Indications 

Tofranil is a prescribed medication for managing depression, potentially enhancing mood, sleep, appetite, and energy, and revitalizing one’s engagement in daily life. 

Tofranil may also be prescribed in conjunction with other treatments to address nocturnal enuresis (bed-wetting) in children. 

As a tricyclic antidepressant, Tofranil functions by rebalancing certain natural brain neurotransmitters crucial for mental balance. In the context of bed-wetting, it may act by inhibiting the impact of acetylcholine, a natural substance, on the bladder. 

Uses and Dosage 

Before taking Tofranil and with every prescription refill, carefully review its medication guide and patient information leaflet. Seek guidance from your healthcare provider or pharmacist if you have any queries. 

The prescribed dosage of this medication is individualized, contingent on the patient’s medical condition and treatment response. In children, dosage considerations may include body weight.  

To minimize potential side effects, your doctor may initiate Tofranil treatment at a conservative dose, with gradual increments as needed. 

For the treatment of depression, Tofranil is typically taken one to four times per day, as prescribed by the doctor, irrespective of food consumption. Should you experience daytime drowsiness, your doctor may instruct you to take the full dose before bedtime. 

For the treatment of bed-wetting in children, Tofranil should be administered one hour before bedtime. If bed-wetting typically occurs earlier in the night, the medication may be administered earlier, with separate doses, such as one in the afternoon and one at bedtime. 

For optimal results, take this medication exactly as directed and at around the same time each day. Refrain from altering the prescribed dosage or frequency of intake, as doing so can lead to increased side effects without accelerating the improvement of your condition. 

Keep taking Tofranil even if you experience improvement in your condition. Seek medical advice before ceasing this medication, as sudden discontinuation may exacerbate certain conditions. Gradual reduction of dosage might be necessary. 

If this medication is used for a prolonged duration in children for nocturnal enuresis, its efficacy may diminish and necessitate adjustment of the dosage. Consult your doctor if there is a decline in the effectiveness of this medication. 

Side Effects 

Listed below are the potential adverse effects of Tofranil. Should any of these effects persist or worsen, promptly inform your doctor. 

Common Side Effects 

• Elevated blood pressure 
• Tingling sensation, weakness, or impaired coordination 
• Dry mouth, nausea, or vomiting 
• Breast swelling (in men or women) 

Serious Side Effects 

• Easy bruising, unusual bleeding, or purple or red spots under the skin 
• Tunnel vision, eye discomfort or swelling, or seeing halos around lights 
• A light-headed feeling, with a potential of passing out 
• New or worsening chest pain, rapid or irregular heartbeats 
• Sudden numbness or weakness, vision problems, speech difficulties, or balance issues 
• Fever or sore throat 
• Confusion, hallucinations, or unusual thoughts or behavior 
• Painful or difficult urination 
• Seizures (convulsions) 
• Jaundice (yellowing of the skin or eyes) 

Call your doctor at once if you experience any of the serious side effects listed above. 

Allergic Reactions 

Although rare, a severe allergic reaction to Tofranil may occur. Prompt medical attention is necessary upon observing any indications of an allergic response, including: 

• Hives 
• Face, lips, tongue, or throat swelling or itching 
• Difficulty breathing 

Not all side effects of Tofranil are included in this list. Report to your doctor if any unlisted effects occur. 

Cautions 

Before starting treatment with Tofranil, inform your doctor of any known allergies, particularly to imipramine or to other tricyclic antidepressants (e.g., desipramine, amitriptyline). 

Consult your pharmacist for additional information about Tofranil, as it may contain inactive ingredients that may cause allergic reactions or other complications. 

To ensure Tofranil is safe for you, disclose to your physician your medical background, especially if you have a history of: 

• Respiratory issues like asthma or chronic bronchitis 
• Personal or family history of angle-closure glaucoma 
• Diabetes 
• Eating disorders, such as bulimia 
• Heart conditions, including arrhythmias, coronary artery disease, and heart attack 
• Liver problems 
• Kidney issues 
• Personal or family history of mental/mood disorders like bipolar disorder or schizophrenia 
• Seizures 
• Hyperthyroidism (overactive thyroid) 
• Difficulty urinating, potentially due to an enlarged prostate 
• Conditions that raise seizure risks, like alcohol/sedative dependency, electroconvulsive therapy use, or brain injury/disease such as stroke 
• Certain tumor types like pheochromocytoma or neuroblastoma 

Notify all your healthcare providers of any current or recently started or stopped medications, including prescription and over-the-counter drugs, vitamins, and herbal supplements, to reduce the risk of drug interaction with Tofranil. 

Some products that may interact with Tofranil include: 

• High blood pressure medications like clonidine, guanadrel, and guanethidine 
• Digoxin 
• Disopyramide 

• Thyroid supplements 
• Valproic acid 

Imipramine closely resembles desipramine. Avoid using medications that contain desipramine while taking Tofranil. 

Taking Tofranil with MAO inhibitors can lead to a potentially life-threatening drug interaction. Refrain from using MAO inhibitors (including isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) while on this treatment.  

In most cases, MAO inhibitors should not be taken for two weeks prior to and following Tofranil. Consult your healthcare provider for guidance on when to initiate or discontinue this medication. 

Tofranil’s effectiveness can be influenced by other medications that impact its removal from your body. Examples include: 

• Barbiturates (e.g., phenobarbital)  
• Cimetidine 
• Haloperidol 
• Certain heart rhythm drugs (e.g., flecainide, propafenone) 
• Halofantrine 
• Specific HIV protease inhibitors (e.g., fosamprenavir) 
• Phenothiazines (e.g., thioridazine) 
• Pimozide 
• Particular anti-seizure medications (e.g., phenytoin) 
• Trazodone 

Ensure to review the packaging of all your medications (e.g., cough and cold remedies) as they might include ingredients causing drowsiness or decongestants that can elevate heart rate or blood pressure. Consult your pharmacist for guidance on the proper usage of such products. 

Inform your doctor or pharmacist if you are using other substances that induce drowsiness, including: 

• Alcohol 
• Marijuana (cannabis) 
• Antihistamines (e.g., cetirizine, diphenhydramine) 
• Medications for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem) 
• Muscle relaxants (e.g., carisoprodol, cyclobenzaprine) 
• Opioid pain relievers (e.g., codeine, hydrocodone) 

Exercise caution when driving or using machinery after taking Tofranil, since it can cause drowsiness. 

Taking Tofranil can increase the skin’s sensitivity to sunlight. Minimize unnecessary or prolonged sun exposure and wear protective clothing, sunglasses, and sunscreen when going out. 

For individuals with diabetes, Tofranil may hinder blood sugar control. Regularly monitor blood sugar levels as instructed and inform your doctor of the results. If you experience symptoms like excessive thirst or urination, promptly notify your doctor. They may need to modify your diabetes medication, exercise routine, or dietary plan. 

Seek guidance from your doctor concerning the potential risks and benefits associated with Tofranil usage in individuals aged 65 or older. Older adults should refrain from taking this medication as it is not as safe and effective as other available medications for treating the same condition. 

Seek medical advice before administering this medication to a child. Tofranil is not authorized for treating depression in individuals below 18 years of age. Furthermore, it should not be employed for managing bed-wetting in children under 6 years old. 

The potential effects of Tofranil on a developing fetus are uncertain. Inform your healthcare provider if you are currently pregnant or intend to conceive. 

Imipramine can transfer to breast milk and potentially cause adverse effects on a nursing baby. Seek medical advice before breastfeeding.