Tofranil (imipramine hydrochloride) is a tricyclic antidepressant (TCA) with a well-established clinical profile for managing major depressive disorders and select off-label conditions. As a tertiary amine TCA, it exerts its therapeutic effects through potent inhibition of norepinephrine and serotonin reuptake, modulating key neurotransmitter systems implicated in mood regulation. Its robust efficacy is supported by decades of clinical use and evidence-based guidelines, offering a reliable option for patients with moderate to severe depressive episodes. This agent is particularly noted for its dual impact on both depressive symptoms and certain comorbid conditions, providing a comprehensive neurochemical approach to mental health management.

Features

• Contains imipramine hydrochloride as the active pharmaceutical ingredient
• Available in 10 mg, 25 mg, and 50 mg oral tablets
• Exhibits high bioavailability with extensive tissue distribution
• Demonstrates potent inhibition of norepinephrine and serotonin reuptake transporters
• Features active metabolite desipramine, contributing to overall pharmacodynamic profile
• Possesses anticholinergic, antihistaminic, and antiadrenergic properties

Benefits

• Achieves significant improvement in core depressive symptoms including anhedonia, low mood, and psychomotor retardation
• Provides relief from associated anxiety symptoms often present in depressive disorders
• Offers potential benefit for certain chronic pain conditions through central modulation of pain pathways
• May reduce frequency of nocturnal enuresis in pediatric patients through anticholinergic effects on bladder detrusor muscle
• Demonstrates long-term maintenance of therapeutic effect with appropriate dosing titration
• Presents cost-effective treatment option within the TCA class compared to newer antidepressants

Common use

Tofranil is primarily indicated for the treatment of major depressive disorder in adult patients. Its therapeutic application extends to managing symptoms of depression with associated anxiety, as the dual neurotransmitter modulation addresses both affective and anxious components. Off-label uses include management of neuropathic pain conditions such as diabetic neuropathy and post-herpetic neuralgia, where its effect on pain modulation pathways provides analgesic benefits. In pediatric populations, it is sometimes employed for nocturnal enuresis treatment due to its anticholinergic effects on bladder muscle contraction. Some clinical evidence supports its use in panic disorder and certain eating disorders, though these applications require careful risk-benefit assessment.

Dosage and direction

Initial dosing for depression in adults typically begins at 25-50 mg orally once daily at bedtime, gradually increasing by 25-50 mg every 3-7 days based on tolerance and therapeutic response. The effective maintenance dose ranges from 75-150 mg daily, though severe cases may require up to 300 mg daily in divided doses. Elderly patients and adolescents should initiate therapy at lower doses of 10-25 mg daily with gradual titration. For nocturnal enuresis in children over 6 years, dosage typically begins at 25 mg one hour before bedtime, titrating upward to a maximum of 50 mg nightly. Administration with food may minimize gastrointestinal discomfort. Full therapeutic effect may require 2-4 weeks of consistent dosing.

Precautions

Patients should be monitored for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Caution is advised in patients with cardiovascular disorders due to potential orthostatic hypotension and tachycardia. Regular monitoring of blood pressure and heart rate is recommended, particularly during dose titration. Use with caution in patients with history of seizures, as TCA therapy may lower seizure threshold. Hepatic and renal function should be assessed periodically during long-term therapy. Abrupt discontinuation should be avoided due to potential withdrawal symptoms including nausea, headache, and malaise.

Contraindications

Tofranil is contraindicated in patients with known hypersensitivity to imipramine or other tricyclic antidepressants. Concomitant use with monoamine oxidase inhibitors (MAOIs) is absolutely contraindicated due to risk of serotonin syndrome; a minimum 14-day washout period must be observed when switching between these classes. Additional contraindications include recent myocardial infarction, uncompensated heart failure, and certain cardiac conduction abnormalities. Use during the acute recovery phase after myocardial infarction is contraindicated. Patients with narrow-angle glaucoma or urinary retention should not receive Tofranil due to its anticholinergic properties.

Possible side effect

Common adverse effects include dry mouth (approximately 40% of patients), constipation (30%), blurred vision (25%), dizziness (20%), and sedation (15-20%). Orthostatic hypotension occurs in approximately 15% of patients, particularly elderly individuals. Weight gain of 2-4 kg may develop over several months of therapy. Less frequently, patients may experience tachycardia, sweating, or sexual dysfunction including decreased libido and erectile dysfunction. Rare but serious side effects include leukopenia, agranulocytosis, and hepatitis. Neurologic effects may include tremor and paresthesia. Allergic reactions including skin rash and photosensitivity occur infrequently.

Drug interaction

Concomitant use with MAOIs may precipitate serotonin syndrome or hypertensive crisis. CYP2D6 inhibitors such as fluoxetine and paroxetine may significantly increase Tofranil plasma concentrations. Anticholinergic drugs may potentiate dry mouth, constipation, and urinary retention. Barbiturates may decrease Tofranil concentrations through enzyme induction. Concurrent use with sympathomimetics may enhance cardiovascular effects. Alcohol may potentiate central nervous system depression. Antihypertensive agents may have their effects potentiated. Warfarin metabolism may be affected, requiring closer monitoring of coagulation parameters.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is接近 time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses is not recommended due to increased risk of adverse effects. Patients should be advised to maintain consistent dosing timing to ensure stable plasma concentrations. If multiple doses are missed, medical consultation is recommended before resuming therapy, as dose adjustment may be necessary.

Overdose

Tofranil overdose represents a medical emergency requiring immediate attention. Symptoms may include severe anticholinergic effects (dry mucous membranes, blurred vision, urinary retention), cardiac conduction abnormalities (prolonged QRS and QT intervals), seizures, respiratory depression, and coma. Cardiovascular manifestations may include hypotension, tachycardia, and arrhythmias. Management involves gastric lavage if presentation is early, activated charcoal administration, and comprehensive supportive care. Sodium bicarbonate is indicated for QRS prolongation exceeding 100 milliseconds. ECG monitoring should continue for at least 24 hours due to potential for delayed arrhythmias.

Storage

Store at controlled room temperature between 20-25°C (68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from light and moisture. Keep container tightly closed. Dispense in original container with child-resistant closure. Do not store in bathroom medicine cabinet due to humidity fluctuations. Keep out of reach of children and pets. Properly discard any medication that is outdated or no longer needed through medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient response to Tofranil may vary based on numerous factors including age, concomitant medications, and underlying health conditions. Treatment decisions should be made in consultation with a qualified healthcare professional who can assess individual patient needs and monitor therapy appropriately. Never initiate, adjust, or discontinue medication without professional medical supervision.

Reviews

Clinical studies demonstrate response rates of 60-70% in major depressive disorder with complete remission achieved in approximately 50% of patients. Many clinicians report particular efficacy in depression with melancholic features and cases with significant somatic symptoms. Long-term users often describe sustained mood stability after appropriate dose titration. Some patients note initial side effects that typically diminish after several weeks of continued therapy. The medication’s cost-effectiveness is frequently cited as a positive attribute compared to newer antidepressant classes. However, some patients discontinue due to anticholinergic side effects or weight gain concerns.