Tofranil (Imipramine)
Class and Category of Drug
Before you buy Tofranil (Imipramine) online, read common information about the medication.
Chemical class: Dibenzazepine derivative
Therapeutic class: Antidepressant
Pregnancy category: Not rated
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Drug Indications and Dosages
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To treat depression
Capsules
Adults. Initial: 75 mg daily at bedtime, gradually increased as needed and tolerated. Maximum: 300 mg daily (hospitalized patients), 200 mg/day (outpatients).
Tablets
Adults. Initial: 25 to 50 mg t.i.d. or q.i.d., gradually increased as needed and tolerated. Maximum: 300 mg daily (hospitalized patients), 200 mg daily (outpatients).
Dosage AdjustmentInitial dosage reduced to 25 mg at bedtime for depressed elderly
patients; then adjusted as needed and tolerated up to 100 mg daily in divided doses. Adolescents. Initial: 25 to 50 mg daily in divided doses, adjusted as needed and tolerated. Maximum: 100 mg daily. Children ages 6 to 12.10 to 30 mg daily in divided doses b.i.d.
As adjunct to treat childhood enuresis
Tablets
Children age 6 and over. 25 mg 1 hr before bedtime. Increased to 50 mg if no response occurs within 1 wk and child is under age 12; increased to 75 mg if child is age 12 or over. Maximum: 2.5 mg/kg daily.
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Contraindications of Drug
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Acute recovery period after MI; hypersensitivity to imipramine, other tricyclic antidepressants, or their components; use within 2 weeks of MAO inhibitor therapy
Generic Drug Interactions
Drugs
amantadine, anticholinergics, antidyskinetics, antihistamines: Risk of increased anticholinergic effects, including confusion, hallucinations, and nightmares
anticonvulsants: Increased risk of CNS depression, increased risk of seizures, decreased effectiveness of imipramine
antithyroid drugs: Possibly agranulocytosis
barbiturates, carbamazepine: Possibly decreased imipramine level and effects
cimetidine, fluoxetine: Possibly increased blood imipramine level
clonidine, guanadrel, guanethidine: Possibly decreased antihypertensive effects of these drugs, increased CNS depression (clonidine)
CNS depressants: Increased CNS depression, respiratory depression, and hypotension
disulfiram, ethchlorvynol: Risk of delirium, increased CNS depression (ethchlorvynol)
estramustine, estrogen-containing oral contraceptives, estrogens: Risk of increased bioavailability of imipramine, increased depression
MAO inhibitors: Increased risk of hypertensive crisis, severe seizures, and death
oral anticoagulants: Possibly increased anticoagulant activity
pimozide, probucol: Risk of arrhythmias
sympathomimetics (including ophthalmic epinephrine and vasoconstrictive local anesthetics): Increased risk of arrhythmias, hyperpyrexia, hypertension, tachycardia
thyroid hormones: Risk of increased therapeutic and adverse effects of both drugs
Activities
alcohol use: Increased CNS depression, increased alcohol effects sun exposure: Increased risk of photosensitivity
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Drugs Adverse Reactions
Central Nervous System: Anxiety, ataxia, chills, confusion, delirium, dizziness, drowsiness, excitation, extrapyramidal reactions, fever, hallucinations, headache, insomnia, nervousness, nightmares, parkinsonism, seizures, stroke, suicidal ideation, tremor
Cardiovascular: Arrhythmias, orthostatic hypotension, palpitations
Eyes, Ears, Nose, And Throat: Blurred vision, dry mouth, increased intraocular pressure, pharyngitis, taste perversion, tinnitus, tongue swelling
Endocrine: Gynecomastia, syndrome of inappropriate ADH secretion
Gastrointestinal: Constipation, diarrhea, heartburn, ileus, increased appetite, nausea, vomiting
Genitourinary: Impotence, libido changes, testicular swelling, urine retention
Hematologic: Agranulocytosis, bone marrow depression
Respiratory: Wheezing
Skin: Alopecia, diaphoresis, jaundice, photosensitivity, pruritus, rash, urticaria
Other: Allergic reaction, facial edema, weight gain
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Nursing Considerations for Generic Drugs
Use imipramine cautiously in patients with a history of urine retention or angle-closure glaucoma because drug's anti-
cholinergic effects may cause urine retention and increased intraocular pressure. WARNING Don't give MAO inhibitors within 2 weeks of imipramine. Patient may experience hypertensive crisis, seizures, and death.
Frequently assess for adverse reactions during first 2 hours of therapy.
Check supine and standing blood pressure for orthostatic hypotension before and during imipramine therapy and before dosage increases.
When drug is used for depression, expect mood elevation to take 2 to 3 weeks. Watch patient closely for suicidal tendencies, especially children and adolescents and especially when therapy starts or dosage changes, because depression may worsen temporarily at these times.
Avoid abrupt withdrawal of drug in patients on long-term therapy. Such withdrawal may cause headache, malaise, nausea, sleep disturbance, and vomiting.
Taper drug gradually, as ordered, a few days before surgery to avoid risk of hypertension during surgery.
Obtain CBC, as ordered, if patient experiences signs and symptoms of infection, such as fever or pharyngitis.
Limit amount of drug given to potentially suicidal patient.
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Imipramine
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
British Pharmacopoeia, 2008 edition: Imipramine Tablets;
The United States Pharmacopeia 31, 2008: Imipramine Hydrochloride Injection; Imipramine Hydrochloride Tablets.
Proprietary Preparations
Argentina: Elepsin; Tofranil;
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