Imipramine in nocturnal enuresis

• imipramine is the most often used tricyclic antidepressant in the management of nocturnal enuresis
• there is evidence that patients have similar response rates with tricyclic antidepressants in comparison to desmopressin and that the relapse rate is equally high
• not used as first-line treatment - because of potential cardiac side-effects - a review on the management of nocturnal enuresis concluded that (2) "..The risks of using imipramine generally outweigh any potential benefit in tackling bedwetting"
• common adverse effects include constipation, dry mouth, blurred vision
• the summary of drug characteristics must be consulted before prescribing this drug

NICE state guidance regarding the use of tricyclics in the management of nocturnal enuresis (3). Summary points are:

• tricyclics should not be used as the first-line treatment for bedwetting in children and young people
• if offering a tricyclic, imipramine should be used for the treatment of bedwetting in children and young people
  • imipramine should be considered for children and young people with bedwetting who:
    • have not responded to all other treatments and
    • have been assessed by a healthcare professional with expertise in the management of bedwetting that has not responded to an alarm and/or desmopressin
• relapse rates for use of tricyclics are relatively high (for example, more than two out of three children and young people will relapse after a 3-month course of imipramine)
• the initial treatment course is for 3 months and further courses may be considered
• there are particular dangers of imipramine overdose, and the importance of taking only the prescribed amount and storing it safely should be stressed
• a medical review should be performed every 3 months in children and young people who are using repeated courses of imipramine for the management of bedwetting
• when withdrawing imipramine then withdraw imipramine gradually when stopping treatment for bedwetting in children and young people

Some experts suggest screening for long QT syndrome with an electrocardiogram before initiation of therapy (4)

Reference:

1. Lister-Sharp D et al (1997). A systematic review of the effectiveness of interventions for managing childhood nocturnal enuresis. CDR report 11 1997. NHS Centre for reviews and dissemination. University of York.
2. Drug and Therapeutics Bulletin (2004); 42(5):33-7.
3. NICE (October 2010).Nocturnal enuresis - The management of bedwetting in children and young people
4. Gomez Rincon M, Leslie SW, Lotfollahzadeh S. Nocturnal Enuresis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545181/