Tofranil (Imipramine): Uses, Side Effects, Warnings, & More

What Is Tofranil (Imipramine)?

Tofranil, also known as imipramine, is an antidepressant medication that belongs to the class of tricyclic antidepressants. It works by affecting neurotransmitters in the brain, such as serotonin and norepinephrine, which play a role in mood regulation. Imipramine is primarily used to treat conditions like depression and nocturnal enuresis (bedwetting) in children aged six years and older.¹

How Does Imipramine Work?

Imipramine works by helping to balance certain chemicals in the brain that affect our mood. It aims to increase the levels of body chemicals like serotonin and norepinephrine, which may alleviate depression symptoms. This balance of chemicals is important for improving depression symptoms and a person’s sense of well-being.

What Is Imipramine Used to Treat?

Imipramine is FDA-approved to treat two main conditions: bedwetting and depression in children aged 6 and older. When a medication is FDA-approved, it means that the U.S. Food and Drug Administration has carefully reviewed its safety and effectiveness for specific uses.

Imipramine Warnings & Precautions

Taking imipramine requires careful attention to warnings and precautions due to potential risks. Patients, especially those with major depressive disorder (MDD), should be monitored closely for clinical worsening, suicidality, and unusual behavior, particularly during initial treatment or dosage changes.²

Imipramine has been associated with side effects like anxiety, agitation, and insomnia in both adults and children. Furthermore, patients with cardiac issues, narrow-angle glaucoma, urinary retention history, or seizure disorders should exercise extreme caution while using imipramine. It’s crucial to consult a healthcare provider to address concerns and determine the appropriate course of action.

Precautions for taking imipramine include:¹

• Use during pregnancy and breastfeeding: Imipramine’s effects on pregnant women and breastfeeding infants are not fully understood. Since the drug may pass into breast milk, nursing mothers are generally advised to avoid it due to potential harm to the child.
• Heart health: Imipramine may affect heart function, especially in individuals with cardiovascular disease. Electrocardiogram (ECG) monitoring is recommended, and patients with any heart-related issues should be closely watched during treatment.
• Suicidal thoughts: Depression itself carries a risk of suicide, and imipramine treatment could sometimes lead to worsening symptoms, such as suicidal ideation.
• Photosensitivity: Imipramine can make the skin more sensitive to sunlight, potentially leading to skin reactions. Patients should limit sun exposure and consider using protective measures when outdoors.
• Blood sugar: Imipramine use has been associated with both elevation and lowering of blood sugar levels. Diabetic patients should monitor their blood sugar levels carefully while taking this medication.
• Kidney and liver function: Individuals with impaired kidney or liver function should use imipramine cautiously, as the drug’s effects could be more pronounced in these cases.
• Fever and sore throat: Patients who develop fever and sore throat while on imipramine should have their blood counts checked, as the drug might affect white blood cell levels.
• Geriatric use: Elderly individuals, especially those with heart or liver issues, should start with lower doses of imipramine due to potential age-related changes in metabolism and organ function.
• Pediatric use: Imipramine is FDA-approved for bedwetting in children aged 6 and older, but its use in children younger than age 6 isn’t well established.

Interactions With Imipramine

Imipramine interactions are important to understand, as they can impact its effectiveness and safety. For instance, the way your body metabolizes imipramine, mediated by the enzyme CYP2D6, can be affected by certain medications. Some drugs can inhibit this enzyme, causing imipramine levels to rise and potentially leading to adverse effects.

To ensure safe use, it’s essential to discuss all medications, substances, and herbs you’re taking with your healthcare provider before starting imipramine treatment.

6 substances you should avoid while taking imipramine include:¹

• CYP2D6 metabolism: Imipramine is broken down in the body by an enzyme called CYP2D6. Some people’s enzymes work slower, making imipramine stay in the body longer. Certain drugs can also slow down this enzyme, which can make imipramine levels go up. If you’re taking these drugs with imipramine, your doctor might need to watch you closely and adjust your imipramine dose.
• Hepatic enzyme interactions: Some drugs, like cimetidine and fluoxetine, can make imipramine levels go higher. Other medications, such as barbiturates and phenytoin, can lower them. This might mean your imipramine dose needs to be changed if you’re also taking these other drugs.
• Anticholinergic drugs: If you’re taking imipramine along with anticholinergic drugs, it’s important to keep a close eye on any strong effects they might cause, like problems with digestion.
• Sympathomimetic amines: Products with sympathomimetic amines (like some decongestants) can make imipramine’s effects stronger and cause issues.
• Blood pressure medications: Using imipramine and blood pressure medications together can make their effects stronger.
• Alcohol: Mixing alcohol with imipramine can make you feel extra drowsy and sleepy, so it’s better to avoid it.

