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:
- 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
- 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:
- Methylene Blue
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:
- Arsenic Trioxide
- Chloral Hydrate
- Iobenguane I 123
- Morphine Sulfate Liposome
- Peginterferon Alfa-2b
- Perflutren Lipid Microsphere
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
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:
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.