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Imipramine (Tofranil) is a tricyclic antidepressant that can, among other reasons, be prescribed in the treatment of major depressive disorder. What should prospective patients know about it?

Imipramine — also sold under the brand name Tofranil — is a tricyclic antidepressant. First developed in the 1950s, TCAs are among the first ever antidepressants to appear on the market. Though they also help in the treatment of many conditions besides major depressive disorder, they alleviate the symptoms of depression by making more serotonin, dopamine, and norepinephrine available to the brain. Tofranil is one of the most commonly prescribed TCAs around.

What do you need to know if your doctor is prescribing you imipramine to help you overcome depression?

How do you take imipramine? What dosage will your doctor put you on?

Tofranil​ comes in capsules and tablets. While the tablets are available in doses of 10, 25, and 50 mg, the capsules come in doses of 75, 100, 125, and 150 mg. Keep in mind that imipramine is prescribed for reasons other than depression — such as bedwetting — as well. Depressed people receiving this antidepressant in an outpatient setting will often be started at 75 mg daily, and this can be increased gradually if necessary. Many depressed people will end up with a daily dose of 150 mg, with 200 mg being the maximum. Adolescents and elderly people taking Tofranil​, meanwhile, will usually be prescribed a dose of 50 mg. 

Regardless of your dosage, it is possible that you will be asked to take your imipramine once a day (with or without food), or several times daily. Always take your medication exactly as instructed; do not skip doses and do not take more than prescribed. Should you overdose, get in touch with poison control right away.

As with all antidepressants, it is important to keep taking your imipramine (Tofranil​) even if you do not notice an immediate improvement in your depression symptoms. It can take a week, three weeks, or even longer for the full effect to be reached, and sudden cessation can lead to withdrawal symptoms. 

What side effects can imipramine cause?

The more common side effects of imipramine (Tofranil​) include:

  • A dry mouth
  • Nausea
  • Drowsiness
  • Fatigue
  • Constipation
  • Excessive sweating
  • More frequent urination or having a hard time urinating
  • Skin reacts more intensely to sunlight
  • Appetite changes that can lead to weight gain
  • Low blood pressure on changing position

In addition, some people experience sexual dysfunction, such as a lowered libido, experience nightmares, and feel anxious or overly excited. Should you encounter some of these side effects when you first begin taking imipramine, this doesn't necessarily mean those side effects will follow you around the whole time you are on the medication. Should they persist or really bother you, always let your doctor know — another antidepressant may be better for you. 

Like other antidepressants, and other medications in general, imipramine can also cause rarer and more serious side effects. Let your doctor know right away, or head for the ER, if you:

  • Have slow or slurred speech and find it difficult to talk
  • Experience a stiff jaw and neck and have muscle spasms in your back
  • Experience tremors — shaking of parts of your body
  • Cannot walk normally and develop a shuffling gait
  • Have a fever or sore throat
  • Experience the yellowing of your skin or eyes (jaundice)
  • Develop a bad skin rash
  • Notice that your heart beat becomes rapid or irregular

Warnings: What else do you need to know about Tofranil​?

Tofranil​ isn't suitable for everyone. While patients should not need to research whether Tofranil​ is contraindicated for them — meaning they can't take it — because that's the prescribing doctor's responsibility, you do need to:

  • Tell your doctor about any medical conditions you may suffer from besides depression
  • Let your doctor know what other medications you take, even occasionally, and even over the counter drugs — likewise, if you need to pick up medications from the pharmacy after you start taking Tofranil​, let them know you're on it
  • Inform your doctor if you use street drugs or alcohol
  • You have known allergies to any medications
  • You are pregnant, trying to conceive, or currently nursing a baby

People who are using monoamine oxidase inhibitors (MAOIs), another kind of antidepressant, cannot take Tofranil​. If you have recently come off a MAOI, do not take imipramine for 14 days. You cannot use imipramine if you have recently suffered a heart attack, or have been shown to be sensitive to TCAs in general, either. 

While Tofranil​ can be prescribed to young people under the age of 24, this antidepressant, like others, comes with a small risk of sudden suicidal feelings. Young people starting off on Tofranil​ should be monitored closely for these symptoms. Older people, too, should keep an eye out for a sudden worsening of their depressive symptoms. 

In conclusion

Your prescribing doctor should leave you with precise instructions as to how to take your antidepressant and what to do if side effects crop up. Follow them to the letter, but always ask for clarification if something is not clear to you. Like other antidepressants, imipramine takes a while to start relieving your symptoms. This does not mean that the medication isn't working for you, so keep taking it.

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