Overview
Tofranil is the brand name for Imipramine, a tricyclic antidepressant. Tofranil is an anticholinergic - a drug that blocks the parasympathetic nerves. Its properties are most closely related to the tricyclic antidepressants Elavil (Amitriptyline) and Adapin (Doxepin.)

Tofranil’s effects may be felt in about two to four weeks.

Why is this drug prescribed?
Tofranil is used primarily to treat depression. In manic depression, it may aggravate or lead to a manic episode.

In children, Tofranil is used to treat bedwetting (enuresis) in children over 5 years old. It is used as a short-term therapy for bedwetting that does not have an organic cause, and use for longer than six months can lead to a decreased effectiveness of this drug.

This drug is also used to treat:

1. obsessive-compulsive disorder (OCD)
2. delusions
3. chronic, severe pain
4. cocaine withdrawal
5. ADHD
6. panic attacks and/or panic disorder
7. binge eating and purging in bulimia

Warnings and Precautions
Tofranil is recommended for children only as a therapy for bedwetting, and only then in children over five years old. Dosage must be kept low because there is a higher possibility of toxic effects on the heart in children. Children are at a higher risk of overdose than adults and in infants and young children overdose of Tofranil can be serious or even fatal.

Dosage in adolescents may need to be reduced.

Suddenly discontinuing Tofranil may cause withdrawal. Dosages should be gradually tapered when this drug is discontinued.

Tofranil can cause photosensitivity and can reduce sweating which impairs the body's ability to adapt to heat. Patients should avoid saunas and other very hot environments.

Tofranil can cause drowsiness or trouble thinking in some people. Patients should not drive or operate heavy machinery until they know that this drug does not affect the ability to safely engage in these activities.

For Pregnant or Nursing Mothers: Tofranil’s safety during pregnancy has not been established. Newborns whose mothers had taken imipramine up until delivery have

shown symptoms such as breathing difficulty, lethargy, colic, irritability,

high or low blood pressure, tremor or spasms during the first few hours or days. Tofranil should be especially avoided during the first trimester and last seven weeks of pregnancy. Tofranil passes into breast milk and nursing mothers should not take this drug.

Contraindications
Tofranil should Not be used for people with the following medical conditions:

1. diabetes – blood glucose levels may need to be checked more frequently than usual
2. severe hepatic or renal damage
3. a history of blood disease
4. an allergy to Tofranil or other tricyclic antidepressants in the dibenzazepine group
5. recent myocardial infarction
6. convulsive disorders
7. glaucoma
8. heart disease – patients may be given Tofranil with very careful monitoring
9. hyperthyroid patients – use with caution
10. seizures
11. difficulty urinating

Adverse Reactions
Tofranil may cause the following reactions:

1. rash
2. hives
3. swelling of face or tongue
4. headache
5. dizziness
6. nervousness
7. weakness
8. tremors
9. fainting
10. dental cavities
11. altered taste
12. nausea
13. photosensitivity
14. decreased / increased libido
15. impaired erection or inhibited female orgasm
16. seizures
17. delirium
18. delusions
19. hallucinations
20. Tourette syndrome
21. liver / kidney toxicity
22. heart rhythm disturbances
23. abnormally low white blood cell and platelet count

The side effects most common in children are:

1. nervousness
2. sleep disorders
3. stomach and intestinal problems
4. tiredness
5. anxiety
6. collapse
7. constipation
8. convulsions
9. emotional instability
10. fainting

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Tofranil are:

1. MAO Inhibitors (within 14 days) – serious or even fatal reactions may occur when taken with Tofranil.
2. all atropinelike drugs, all sedative drugs (including barbiturates), norepinephrine, Dilantin (phenytoin), and Coumadin (warfarin) – Tofranil can increase their effects.
3. Catapres (clonidine), Hylorel (guanadrel), Ismelin / Esimil (guanethidine), and Tenex (guanfacine) – Tofranil can decrease the effects of these drugs.
4. Tagamet (cimetidine), estrogens, Prozac (fluoxetine), Luvox (fluvoxamine), Normodyne (labetalol), Ritalin (methylphenidate), oral contraceptives, phenothiazines, Quinaglute (quinidine), and Zantac (ranitidine) – these drugs can increase Tofranil’s effects.
5. Antihistamines – when taken with Tofranil can cause urinary retention, acute glaucoma, or excessive anticholinergic (parasympathetic nerve blocking) actions.
6. Placidyl (ethchlorvynol) - can cause delirium when taken with Tofranil.
7. Norvir (ritonavir) and other protease inhibitors – these drugs can cause toxicity when taken with Tofranil.
8. Stimulant drugs such as cocaine or amphetamines can cause very high blood pressure and/or high fever when taken with Tofranil.
9. Thyroid medications when taken with Tofranil can increase the risk of heart rhythm disorders.
10. Alcohol – when combined with Tofranil its intoxicating effects are increased and the combination can result in significantly depressed brain function.
11. smoking – can increase the rate of elimination of Tofranil from the body and a larger dose may be needed.
12. Marijuana – can increase drowsiness and dry mouth side effects of Tofranil.
13. blood thinners
14. Lithium

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