Drug interactions
Asenapine + Imipramine
Severity: Major
Asenapine and Imipramine: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Asenapine weakly inhibits CYP2D6, which may increase imipramine and desipramine concentrations. Both drugs also prolong the QT interval and cause sedation, so arrhythmia risk and drowsiness may be greater.
What this interaction means in plain words
Asenapine and Imipramine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Asenapine belongs to Central Nervous System; Imipramine belongs to Central Nervous System.
Why it happens
Additive QT prolongation and CNS depression, plus CYP2D6 inhibition by asenapine reducing imipramine clearance.
What to do
Obtain a baseline ECG and monitor the QTc, correcting electrolytes. Consider reducing the imipramine dose and monitor for tricyclic toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Other interactions of Asenapine
- Asenapine + Pimozide Contraindicated
- Asenapine + Thioridazine Contraindicated
- Asenapine + Vandetanib Contraindicated
- Adagrasib + Asenapine Major
- Alfentanil + Asenapine Major
- Alfuzosin + Asenapine Major
Frequently asked questions
Can I take Asenapine with Imipramine?
MediHelp rates the interaction as major. Asenapine and Imipramine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Asenapine weakly inhibits CYP2D6, which may increase imipramine and desipramine concentrations. Both drugs also prolong the QT interval and cause sedation, so arrhythmia risk and drowsiness may be greater.
How serious is the interaction between Asenapine and Imipramine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain a baseline ECG and monitor the QTc, correcting electrolytes. Consider reducing the imipramine dose and monitor for tricyclic toxicity.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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