Drug General Information (ID: DDIXH7LOVC)
Drug Name			Imipramine		Drug Info		Bismuth subsalicylate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Antidiarrheals
Structure

Mechanism of Imipramine-Bismuth subsalicylate Interaction (Severity Level: Moderate)
Competitive binding of plasma proteins Click to Show/Hide Mechanism Graph
Drug Name		Imipramine				Bismuth subsalicylate
Mechanism		Competition for plasma protein binding sites				Competition for plasma protein binding sites
Key Mechanism Factor 1
		Factor Name		Plasma protein binding
		Factor Description		Plasma protein binding refers to the degree of binding of a drug to proteins in the blood, and the lower the degree of binding, the more efficiently the drug can cross cell membranes or diffuse. Plasma protein binding alters the distribution and therapeutic characteristics of the drugs.
Mechanism Description		Increased plasma concentration of Bismuth subsalicylate and Imipramine due to competitive binding of plasma proteins

Recommended Action
Management		Pharmacologic response to imipramine should be monitored more closely whenever a salicylate is added to or withdrawn from therapy, and the imipramine dosage adjusted as necessary. Patients should be advised to notify their physician if they experience increased adverse effects of imipramine such as dry mouth, constipation, urinary retention, blurred vision, palpitations, and tachycardia.

References
1	Juarez-Olguin H, Jung-Cook H, Flores-Perez J, Asseff IL "Clinical Evidence of an Interaction Between Imipramine and Acetylsalicylic Acid on Protein Binding in Depressed Patients." Clin Neuropharmacol 25 (2002): 32-36. [PMID: 11852294]