1 What is Tofranil?

Brand: Tofranil, Tofranil-PM

Generic: Imipramine

Tofranil is tricyclic antidepressant medication prescribed to treat depression (major depressive disorder). It is thought to work by increasing the activity of a certain chemical called serotonin in the brain.

Doctors also prescribe Imipramine tablets to treat enuresis or inability to control urination, in children. Imipramine oral tablets are available only with a prescription.

2 What to Know Before Using

Before using Tofranil, you must know all about the risks and complications associated with it.

The doctor will first consider the following before prescribing you with Tofranil:

Allergies: There is a possibility you might have allergies to Imipramine. Talk to your doctor and mention your allergies to food, drugs or animal substances.

Pediatric and Geriatric use: The efficacy and safety of Imipramine tablets in treating depression in children are not fully understood. Doctors may prescribe Imipramine for enuresis in children.

Elderly patients can use Imipramine, but they may need close monitoring to avoid problems in the kidneys, liver or the heart.

Pregnancy and breastfeeding: The doctor may weigh the benefits and possible risks of Imipramine if you are pregnant or breastfeeding. Imipramine is an FDA category C drug, which means that animal studies have shown that it cause harm to the fetus. If you got pregnant while on Imipramine treatment, call your doctor immediately.

It is not well known if Imipramine can be expressed through breastmilk. If you are taking Imipramine, call your doctor first before deciding to breastfeed.

Interactions with alcohol and tobacco: Before you take Imipramine, tell your doctor if you use tobacco or alcohol. Using tobacco may necessitate changes in dose of Imipramine. Alcohol is also known to increase side effects of Imipramine. It is recommended you stop using tobacco or alcohol while having Imipramine treatment.

Medical conditions: Imipramine may worsen symptoms of certain medical conditions. Make sure to tell the doctor your medical history and present condition.

The doctor may want to know if you have the following conditions before prescribing Tofranil:

  • Diabetes
  • Glaucoma, specifically angle-closure type
  • Heart problems, like a recent heart attack. Imipramine must not be used in patients with recent heart attack
  • Problems in the blood vessels such as atherosclerosis
  • Bipolar disorders, either manic or depressive
  • Schizophrenia
  • History of mania
  • Having or having history of seizures
  • Urinary retention or having a history of it. Imipramine may worsen urinary retention
  • Kidney and liver disease

Drug interactions: Imipramine has several drug interactions. Make sure to tell the doctor all the medicines you take before using Tofranil. Here are the medicines that should never be used with Imipramine.

If you use these medications, the doctor may switch to other alternatives for Tofranil or change the medications you take:

  • Amifampridine
  • Bepridil
  • Cisapride
  • Dronedarone
  • Furazolidone
  • Grepafloxacin
  • Iproniazid
  • Isocarboxazid
  • Levomethadyl
  • Linezolid
  • Mesoridazine
  • Methylene Blue
  • Metoclopramide
  • Moclobemide
  • Pargyline
  • Phenelzine
  • Pimozide
  • Piperaquine
  • Procarbazine
  • Ranolazine
  • Rasagiline
  • Saquinavir
  • Selegiline
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Tranylcypromine
  • Ziprasidone

The following medications are also incompatible with Imipramine. However, you may also need these medications.

In that case, the doctor may change the dose or schedule when to take medications:

  • Acecainide
  • Albuterol
  • Alfuzosin
  • Almotriptan
  • Amiodarone
  • Amisulpride
  • Amitriptyline
  • Amoxapine
  • Amprenavir
  • Anagrelide
  • Apomorphine
  • Aprindine
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether
  • Asenapine
  • Astemizole
  • Atazanavir
  • Azimilide
  • Azithromycin
  • Bretylium
  • Bupropion
  • Buserelin
  • Chloral Hydrate
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Clarithromycin
  • Clomipramine
  • Clonidine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Darifenacin
  • Darunavir
  • Dasatinib
  • Degarelix
  • Delamanid
  • Desipramine
  • Deslorelin
  • Desvenlafaxine
  • Dextromethorphan
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Donepezil
  • Droperidol
  • Enflurane
  • Epinephrine
  • Erythromycin
  • Escitalopram
  • Etilefrine
  • Fentanyl
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Foscarnet
  • Frovatriptan
  • Gatifloxacin
  • Gemifloxacin
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Halothane
  • Histrelin
  • Hydroxychloroquine
  • Ibutilide
  • Iloperidone
  • Indacaterol
  • Iobenguane I 123
  • Isoflurane
  • Isradipine
  • Ivabradine
  • Lapatinib
  • Leuprolide
  • Levalbuterol
  • Levofloxacin
  • Levomilnacipran
  • Levothyroxine
  • Lidoflazine
  • Lorcainide
  • Lorcaserin
  • Lumefantrine
  • Mefloquine
  • Meperidine
  • Methadone
  • Methoxamine
  • Metronidazole
  • Midodrine
  • Mifepristone
  • Mirtazapine
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nafarelin
  • Naratriptan
  • Nefopam
  • Nilotinib
  • Norepinephrine
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olodaterol
  • Ondansetron
  • Oxilofrine
  • Oxymorphone
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentamidine
  • Perflutren Lipid Microsphere
  • Phenylephrine
  • Pixantrone
  • Posaconazole
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Risperidone
  • Sematilide
  • Sertindole
  • Sertraline
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Spiramycin
  • Sulfamethoxazole
  • Sultopride
  • Sumatriptan
  • Sunitinib
  • Tapentadol
  • Tedisamil
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Toremifene
  • Tramadol
  • Trazodone
  • Trifluoperazine
  • Trimethoprim
  • Triptorelin
  • Tryptophan
  • Umeclidinium
  • Vandetanib
  • Vardenafil
  • Vasopressin
  • Vemurafenib
  • Venlafaxine
  • Vilanterol
  • Vilazodone
  • Vinflunine
  • Voriconazole
  • Vortioxetine
  • Zolmitriptan
  • Zotepine

