Tofranil (imipramine hydrochloride) is a tricyclic antidepressant (TCA) with established efficacy in the management of major depressive disorder. It functions primarily by inhibiting the reuptake of norepinephrine and serotonin in the central nervous system, thereby increasing the availability of these crucial neurotransmitters. Clinically, it is recognized for its robust antidepressant and, in some cases, anxiolytic effects. Appropriate patient selection and adherence to dosing protocols are essential for optimizing therapeutic outcomes while minimizing adverse effects.

Features

• Active ingredient: Imipramine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg oral tablets
• Potent norepinephrine and serotonin reuptake inhibition
• Long half-life permitting once-daily dosing in maintenance phase
• Generic availability ensuring cost-effective treatment option

Benefits

• Effective alleviation of depressive symptoms including low mood, anhedonia, and fatigue
• Restoration of normal sleep architecture, particularly improving sleep continuity
• Reduction of anxiety symptoms often comorbid with depression
• Established long-term efficacy in preventing relapse of depressive episodes
• May provide adjunctive benefit in certain chronic pain conditions

Common use

Tofranil is primarily indicated for the treatment of major depressive disorder in adults. It is also used off-label for panic disorder, neuropathic pain, and as a second-line agent for certain anxiety disorders. Its use in pediatric populations is limited and requires careful risk-benefit assessment due to increased susceptibility to adverse effects.

Dosage and direction

Initial dosing for depression in adults typically begins at 75 mg daily, administered in divided doses or as a single nightly dose to minimize daytime sedation. Dosage may be gradually increased under medical supervision, not exceeding 300 mg daily for outpatients or 400 mg daily in hospitalized patients. Elderly patients and adolescents require lower initial doses, usually starting at 30–40 mg daily. Therapeutic effects may take 2–4 weeks to manifest fully. Abrupt discontinuation should be avoided; taper gradually over several weeks.

Precautions

Monitor patients for worsening depression or emergence of suicidal ideation, particularly during initial treatment or dosage adjustments. Use with caution in patients with cardiovascular disease, as TCAs can cause orthostatic hypotension, tachycardia, and prolonged QT interval. Regular ECG monitoring is advised in patients with preexisting cardiac conditions. Caution is warranted in patients with glaucoma, urinary retention, or thyroid disorders. Alcohol consumption should be avoided due to additive CNS depression.

Contraindications

Hypersensitivity to imipramine or other tricyclic antidepressants. Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Acute recovery phase after myocardial infarction. Severe liver impairment.

Possible side effects

Common: Dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension, drowsiness, weight gain. Less common: Tachycardia, ECG changes, confusion (especially in elderly), rash, photosensitivity. Rare but serious: Neuroleptic malignant syndrome, seizures, agranulocytosis, hepatitis.

Drug interaction

MAOIs: Risk of serotonin syndrome and hypertensive crisis. SSRIs/SNRIs: Increased serotonergic effects. Anticholinergics: Additive anticholinergic effects. CNS depressants (alcohol, benzodiazepines, opioids): Enhanced sedation. Antihypertensives: Potentiated hypotension. Sympathomimetics: Increased cardiovascular effects. CYP2D6 inhibitors (e.g., fluoxetine, quinidine): May increase imipramine levels.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to ensure stable plasma concentrations.

Overdose

TCA overdose is potentially fatal and constitutes a medical emergency. Symptoms include severe drowsiness, confusion, hallucinations, tachycardia, hypotension, respiratory depression, seizures, and cardiac arrhythmias. Management includes gastric lavage (if presented early), activated charcoal, continuous ECG monitoring, and supportive care. Sodium bicarbonate is used to correct acidosis and protect against cardiotoxicity.

Storage

Store at room temperature (15–30°C) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions. Do not initiate or discontinue Tofranil without medical supervision.

Reviews

“After trying several antidepressants, Tofranil provided the most consistent relief from my depressive symptoms, though the initial side effects required careful management.” – Patient, 42
“An old but effective option in treatment-resistant depression when newer agents fail. Requires vigilant monitoring but can be transformative.” – Psychiatrist, 15 years experience
“Effective for both depression and my neuropathic pain, though the anticholinergic effects remain challenging.” – Patient, 58
“Remains a valuable tool in our arsenal, particularly for patients with comorbid chronic pain and depression.” – Pain Specialist, 10 years experience