side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Table of Contents (hide)
- 1. Other US brand names & branded generic names1
- 2. FDA Approved Uses of Tofranil (imipramine)
- 3. Off-Label Uses of Tofranil (imipramine)
- 4. Tofranil’s (imipramine) pros and cons
- 5. Tofranil’s (imipramine) Side Effects
- 6. Interesting Stuff Your Doctor Probably Won’t Tell You
- 7. Tofranil’s (imipramine) Dosage and How to Take Tofranil (imipramine)
- 8. How Long Tofranil (imipramine) Takes to Work
- 9. How to Stop Taking Tofranil (imipramine)
- 10. Tofranil’s (imipramine) Half-Life & Average Time to Clear Out of Your System
- 11. Days to Reach a Steady State
- 12. Shelf life
- 13. Comments
- 14. Tofranil Ratings, Reviews, & Other Sites of Interest
- 15. Bibliography
|US brand name: Tofranil|
|Generic name: imipramine|
Other Forms: Intramuscular injection, oral solution.
1. Other US brand names & branded generic names1
- Tofranil-PM (imipramine pamoate)
- Antidep (India)
- Apo-Imipramine (Canada)
- Chrytemin (Japan)
- Daypress (Japan)
- Depsol (India)
- Depsonil (India)
- Ethipramine (South Africa)
- Fronil (Taiwan)
- Imidol (Japan)
- Imiprex (Bahrain; Cyprus; Egypt; Iran; Iraq; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates)
- Melipramine (Australia)
- Primonil (Israel)
- Pryleugan (Germany)
- Sermonil (Thailand)
- Talpramin (Mexico)
- Tofranil-PM (Colombia; Mexico)
- Venefon (Greece)
Depression. Childhood enuresis (you know, never being able to hold it in and constant bedwetting).
- Neuropathic and chronic pain (compare it to codeine in this study)
- Somatoform pain disorder (where they think it’s all in your head)
- Migraines, although other TCAs might work better. Presuming anticonvulsants don’t do it for you in the first place.
- Combat post traumatic stress disorder (PTSD)
- Panic/Anxiety disorders when benzodiazepines are no longer indicated.
- Chronic alcoholism
- Behavioral disorders in children
- Narcolepsy-cataplexy with loss of sphincter control Best. Off-label. Use. Ever!
- Schizophrenia and other psychoses. This isn’t an off-label usage so much as what imipramine was originally developed to do.
Tofranil (imipramine HCl) has been since forever, so it is cheap as dirt and doctors should be familiar with its uses and effects.
Tofranil (imipramine HCl) has been since forever, so older and/or non-psychiatric doctors are too willing to turn to it first when other meds may be more appropriate; and younger doctors have never heard of it so they won’t prescribe it when it would be a good first or second med to try. Although the ‘new’ and ‘improved’ Tofranil-PM (imipramine pamoate) might have made enough inroads to show up on some doctors’ radar.
The anticholinergic side effects typical when starting TCAs - headache, nausea, sweating, dry mouth, sleepiness or insomnia, constipation, urinary hesitancy, and blurry vision. If you get any, or all of these, expect them to pass in a week or two. Maybe. Weight gain is also common and may or may not go away. Sedation, constipation, dry mouth, and urinary hesitancy are the most likely to stick around.
Heart palpitations, no libido and other sexual dysfunctions. Agitation. Memory loss.
Toxic megacolon, AKA Ogilvie’s syndrome. Hyperpigmentation. “Proneness to falling.” Transient (temporary) blindness. I first learned about this one from rabbitinthemoon’s experience, as posted on our forum. It’s not yet listed in the PI sheet or the literature.
Desipramine is an active intermediate metabolite of Tofranil (imipramine HCl). So just as Lexapro has fewer and less harsh side effects than Celexa, the same may apply to desipramine and imipramine. However, Tofranil (imipramine) is more like Wellbutrin than Celexa, and desipramine is just one of two metabolites along with the imipramine that do something, so desipramine may not do it for you. Not only that, Tofranil-PM is imipramine pamoate, not imipramine hydrochloride. While the FDA keeps telling us there’s no significant difference between the different salts, consumer experience, and especially the pharmacokinetics, beg to differ.
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Initial dose for outpatients should be 75mg a day. Try it at bedtime first and see if it makes you either tired or wired, but the odds are going to be tired. You can go up to 150mg a day. The maintenance dosage will be in the range of 50–150mg a day. With that in mind I’d suggest starting at 25–50mg a day. Or even 10mg, as they make 10mg tablets.
