Imipramine Therapy for Childhood Enuresis

Dosing and Treatment Guidelines

For childhood enuresis, imipramine should be dosed at 25-50 mg at bedtime for children aged 6 and older, with the higher dose given to children older than 9 years 1, 2
Treatment should be evaluated after 1 month 1, 2
If treatment is successful, taper to the lowest effective dose and ensure regular drug holidays of at least 2 weeks every third month to decrease the risk of tolerance 1, 2

Imipramine should only be used as third-line therapy for enuresis at tertiary care facilities due to safety concerns and side effects 1, 2, 3
The drug should be kept securely locked and out of reach of smaller siblings due to potential cardiotoxicity and fatal overdose risk 1, 2
ECG monitoring is essential before starting treatment if there is any history of palpitations or syncope in the child, or any sudden cardiac death or unstable arrhythmia in the family 1, 2

Approximately 50% of unselected children with enuresis respond to imipramine 1, 2
Potentially cardiotoxic - can cause conduction defects, arrhythmias, tachycardia 1, 2
Overdose may prove fatal 1, 2
Common side effects include mood changes, nausea, and insomnia 1, 2
When there is a partial response, desmopressin at the standard dose may be added, provided that fluid intake is restricted during evening and night 1, 2

Imipramine should only be considered after first-line therapies (enuresis alarm and desmopressin) have failed, due to its potential for serious side effects and the availability of safer alternatives 1, 2, 3