https://www.medicalnewstoday.com/articles/dementia-and-overactive-bladder
There are several types of urinary incontinence. One of these – especially common in people with dementia – is an overactive bladder. This causes the feeling of a sudden and intense need to pee, and frequent peeing.
Medical management of neurogenic bladder with oral therapy
Imipramine
Imipramine is a tricyclic antidepressant that is currently rarely used for the treatment of depression given the availability of therapy with more favorable side effect profiles. These medications have, however, been shown to relax the detrusor muscle by acting as muscarinic receptor agonist, directly inhibits smooth muscle and also decreases bladder overactivity by blocking the reuptake of serotonin. Other pharmacological effects of imipramine include the peripheral blockade of noradrenaline, stimulating the beta receptors at dome of the bladder which in turn decreases bladder contractility (55). Imipramine has been historically used to treat nocturnal enuresis in children and adults, but has also been effectively used to treat neurogenic DO. Cole and Fried studied the use of imipramine in ten patients with NGB with incontinence secondary to DO. Six patients noted improvements in their urinary incontinence (three with complete resolution of incontinence) and bladder capacity as well as compliance were improved in responders (56).
In clinical trials imipramine has also been shown to increase compliance in the pediatric NGB (57,58). To date, tricyclic antidepressants have no RCTs to support their use for urologic indications and have been related to cardiac events so must be used with caution, especially in the elderly (Table 1).
| Imipramine | 10–45 mg divided BID or TID | Dizziness, drowsiness, dry mouth, constipation, blurred vision, nightmares, dyspepsia, breast swelling, lethal cardiac arrhythmia at high doses (overdose) |
