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What is Tofranil for?

Tofranil hydrochloride (imipramine) is a medicine called a tricyclic antidepressant (TCA). It is prescribed for the following reasons:

  • Treatment of depression in adults.
  • Treatment of nocturnal enuresis (nocturnal enuresis) in children over six if other treatments were ineffective.

How does Tofranil work?

Tofranil works by reducing the activity of the neurotransmitters serotonin and norepinephrine in the brain. Neurotransmitters are natural chemicals in the body that act as chemical messengers between nerve cells. It is well known that serotonin and norepinephrine regulate, among other things, emotions, mood and behavior. In depressive diseases, less serotonin and norepinephrine than normal are released by the nerve cells of the brain. Tofranil prolongs the action of serotonin and norepinephrine released in the brain. Over time, this helps to improve mood and relieve depression.

Imipramine acts in case of nocturnal enuresis, as it also blocks receptors called cholinergic or muscarinic receptors located on the surface of the muscle cells of the bladder wall. This helps the muscles of the bladder wall to relax, reducing unstable and involuntary contractions of the bladder. It increases the bladder's ability to retain urine, reduces the need to drain urine and can help the child stay dry at night.

How long does it take for Tofranil to act?

  1. In case of depression, imipramine can take between two and four weeks to make you feel better. Therefore, it is very important that you continue to take it, even if it does not make much difference at first glance. Normally, you should take imipramine daily for several months to treat depression and at least six months after you feel better. You must take it as long as your doctor asks. If you feel that your depression has worsened or if you have painful thoughts or feelings about suicide or self-injury during the first few weeks or at any time during or after treatment, it is very important to be comfortable with talking to your doctor.
  2. It may also take a few weeks for imipramine to be effective when used to wet the bed. It is important that you continue to give it to your child as directed by the doctor, even if you do not think it will help you from the start. As a general rule, a three-month treatment period is prescribed. Thereafter, the child must be re-examined by his specialist to determine if additional classes are useful.

How do you take Tofranil?

  • Always follow the instructions of your doctor. Remember that Imipramine takes a long time to work. So take it as prescribed, even if it does not make a big difference at first. Do not take more than the dose prescribed by your doctor.
  • Imipramine tablets and fluids can be taken with or without food on an empty stomach or on an empty stomach.
  • In depression, imipramine is usually taken three times a day, but it can also be prescribed as a single dose at bedtime. Follow the instructions of your doctor. Try to take your doses at the same time each day - this will help you remember to take them.
  • If you forget to take a dose at the usual time, take it as soon as you remember, unless it is almost time for your next dose. In this case, simply skip the missed dose and take the next dose as usual, when the time comes. Do not take a double dose if you forget to take the previous dose.
  • To wet your child, he should receive the prescribed dose of imipramine once a day before going to bed.
  • If you forget to give your child a dose at bedtime, just leave the missed dose. Give the next dose to your child as usual the next night. Do not double the dose if you forget to take the previous dose.

What should I know about taking Tofranil?

  • Tofranil may cause drowsiness, dizziness, difficulty concentrating and blurred vision, as well as impairing your ability to drive and use machines safely. Do not drive or use machinery if touched.
  • Avoid drinking alcohol while taking Imipramine, as this increases the risk of drowsiness, dizziness, confusion or blurring. This effect is probably worse if you drink alcohol at the beginning of treatment or after an increase in the dose.
  • Tofranil can cause dizziness or restlessness when you get up from a supine or sitting position, especially if you are taking the medicine for the first time. If you get up slowly, you can avoid it. If you or your child is dizzy, sit or lie down until the symptoms disappear.
  • Imipramine can cause dry mouth, which can increase the risk of tooth decay if imipramine is taken over a long period. It is important that you practice good oral hygiene and that you visit your dentist regularly.
  • Imipramine can cause dry eyes. When wearing contact lenses, be aware that they are more likely to irritate the surface of your eyes. Ask your doctor, pharmacist or optometrist how to avoid this.
  • If you need surgery, tell the anesthetist that you are taking imipramine. Tofranil does not create dependency. However, it should not be stopped suddenly, as it can lead to withdrawal symptoms such as nausea, tremor, headache, difficulty sleeping, sweating, irritability, agitation or anxiety. Withdrawal symptoms are transient and do not depend on addiction. They can usually be avoided by phasing out imipramine, usually over a period of weeks or months, depending on your personal circumstances. Follow your doctor's instructions when it is time to stop treatment.