The following drugs may increase the side effects of Imipramine, but taking them together may be necessary.

In that case, the doctor may change the dose or schedule when to take them:

  • Acenocoumarol
  • Alprazolam
  • Arbutamine
  • Atomoxetine
  • Butalbital
  • Cannabis
  • Carbamazepine
  • Cimetidine
  • Citalopram
  • Dicumarol
  • Fluvoxamine
  • Fosphenytoin
  • Mibefradil
  • Phenindione
  • Phenprocoumon
  • Phenytoin
  • Ritonavir
  • S-Adenosylmethionine

3 Proper Usage

To use Tofranil properly, you must follow all instructions given by your doctor. Here are the following doses for Imipramine:

Imipramine capsule forms for depression:

  • Adults – Dose starts at75 mg per day, and the dose is adjusted by the doctor as needed. The dose should not exceed 200 mg per day unless you are closely monitored in the hospital.
  • Teenagers and elderly- dose starts at 25 mg to 50 mg per day, and the dose is adjusted by the doctor as needed. The dose usually should not exceed 100 mg per day.
  • Children – Dose is determined by the doctor.

Imipramine tablet forms for depression:

  • Adults – Dose starts at75 mg per day, and the dose is adjusted by the doctor as needed. The dose should not exceed 200 mg per day unless you are closely monitored in the hospital.
  • Teenagers and elderly- dose starts at 30 mg to 40 mg per day, and the dose is adjusted by the doctor as needed. The dose usually should not exceed 100 mg per day.
  • Children – Dose is determined by the doctor.
  • Imipramine tablet forms for enuresis
  • Children 6 years of age and older – Dose starts at 25 mg per day, taken at one hour before bedtime.
  • Children younger than 6 years old - dose is determined by the doctor.

The doctor will determine the dose of Tofranil so you may be given a dose different from the ones stated. The dose of Imipramine is different from patient to patient. Always follow the prescribed dose to avoid adverse effects.

Tofranil medication comes with a medication guide. Always read this guide carefully, including the warnings. Ask your doctor if you have any questions.

4 Precautions to Take

In using Tofranil, you must be careful and take some precautions as advised by your doctor. Like any other antidepressant, Tofranil comes with a boxed warning stating the increased risk of suicidal thinking and behavior in children, adolescents, and young adults.

If you are taking Imipramine and you have suicidal thoughts, call your doctor immediately. If you are a parent of a child taking Imipramine, make sure to do appropriate monitoring and observe for worsening of symptoms, unusual changes in behavior, or suicidal behavior.

Aside from suicidal behavior, Imipramine may cause agitation, irritability, and other abnormal behaviors. Some patients feel more depressed while others report having insomnia, aggression, recklessness and mania. If you have these behaviors when taking Imipramine, call your doctor immediately. The doctor may change the dose of Imipramine if these symptoms become too severe.

Certain medications are not appropriate to use with Imipramine due to the risk of serious adverse effects. Some of these medications include monoamine oxidase (MAO) inhibitor (e.g., isocarboxazid, linezolid), methylene blue injection, phenelzine, selegiline, or tranylcypromine. If you use these medications, wait for 2 weeks before taking Imipramine.

You can resume taking these medications at least two weeks after last taking Imipramine. Taking these medications together with Imipramine may result to severe high blood pressure, confusion, agitation, restlessness, stomach cramps, high fevers, and convulsions.

