side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

>
> Tofranil


US brand name: Tofranil
Generic name: imipramine

Other Forms: Intramuscular injection, oral solution.

Class: Antidepressants. Specifically a Tricyclic Antidepressants (TCAs)

1.  Other US brand names & branded generic names1

  • Tofranil-PM (imipramine pamoate)
  • Imiprin
  • Janimine
  • 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)

2.  FDA Approved Uses of Tofranil (imipramine)

Depression. Childhood enuresis (you know, never being able to hold it in and constant bedwetting).

3.  Off-Label Uses of Tofranil (imipramine)

4.  Tofranil’s (imipramine) pros and cons

4.1  Pros

Tofranil (imipramine HCl) has been since forever, so it is cheap as dirt and doctors should be familiar with its uses and effects.

4.2  Cons

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.

5.  Tofranil’s (imipramine) Side Effects

5.1  Typical Side Effects

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.

5.2  Not So Common Side Effects

Heart palpitations, no libido and other sexual dysfunctions. Agitation. Memory loss.

5.3  Freaky Rare Side Effects

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.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

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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7.  Tofranil’s (imipramine) Dosage and How to Take Tofranil (imipramine)

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.

8.  How Long Tofranil (imipramine) Takes to Work

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.

9.  How to Stop Taking Tofranil (imipramine)

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.

10.  Tofranil’s (imipramine) Half-Life & Average Time to Clear Out of Your System

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.

11.  Days to Reach a Steady State

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.

12.  Shelf life

  • Tablets: 3 years.
  • Oral Solution: 3 years, 30 days after opening.

13.  Comments

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.

The odds favor relief for endogenous depression - i.e. being depressed for no good reason. Although this study shows Zoloft to be more effective and to suck less for non-melancholic depression.

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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14.  Tofranil Ratings, Reviews, & Other Sites of Interest

Tofranil Ratings & Reviews Page.

14.1  Rate Tofranil

Give your overall impression of Tofranil on a scale of 0 to 5. Detailed ratings and reviews are available on the Tofranil Ratings & Reviews Page.

Get all critical about Tofranil

4 stars Rating 3.7 out of 5 from 22 criticisms.
Vote Distribution: 3 – 0 – 1 – 1 – 8 – 9


14.2  Rate this article

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

3.5 stars Rates 3.4 out of 5 from 13 value judgments.
Vote Distribution: 2 – 1 – 0 – 2 – 3 – 5



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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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14.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Tofranil discussion board.



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15.  References

  1. Tofranil (imipramine) Full US Prescribing Information

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. We 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 we write these damn things. 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. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Sunday, 23 March, 2014 at 17:49:29 by SomeMedCriticPage Author Date created
“Tofranil (imipramine): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © Jerod Poore Published online 2011/03/17
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Tofranil, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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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.



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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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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.

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3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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