Imipramine Treatment of Enuresis

To the Editor .—We should like to comment on the use of imipramine pamoate in the treatment of childhood enuresis. 1 The case reports of toxic overdosage with this tricyclic anti-depressant tranquilizer appear to be increasing in direct proportion to the general use of this drug. Severe symptoms may occur after the ingestion of 10 mg/kg, inevitable severe symptoms with ingestion of 20 mg/kg, and the potential fatal dose in man is 40 mg/kg. A fatal outcome was reported in an 18-month-old child who ingested 14 tablets (350 mg). 2-7 When physicians prescribe this medication, they should ensure that it is dispensed in a safety packaging device. Perhaps it should be reserved for the enuretic seriously disturbed by the problem.