Brand Name: Tofranil PM (Tofranil available in generic)

Manufacturer: Novartis Pharmaceuticals

Description: Imipramine is the original tricyclic antidepressant. Though its exact mechanism of action is unknown, it is believed to block the reuptake of norepinephrine (a brain chemical - neurotransmitter) at nerve endings.

Indications and Use: Tofranil PM is approved for use in depression.  It has also been helpful in treating Attention Deficit Hyperactivity Disorder, anxiety disorder, and for some types of pain control.

Contraindications, Warnings, and Precautions: Imipramine is contraindicated in patients on MAOI's (monoamine oxidase inhibitors), in patients who are recovering from a heart attack, and in patients with a known hypersensitivity. It should be used only with extreme caution in patients with cardiovascular disease because of Imipramine's known affect on the electrical conductivity of the heart. (In children, dosing should not usually exceed 2.5mg per kilogram of body weight per day, and EKG (electrocardiogram) monitoring should be done.)  Imipramine should be used with extreme caution in patients with increased intraocular pressure or urinary retention, patients with hyperthyroid or patients with seizure disorder history, as Imipramine can lower the seizure threshold. Imipramine should not be given with guanethidine, clonidine or similar medications as it may block their therapeutic effects. Patients on Imipramine should avoid alcohol. Imipramine is not recommended for pregnant women because of the risk of fetal malformations. Since it is probably excreted in breast milk, it is not recommended for nursing mothers. Imipramine should be gradually discontinued prior to elective surgery.

Adverse Reactions: Possible common side effects are dry mouth, drowsiness, and constipation. Since it is usually given at bedtime, drowsiness is often a desired side effect. Other potential side effects are nausea and vomiting, dizziness, blurred vision, tremors, increased sweating, weight gain, decreased libido, and urinary retention. Less common side effects which should be reported to your doctor are: tachycardia (rapid heart rate), palpitations, insomnia, anxiety, and skin rash. It is important to know that Imipramine may cause increased sensitivity to the sun, necessitating the use of a sun screen. It may also make one intolerant of heavy exercise in hot weather. One should be careful to avoid overheating and /or dehydration.

Dosing Range:  The usual maintenance dose for adults is 75 mg to 150mg per day, but it may go higher (up to 250 to 300 mg per day. An Imipramine (blood) level drawn 10 to 12 hours after the last dose will determine if the dose is within a therapeutic range (150-300 ng/ml). To avoid or minimize side effects, dosing should begin low and be increased gradually.  In children, dosing should not usually exceed 2.5mg per kilogram a day.  EKG should be monitored.

Stopping this medication abruptly can cause a rebound withdrawal effect involving nausea and vomiting, headache, and malaise. It is recommended that one taper off this medication slowly. It is not addictive.

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© 2000 Red Oak Psychiatry Associates, P.A.    Updated 11/26/2007