Never stop using Imipramine without notifying your doctor. Imipramine requires gradual tapering of the dose when it is discontinued.

Abruptly stopping the medication can cause withdrawal symptoms such as breathing difficulties, chest pain, confusion, diarrhea, dizziness, lightheadedness, fast heart rate, headache, increased sweating, agitation, muscle pain, nausea, restlessness, runny nose, insomnia, trembling or shaking, unusual fatigue and changes in vision.

Imipramine may cause serotonin syndrome, caused by the drastic increase of serotonin in the brain, when taken with certain medications such as buspirone, fentanyl, lithium, methylene blue injection, tryptophan, St. John's wort, or some pain or migraine medicines (e.g., rizatriptan, sumatriptan, and tramadol).

Symptoms of serotonin syndrome include increased heart rate, dilated pupils, shivering, uncontrollable jerking or twitching of the body, agitation, and hallucinations.

Serotonin syndrome can be life-threatening and can cause cardiac arrest. Call your doctor if you use these medications.
Alcohol and other CNS depressants may enhance drowsy effects of Imipramine.

Some examples of CNS depressants include antihistamines, medicines for colds and flu, tranquilizers, sedatives, prescription pain medications, narcotics, anesthetics (including dental anesthetics), muscle relaxants, and medications for seizures. Call your doctor first before taking any of these medications when taking Imipramine.

Before having any kind of surgery or dental work, always tell your health provider that you are taking Imipramine. Imipramine may cause changes in blood sugar levels so it may alter urine or blood tests that check your blood sugar.

Imipramine may also make you more sensitive to sunlight. Always use sunscreen outdoors and avoid using sunlamps or tanning beds. Note that Imipramine may cause drowsiness, which can affect your ability to drive or operate heavy machinery. 

If you are taking Imipramine, do not take any other prescription medication, supplement, herbal product or over-the-counter medication without calling the doctor.

5 Potential Side Effects

Make sure you meet with your doctor in using Tofranil to avoid unwanted potential side effects.

Tofranil may cause the following side effects, which may require medical attention:

  • Agitation
  • Abdominal pain
  • Vision changes, like blurring or double vision
  • Tingling, burning, crawling or sensation of ‘pins and needles.'
  • Chest pain
  • Clay-colored stools
  • Cold sweats
  • Confusion
  • Tinnitus, or continuous buzzing or ringing in the ears
  • A cough or hoarseness
  • Reduced frequency of urination
  • Dribbling urine
  • Dizziness, lightheadedness, or actual fainting when suddenly rising up from sitting or lying position
  • Dryness of mouth
  • Having hallucinations
  • Having delusions or false beliefs
  • Unusual changes in behavior, like being paranoid
  • Aggression or hostility
  • Fever, with or without chills
  • Flushed, dry skin
  • Hearing loss
  • Loss of control of muscles on the face, arms or legs
  • Irritability
  • Lack of coordination
  • Fatigue
  • Lethargy
  • Lack of body coordination or loss of balance
  • Muscle spasms or jerking of the extremities
  • Trembling of the muscles, jerking or stiffness
  • Having nightmares
  • Pain in the arms, jaw, back or neck
  • Painful or difficult urination
  • Having purple or red pinpoint spots on the skin
  • Rapid weight gain
  • Redness or flushing of the face, neck, chest or arms
  • Restlessness
  • Seizures
  • Shakiness and unsteady gait
  • Slowness of speech
  • Sore throat
  • Stiffness of the limbs
  • Stupor, or being in continually sleepy state
  • Trouble sleeping
  • Weakness of the arms, legs or feet
  • Yellowing of eyes and skin

Here are the symptoms of Tofranil overdose, which requires emergency attention:

  • Bluish color of the skin of fingernails, lips, palms and skin
  • Cold clammy skin
  • Reduced awareness or responsiveness
  • Difficulty breathing
  • Disorientation
  • Hallucinations
  • Fast weak pulse
  • Irregular, slow or fast breathing
  • Severe drowsiness

If these symptoms occur, get emergency help, call your doctor and go to the nearest hospital. Here are side effects of Imipramine that are bothersome but do not always require medical attention.

These symptoms tend to fade as your body becomes accustomed to Tofranil:

  • Enlarged pupils of the eyes
  • Black tongue
  • Reduced interest in sex
  • Constipation
  • Enlargement of the breast in men (gynecomastia)
  • Hives
  • Sensitivity to light
  • Increased urge to urinate at night
  • Redness or discoloration of skin
  • Unpleasant changes in taste
  • Swelling of the testicles
  • Swelling of the breasts in males and females
  • Expressing milk from the breasts
  • Waking up to urinate at night

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