contraindications

Imipramine should not be used concurrently with or within 14 days of MAO inhibitors due to the risk of severe interactions, including hypertensive crises. It is contraindicated in patients with significant hepatic or renal impairment, a history of blood disorders, hypersensitivity to the drug or similar tricyclic antidepressants, and those recovering from a myocardial infarction. It is also not recommended for patients with convulsive disorders or glaucoma.

Side Effects

Common side effects may include dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, dizziness, and impaired coordination. Severe dry mouth may require dosage adjustment. Pramin has been associated with fluctuations in blood pressure and heart rate, and serious cardiovascular events like heart attacks and strokes have been reported. Other side effects may include confusion, insomnia, anxiety, nausea, and gastrointestinal discomfort.

Pregnancy & Lactation

Pregnancy Category D: Limited evidence suggests that imipramine may be excreted in breast milk and poses risks to the fetus.

Precautions & Warnings

Pramin should be used with caution under close medical supervision in patients with benign prostatic hyperplasia, urinary retention, and glaucoma. The sedative effects may be amplified when taken with other CNS depressants. Pramin can increase heart rate and may not be suitable for those with cardiovascular conditions. Close monitoring for suicidal thoughts is recommended, particularly when starting treatment or adjusting dosages.

Overdose Effects

Children are particularly sensitive to imipramine overdose, which can be severe and potentially fatal in infants and young children.

Therapeutic Class

Tricyclic antidepressants and related medications.

Storage Conditions

Store below 30°C in a cool, dry place away from light. Keep out of reach of children.