Tofranil (Imipramine)

Do’s

• Before starting Tofranil and with each refill, carefully review the Medication Guide provided by your pharmacist. If you have any questions, seek guidance from your healthcare provider.
• Tofranil should be taken orally, with or without food, as directed by your healthcare provider. 
• Typically, the dosage ranges from 1 to 4 times daily. If daytime drowsiness occurs, your healthcare provider may instruct you to take the entire dose once daily at bedtime. 
• The specific dosage is determined based on your medical condition and response to treatment. In children, the dosage may also be based on body weight. To minimize the risk of side effects, your healthcare provider may initiate treatment with a low dose and then gradually increase it.
• When Tofranil is used by children for bed-wetting, it should be taken one hour before bedtime. If the child usually wets the bed early at night, the drug may be administered in separate doses, such as one dose in the afternoon and one at bedtime. 
• Consistent use of this medication at the same time(s) each day is essential to obtain the greatest benefit from it.
• Tofranil may not produce immediate effects. It could take up to 3 weeks before the full benefits are experienced, especially when used for depression.
• Even if you feel well, continue taking Tofranil.
• In cases of prolonged use in children for bed-wetting, the effectiveness of the medication may diminish and different dosing may be necessary. Consult a healthcare provider if the medication stops working effectively.

Don’ts

• Avoid taking more or less medication or taking it more frequently than prescribed. 
• Do not discontinue this medication suddenly without consulting your healthcare provider. Abrupt cessation may worsen certain conditions, and your healthcare provider may need to gradually decrease your dose.

Common Side Effects:

• Increased blood pressure
• Tingly feeling, weakness, lack of coordination
• Dry mouth, nausea, vomiting
• Breast swelling (in men or women) 

Serious Side Effects:

• Light-headed feeling, like you might pass out
• New or worsening chest pain, pounding heartbeats, or fluttering in your chest
• Sudden numbness or weakness, problems with vision, speech, or balance
• Fever, sore throat
• Confusion, hallucinations, unusual thoughts or behavior
• Painful or difficult urination
• Seizures (convulsions)
• Jaundice (yellowing of the skin or eyes) 

Not all individuals will experience these side effects, and some may experience different or additional effects. If you have concerns about the side effects of Tofranil, consult with a healthcare provider for personalized advice and guidance.

An ECG recording should be taken prior to the initiation of larger-than-usual doses of Tofranil and at appropriate intervals thereafter until a steady state is achieved. This is particularly important for patients with any evidence of cardiovascular disease, as they require cardiac surveillance at all dosage levels of the drug.

Elderly patients and those with cardiac disease or a prior history of cardiac disease are at special risk of developing cardiac abnormalities associated with the use of Tofranil.

Patients with a history of seizure disorder should use Tofranil with caution, as this drug has been shown to lower the seizure threshold.

Tofranil may interact with other drugs, including guanethidine, clonidine, or similar agents, and methylphenidate hydrochloride. Inform your healthcare provider about all other medicines you use to avoid potential interactions.

Tofranil is not approved for use in pediatric patients, except for pediatric patients with nocturnal enuresis. Families should be advised of the need for close observation and communication with the healthcare provider.

Limited data suggest that Tofranil is likely to be excreted in human breast milk. As a general rule, a woman taking a drug should not nurse since the possibility exists that the drug may be excreted in breast milk and be harmful to the child.

Tofranil may enhance the CNS depressant effects of alcohol, so caution should be exercised when consuming alcohol while taking this medication.

The information provided here is not exhaustive, and individuals considering the use of Tofranil should consult with a healthcare provider for personalized advice and guidance.