Who should not take Tofranil?

  1. People with severe liver disease.
  2. People with an irregular heart rhythm (arrhythmia), heart block or a recent heart attack.
  3. People in the manic phase of bipolar disorder (manic depression).
  4. People who have taken a monoamine oxidase inhibitor antidepressant (MAOI) in the last three weeks.
  5. People with narrow angle glaucoma.
  6. People who can not completely empty their bladder (urinary retention).
  7. People with rare hereditary blood disorders are called porphyria.
  8. People who are allergic or incompatible with any of the constituents of the medication. If you or your child know that you have certain allergies or intolerances, check the ingredients in the package leaflet.
  9. Imipramine should not be used to treat depression in children or to treat enuresis in children under six years of age.

Who might need a lower dose of Tofranil or additional monitoring?

  1. Older people.
  2. People with liver or kidney problems.
  3. People suffering from heart disease or hypertension.
  4. People with low blood pressure.
  5. People with overactive thyroid (hyperthyroidism).
  6. People with adrenal tumors (pheochromocytoma).
  7. People with chronic constipation.
  8. People who have difficulty urinating, such as. B. Men with an enlarged prostate.
  9. People with increased eye pressure or glaucoma.
  10. People with diabetes.
  11. People who have epilepsy or are exposed to seizures, for example. Due to withdrawal from alcohol / drugs, brain damage or other medications.
  12. People receiving electroconvulsive therapy (ECT).
  13. People with psychotic disorders, for example schizophrenia.
  14. People with a history of bipolar affective disorder (manic depression). This medicine should be stopped in people entering a manic phase.

Can I take imipramine during pregnancy or breastfeeding?

  • It is important to consult your doctor if you think you may be pregnant or plan to become pregnant while taking Imipramine. Imipramine should preferably not be used during pregnancy, especially in the first and third trimesters, as its safety is not fully established. However, it is important to discuss with your doctor the risks and benefits of taking the drug versus discontinuing treatment or using other treatments. For example, taking imipramine in the third trimester may result in side effects or withdrawal symptoms in the baby after birth, which may require additional monitoring.
  • If you become pregnant and want to stop taking imipramine, do not do it suddenly. Your doctor will explain how to stop treatment gradually to avoid withdrawal symptoms.
  • Consult your doctor if you wish to breast-feed while taking Imipramine. Imipramine passes into breast milk, but only in very small amounts, which are probably not harmful to a nursing child. If you are taking imipramine, breastfeeding is generally acceptable, as long as your baby is in good health, is not born prematurely, and is being followed for any problem potential such as drowsiness. However, always ask your doctor first, as various factors must be taken into account.

What are the potential side effects of Tofranil?

Medications and their potential side effects can affect individuals in different ways. Here are some of the side effects that can be associated with imipramine. It is not because a side effect is indicated here that all people taking imipramine experience this or any other side effect. Many people find that side effects improve with time. Therefore, it is important to pay attention to treatment.

Very common side effects (affecting more than 1 in 10 people):

  • Dry mouth.
  • Constipation.
  • Blurred vision.
  • Fast heartbeat.
  • Sweating or rinsing.
  • Tremor, usually hands (tremors).
  • Weight gain.

Common side effects (affects 1 in 10 to 1 in 100 people):

  • Drowsiness.
  • Dizziness, especially when getting up.
  • Headache.
  • Sensations of pins and needles.
  • Nausea or vomiting.
  • Loss of appetite.
  • Tired.
  • Feel anxious, agitated or excited.
  • Feeling confused or disoriented
  • Sleep disorders.
  • Palpitations.
  • Irregular heart rhythm.
  • Difficulty urinating
  • Rash.
  • Sexual problems, such as, for example, decreased libido or erection problems.

Read the package leaflet or contact your doctor or pharmacist for more information on possible side effects of imipramine. If you think you have had a side effect, did you know that you can report it via the yellow card website?

Can you take other medicines with imipramine?

It is important to tell your doctor or pharmacist if you or your child is already taking any medication, including over-the-counter medications and herbal medicines, before starting imipramine therapy.

Can I take over-the-counter medications with Imipramine?

