Common uses

Tofranil is used to treat depression. It is a member of the family of drugs called tricyclic antidepressants.
Tofranil is also used on a short-term basis, along with behavioral therapies, to treat bed-wetting in children aged 6 and older. Its effectiveness may decrease with longer use.
Some doctors also prescribe Tofranil to treat bulimia, attention deficit disorder in children, obsessive-compulsive disorder, and panic disorder.
Tofranil-PM, which is usually taken once daily at bedtime, is approved to treat major depression.

Before using

Before using this medicine inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. This includes carbamazepine, cimetidine, dicumarol, clonidine, mibefradil, paroxetine, tramadol, other medicines for depression or emotional disorders, and medicines for seizures. Inform your doctor of any other medical conditions including heart conditions, allergies, pregnancy, or breast-feeding.
Caution should be exercised when imipramine is used with agents that lower blood pressure.
In occasional susceptible patients or in those receiving anticholinergic drugs (including antiparkinsonism agents) in addition, the atropine-like effects may become more pronounced (e.g., paralytic ileus). Close supervision and careful adjustment of dosage is required when imipramine is administered concomitantly with anticholinergic drugs.
Avoid the use of preparations, such as decongestants and local anesthetics, which contain any sympathomimetic amine (e.g., epinephrine, norepinephrine), since it has been reported that tricyclic antidepressants can potentiate the effects of catecholamines.
Imipramine should be discontinued prior to elective surgery for as long as clinically feasible, since little is known about the interaction between imipramine and general anesthetics.
If administered concomitantly with estrogens, the dose of imipramine should be reduced since steroid hormones inhibit the metabolism of imipramine.

Directions

Use Tofranil as directed by your doctor.
• Take Tofranil by mouth with or without food.
• Taking Tofranil at bedtime may help reduce side effects (e.g., daytime drowsiness). Discuss this possibility with your doctor.
• It may take 1 to 3 weeks before you notice the effect of Tofranil. Continue to use Tofranil even if you feel well. Do not miss any doses.

Cautions

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Tofranil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Tofranil has not been studied in children less than 6 years old. Tofranil-PM is not approved for use in children.
Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Tofranil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly—especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior—and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.
You should use Tofranil cautiously if you have or have ever had: narrow-angle glaucoma (increased pressure in the eye); difficulty in urinating; heart, liver, kidney, or thyroid disease; or seizures. Also be cautious if you are taking thyroid medication.
General feelings of illness, headache, and nausea can result if you suddenly stop taking Tofranil. Follow your doctor's instructions closely when discontinuing Tofranil.
Tell your doctor if you develop a sore throat or fever while taking Tofranil.
This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure about your ability.
This drug can make you sensitive to light. Try to stay out of the sun as much as possible while you are taking it.
If you are going to have elective surgery, your doctor will take you off Tofranil.
Both increased and decreased blood sugar levels have been reported during Tofranil therapy. If you have diabetes or low blood sugar (hypoglycemia), your doctor will monitor you closely.
Be sure your doctor knows if you have a history of mental disorders. Tofranil could cause a manic episode in people with bipolar disorder or a psychotic episode in those with schizophrenia.
Unless it's absolutely essential, Tofranil is not recommended for people undergoing electroconvulsive therapy (ECT).

Possible side effects

Check with your doctor if any of these most common side effects persist or become bothersome:
• dizziness; drowsiness; dry mouth; excitement; headache; impotence; nausea; nightmares; pupil dilation; sensitivity to sunlight; sweating; tiredness; upset stomach; vomiting; weakness; weight loss or gain.
Seek medical attention right away if any of these severe side effects occur:
• severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision changes; changes in sex drive; chest pain; confusion; constipation; fainting; fast, slow, or irregular heartbeat; fever; frequent or difficult urination; hallucinations; impulsive behavior or other unusual changes in behavior; jaw, neck, or muscle spasms; mental or mood changes (eg, increased anxiety, mood swings, agitation, irritability, nervousness, restlessness); panic attacks; ringing in the ears; seizures; severe dizziness or drowsiness; sore throat; stomach pain; suicidal thinking or behavior; swelling of the testicles; tremor; trouble sleeping; trouble walking or keeping your balance; twitching of the face or tongue; uncontrolled movements of arms and legs or stiffness; unusual bleeding or bruising; worsening of depression; yellowing of the skin or eyes.

If you take too much

It has been reported that children are more sensitive than adults to overdoses of Tofranil. If you suspect an overdose, seek medical help immediately.
• Symptoms of Tofranil overdose may include:
Agitation, bluish skin, coma, convulsions, difficulty breathing, dilated pupils, drowsiness, heart failure, high fever, involuntary writhing or jerky movements, irregular or rapid heartbeat, lack of coordination, low blood pressure, overactive reflexes, restlessness, rigid muscles, shock, stupor, sweating, vomiting

Additional information

Serious, sometimes fatal, reactions have been known to occur when drugs such as Tofranil are taken with another type of antidepressant called an MAO inhibitor. Drugs in this category include Nardil and Parnate. Do not take Tofranil within 2 weeks of taking one of these drugs. Make sure your doctor and pharmacist know of all the medications you are taking
Drug interactions
Never combine Tofranil with an MAO inhibitor (see "Most important fact about Tofranil"). If Tofranil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tofranil with the following:

Albuterol (Proventil, Ventolin)
Antidepressants that act on serotonin, including Prozac, Paxil, and Zoloft
Antipsychotic drugs such as Mellaril and chlorpromazine
Barbiturates such as Nembutal and Seconal
Blood pressure medications such as Catapres
Carbamazepine (Tegretol)
Cimetidine (Tagamet)
Decongestants such as Sudafed
Drugs that control spasms, such as Cogentin
Epinephrine (EpiPen)
Flecainide (Tambocor)
Guanethidine
Methylphenidate (Ritalin)
Norepinephrine
Other antidepressants such as Elavil and Pamelor
Phenytoin (Dilantin)
Propafenone (Rythmol)
Quinidine
Thyroid medications such as Synthroid
Tranquilizers and sleep aids such as Halcion, Xanax, and Valium
Extreme drowsiness and other potentially serious effects can result if Tofranil is combined with alcohol or other mental depressants, such as narcotic painkillers (Percocet), sleeping medications (Halcion), or tranquilizers (Valium).
If you are switching from Prozac, wait at least 5 weeks after your last dose of Prozac before starting Tofranil.