Side Effects of Imipramine

Imipramine can lead to side effects that happen because of the medication’s direct effects on your body. Some of these might include dry mouth, headaches, nausea, diarrhea, and weight changes.

It’s worth noting that while rare, imipramine can cause serious side effects. You should get in touch with your doctor right away if you notice things like unusual bleeding, chest pain, numbness or weakness, hallucinations, difficulty urinating, or seizures. These serious effects require immediate medical attention.

Common Side Effects of Imipramine

Common side effects of imipramine might include dry mouth, headaches, constipation, nausea, vomiting, diarrhea, and changes in weight. While these effects are generally manageable and might go away as your body gets used to the medication, it’s important to let your doctor or pharmacist know if they become bothersome or persist.

Common side effects of imipramine include:*¹

• Dry mouth
• Blurred vision
• Headaches
• Nausea
• Constipation
• Vomiting
• Loss of appetite
• Diarrhea
• Changes in weight
• Profuse sweating

*All medications, including imipramine, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Serious Side Effects of Imipramine

Serious side effects of imipramine can occur, requiring immediate medical attention. These might include cardiovascular issues, psychiatric problems, tremors, seizures, vision problems, urinary tract infections, unusual bleeding or bruising, and alterations in blood sugar levels.

If you experience any of these severe symptoms, it’s important to reach out to your healthcare provider promptly. While many effects are temporary or go away as your body adjusts, these more serious side effects require swift medical attention.

Serious side effects of imipramine may include:¹

• Irregular heartbeat
• High blood pressure
• Stroke
• Anxiety
• Numbness
• Tremors
• Seizures
• Tinnitus unusual sensation like ringing in the ears
• Urination problems

*All medications, including imipramine, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Antidepressant Discontinuation

Antidepressant discontinuation syndrome, also known as antidepressant withdrawal, can occur when someone suddenly stops or reduces their antidepressant medication. The main symptoms of discontinuation syndrome include dizziness, malaise (discomfort), headaches, nausea, tingling sensations, loss of balance, irritability, agitation, and insomnia.³

If you experience two or more of these symptoms within three days after stopping or reducing your medication, and they can’t be explained by a relapse of depression or another medical condition, it’s essential to seek medical attention.

Allergic Reactions to Imipramine

Allergic reactions to imipramine are possible and can manifest as skin rash, itching, hives, or increased sensitivity to sunlight. It’s important to note that if someone is allergic to desipramine, they may also have a cross-sensitivity to imipramine, as they belong to the same class of medications.

It’s advisable to discuss your concerns with a healthcare professional to determine the best course of action and minimize the risk of adverse reactions.

Allergic reactions to imipramine may include:

• Urticaria (hives)
• Petechiae (small red or purple spots on the skin)
• Skin rash
• Itching
• Edema (swelling of the face and tongue)
• Photosensitization (increased sensitivity to sunlight)
• Drug fever
• Cross-sensitivity with desipramine

In case of an allergic reaction, a healthcare provider may discontinue imipramine and consider alternative medications or treatments that are better suited for the individual and their medical history.

Imipramine Dosages for FDA-Approved Treatment

Dosages of imipramine can vary from person to person based on factors like age, medical condition, and individual response to the medication. The typical dosage range depends on whether a person is hospitalized or an outpatient, their age, and the specific condition being treated.

Imipramine Forms & Strengths

Imipramine is available in different forms and strengths to suit individual needs. Medical professionals take various factors into account when selecting an imipramine form, such as patient age, condition severity, and treatment duration.

Lower dosages are common for elderly, adolescent, and outpatient cases. Hospitalized patients might initiate at 100 mg/day and increase to 200 mg/day, while outpatients may begin with 75 mg/day, potentially increasing to 150 mg/day.

Imipramine is available in the following forms and strengths:¹

• 10 milligrams (mg) triangular, coral-reddish brown sugar-coated tablet, imprinted with the “M” symbol on one side and “10” on the other side.
• 25 milligrams (mg) round, coral-reddish brown sugar-coated tablet, imprinted with the “M” symbol on one side and “25” on the other side.
• 50 milligrams (mg) round, coral-reddish brown sugar-coated tablet, imprinted with the “M” symbol on one side and “50” on the other side.