Always consult your pharmacist before taking a new medicine if you or your child start taking imipramine to make sure the combination is safe. However, here are the most important points to keep in mind:

If you need a pain reliever, you can take acetaminophen or ibuprofen with impramine, if any, for you or your child.

If you find that imipramine makes you drowsy or constipated, avoid taking co-codamol, as this painkiller can make these problems worse.

You should not take a cold or flu remedy that contains an imbalance such as pseudoephedrine or phenylephrine while you are taking imipramine.

If you need an antihistamine, it is best to avoid those that can make you sleepy, such as chlorpheniramine, diphenhydramine and promethazine. Instead, take a non-sedative such as cetirizine or loratadine.

Do not take herbal remedy St. John's wort (Hypericum perforatum) with imipramine.

What about prescription drugs?

If you are also taking other drugs that may cause drowsiness, you may be more likely to feel sleepy with imipramine:

  • Antipsychotics, eg haloperidol
  • Barbiturates, eg phenobarbital, amobarbital (they may also make the antidepressant less effective)
  • Benzodiazepines, eg diazepam, temazepam
  • sedative antihistamines, eg promethazine, hydroxyzine
  • Sleeping pills, eg zopiclone
  • strong opioid analgesics such as morphine, codeine, tramadol, fentanyl other tricyclic antidepressants, for example amitriptyline.

If you take imipramine with antihypertensive medications, including medicines used to treat high blood pressure and medications that can lower blood pressure as a side effect, such as benzodiazepines, you may feel dizzy or if you you faint. If you are taking a blood pressure lowering medication, tell your doctor if you feel dizzy or faint after starting imipramine, as you may need to adjust your dose.

It is likely that you have dry mouth, constipation, difficulty passing urine or blurred vision if you are taking a medicine with anticholinergic effects with imipramine. These include the following:

  • Anticholinergics in urinary incontinence, eg tolterodine, oxybutynin
  • Anticholinergics for Parkinson's symptoms, for example B. procyclidine, trihexyphenidyl
  • Some antihistamines, eg, promethazine, chlorphenamine
  • antispasmodic agents, eg hyoscine, atropine
  • Some antipsychotics, eg chlorpromazine, clozapine
  • some other antidepressants
  • Some drugs for diseases, for example. Meclozine, cyclizine.

If you take other medications or medications that increase serotonin activity in the brain while you are taking imipramine, the likelihood that you will have an undesirable effect called serotonin syndrome, which has symptoms such as excitement, tremor, and increased heart, is higher and diarrhea. Other drugs that increase serotonin activity include:

  1. dapoxetine
  2. dexamfetamine
  3. fentanyl
  4. illicit drugs such as cocaine, amphetamine and ecstasy
  5. lithium
  6. linezolid
  7. methadone
  8. Selegiline, rasagiline or safinamide for Parkinson's disease
  9. SSRIs, tricyclic or related antidepressants, eg paroxetine, citalopram, amitriptyline, duloxetine, venlafaxine
  10. tramadol
  11. Triptans against migraine, eg sumatriptan
  12. Tryptophan.

Tofranil may alter the anticoagulant effects of coumarin-based anticoagulants such as warfarin. Your doctor may want to check your blood clotting time (INR) more frequently if you are taking these two medicines together.

The following medications can increase the level of imipramine in the blood and increase the risk of side effects:

  1. bupropion
  2. cimetidine
  3. diltiazem
  4. fluconazole
  5. methylphenidate
  6. Protease inhibitors for HIV such as ritonavir
  7. quinidine
  8. SSRI antidepressants such as fluvoxamine and fluoxetine
  9. terbinafine
  10. Verapamil.

If you take a dry mouth while taking Imipramine, medicines that have been developed to dissolve and absorb under the tongue, such as For example, sublingual tablets of glyceryl trinitrate (GTN) are less effective against angina pectoris. chest. Indeed, tablets do not dissolve properly in a dry mouth. To remedy this, take a sip of water before taking sublingual tablets.

Imipramine should not be co-administered with a monoamine oxidase inhibitor antidepressant (MAOI), e.g. As phenelzine, tranylcypromine, isocarboxazide or moclobemide are used. Treatment with imipramine should be initiated at the earliest three weeks after stopping MAO and vice versa.

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