Imipramine in the Management of Diarrhea-Predominant IBS

Mechanism of Action and Effects

Tricyclic antidepressants like imipramine modify gut motility and alter visceral nerve responses, with effects occurring before any impact on mood 1, 2
Imipramine normalizes rapid small bowel transit seen in diarrhea-predominant IBS, as noted by the British Society of Gastroenterology guidelines 1, 2

Imipramine can be beneficial for patients with diarrhea-predominant IBS at doses of 25-100 mg/day, according to Clinical Gastroenterology and Hepatology 1, 3, 4
Constipation is the most significant gastrointestinal side effect of tricyclic antidepressants including imipramine 1, 2
The American College of Gastroenterology or similar guideline societies may recommend tricyclic antidepressants for IBS, but the provided text does not specify this, however it does mention that tricyclic antidepressants are best avoided if constipation is a major feature 1, 2

Nocturnal dosing of imipramine often produces the best response with fewer daytime side effects 1
When prescribing tricyclic antidepressants like imipramine, clearly explain they are being used for gut-brain modulation, not depression 5