Remember to take your medication as prescribed by your healthcare provider. If you have any questions or concerns about how to take your medication, consult your healthcare professional.

How Should I Take Imipramine?

To take imipramine effectively, follow your doctor’s instructions closely. The dosage and frequency you take the medication depend on your condition. Imipramine can be taken orally as tablets with or without food, though some might prefer taking it with a meal to prevent stomach upset.

Stick to the prescribed strength and read the label for any specific directions. Consistency is key for the medication’s effectiveness, so make sure to take it as directed by your healthcare provider.

What Happens If I Miss a Dose of Imipramine?

If you miss a dose of imipramine, take it as soon as you remember. However, it’s crucial not to double up on doses to catch up. If it’s close to the time for your next scheduled dose, skip the missed one. Abruptly stopping imipramine or taking extra doses can lead to negative effects and may not improve your condition. Always follow your doctor’s instructions and consult them if you have any concerns about missed doses.

Can You Overdose on Imipramine?

Yes, you can overdose on imipramine, which can be life-threatening. Overdosing can happen, especially when combining imipramine with other drugs, including alcohol.²

Symptoms of an overdose can quickly include confusion, hallucinations, seizures, hyperactive reflexes, muscle rigidity, and agitation. If an overdose is suspected, contact a doctor or poison control center immediately.

What Should You Do If You Take Too Much Imipramine?

If you take too much imipramine, it’s important to get medical help immediately. Call emergency services or your local poison control center. Medical professionals will likely monitor your heart using an electrocardiogram (ECG), start an intravenous line, and take steps to clear the medication from your system.¹

They’ll watch you for about 6 hours to check for any effects on your heart, breathing, blood pressure, and seizures. If issues continue, they may extend the monitoring. After an overdose, it’s a good idea to talk to a mental health professional, especially if you’re struggling emotionally. For children, specific guidance can be obtained from a poison control center.

Questions to Ask Your Healthcare Provider About Tofranil (Imipramine)

If you’re considering taking imipramine or have been prescribed it, there are important questions to ask your healthcare provider, psychiatrist, and therapist. It’s important to discuss your medical history, any current health conditions, and whether imipramine is suitable for you.

If you’re considering a change in medication or treatment, online psychiatry services can provide valuable advice and support, especially if you need to switch prescribers.

Questions to ask your care team about imipramine include:

• How long does it usually take for the effects of imipramine to start working?
• Can I take imipramine alongside my other anxiety or depression medications?
• What’s the recommended dosage to minimize potential side effects?
• Are there any specific side effects I should watch out for?
• How might imipramine impact my daily routine or activities?
• Can imipramine affect my sexual health, and when should I reach out if I experience any related issues?
• Are there certain foods, drinks, or activities I should avoid while taking imipramine?
• What should I do if I miss a dose of imipramine?
• How long do I need to take imipramine? Can I stop it if I feel better?
• Are there any potential interactions between imipramine and other medications or supplements I’m taking?
• What’s the process for adjusting my dosage if needed?
• Should I inform my therapist about my imipramine use and how it might affect our sessions?
• How can I reach out to you or my psychiatrist if I have questions or concerns about imipramine?
• Are there any lifestyle changes or strategies that could enhance the effectiveness of imipramine?

In My Experience

In my experience, understanding the nuances of medication like imipramine is crucial for individuals seeking treatment for depression, anxiety, or enuresis. The detailed dosing instructions, potential side effects, and considerations for specific age groups help tailor the treatment to each person’s unique needs.

It’s imperative to have open and honest conversations with your healthcare provider, whether that’s your doctor, psychiatrist, or therapist. Their expertise can guide you through the process, ensuring you make informed decisions about your treatment plan.

With the right approach, treatment, and professional guidance, there’s a positive outlook for clients managing these challenges. If you’re facing these issues, know that you’re not alone, and there is hope for positive change. Your well-being is worth prioritizing, so take that important step of reaching out for help.

For Further Reading

• How to Get Antidepressants: Everything You Need to Know Choosing Therapy
• How Do Antidepressants Make You Feel? Possible Side Effects & Changes
• Depression: How effective are antidepressants?