Hospitalized patients can go up to 300mg a day, but as much as I love TCAs, I’d be really careful with anything above 200mg a day.
TCAs generally take 14 to 28 days to be fully effective. Given the long time to reach a truly steady state, 21–28 days is more likely.
Unless you need to stop taking Tofranil (imipramine) for something like a severe allergic reaction or something equally bad, your doctor should be recommending that you reduce your dosage by 25–50mg a day every five days if you need to discontinue. TCA’s don’t have a discontinuation syndrome like SSRIs do, but it can be really unpleasant to stop taking any crazy med too quickly.
Nothing published because it’s not a linear med (i.e. It’s wacky). Plus there are two active metabolites in addition to the imipramine itself, so the pharmacokinetics are as complicated as Wellbutrin.
One study puts the range at 4 to 20.2 hours. Another study (about the lack of influence of food on imipramine’s bioavailability) puts it at 21 hours. As desipramine has a half-life of 21 hours, five days is the minimum for everything to be out of your system.
None is published in the PI sheet, and as it has non-linear properties I can’t say that I blame Novartis for leaving out that data. However I did find one study of adults that put it at 19 days for everything involved.
- Tablets: 3 years.
- Oral Solution: 3 years, 30 days after opening.
Developed in 1956, about the same time as MAOIs, imipramine was one of the very first antidepressants that were not some other drug, usually stimulants or tranquilizers. Sort of. Impipramine was originally developed as an antipsychotic that failed the psychosis part, but did great for other aspects of crazy.
When it comes to reuptake inhibition of serotonin and norepinephrine Tofranil (imipramine) is somewhat more potent than Elavil (amitriptyline). And as Elavil (amitriptyline) is a much more potent antihistamine and anticholinergic, Tofranil (imipramine) is likely to suck less.
Tofranil-PM has replaced pretty much replaced Tofranil as the brand-name (branded generic1 really) product in the US, and the difference is imipramine pamoate vs. imipramine hydrochloride. What does that mean to you? Two things. The first is that the current brand is technically different from the generic.
The second is that doesn’t matter, so you may as well get generic imipramine HCl Scratch that, as it turns out these things can make a difference. It’s all a matter of collecting data now to tell if one is better than the other for most people, some people, or the FDA is right in this case and it really doesn’t make much of a difference after all. I don’t know about Tofranil, but it does make a difference with generic versions of extended release Wellbutrin (bupropion hydrochloride) vs. Aplenzin (bupropion hydrobromide) in that the hydrobromide version is way more stable, and thus easier to make a long-lasting version. And, according to Dr. Stahl, it might be less likely to cause seizures. The pharmacokinetics (PK) of Pexeva are different than the PK of Paxil and most paroxetine generics, which has resulted in one reported problem when switching from generic paroxetine HCl to Pexeva. So my money is on the FDA once again lying to us about the differences between various generic products.
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Get all critical about Tofranil
Rating 3.7 out of 5 from 15 criticisms.
Vote Distribution: 2 – 0 – 1 – 1 – 5 – 6
If you’re still feeling judgmental as well as just mental2, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
Get all judgmental about the Tofranil (imipramine) Synopsis
Rating 3.6 out of 5 from 5 value judgments.
Vote Distribution: 0 – 1 – 0 – 1 – 1 – 2
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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If you have any questions not answered here, please see the Crazymeds Tofranil discussion board.
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Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.
Physicians’ Desk Reference Edition 53 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. � 2002. Published by Medical Economics Company.
Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
A Primer of Drug Action Robert M. Julien, M.D., Ph. D. � 2001. Ninth Edition.
The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.
Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
Handbook of Affective Disorders edited by Eugene S. Paykel, M.D. FRCPsych � 1992. Published by The Guilford Press.
Mosby’s 2004 Drug Guide David Nissen PharmD, Editor.� 2004. An imprint of Elsevier.
The Bipolar Disorder Survival Guide David J. Miklowitz, Ph.D. � 2002. Published by The Guilford Press.
1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.
2 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
If you have any questions not answered here, please see the Crazymeds Tofranil discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Sunday, 23 March, 2014 at 17:49:29 by SomeMedCritic||Page Author: JerodPoore||Date created Thursday, 17 March, 2011 at 15:07:04|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]