An older adult patient who is to begin taking imipramine (Tofranil) asks the nurse when the drug should be taken. The nurse will instruct the patient to:
a. divide the daily dose into two equal doses 12 hours apart.
b. take the entire dose at bedtime to minimize sedative effects.
c. take the medication once daily in the late afternoon.
d. take the medication once daily in the morning.
ANS: A
For many patients, taking the entire dose of a TCA at bedtime is advantageous for facilitating adherence, minimizing daytime sedation, and promoting sleep. However, older adult patients are at greater risk for cardiotoxicity and may experience intolerable effects on the heart if the entire dose is taken at once; therefore, twice-daily dosing is recommended in the elderly.
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