Tofranil (imipramine) is a tricyclic antidepressant primarily used to treat depression and, in patients at least 6 years of age, bedwetting, which is formally called nocturnal enuresis. Though not particularly common, it is also sometimes used in an assortment of other conditions, including chronic pain, night terrors, panic attacks, and migraines. The exact mechanism by which it works is unclear in all conditions.

The medication is administered by tablets, which may be taken once per day to several times per day, depending on the condition being treated and patient response. Treatment typically lasts at least a few months, sometimes much longer.

This product is also known by the brand name Antidep.

Treating Depression with Tofranil

Like most antidepressants, Tofranil is thought to work by stabilizing substances in the brain, such as serotonin, norepinephrine, dopamine and so forth. It may take about two to four weeks for substantial benefit to be seen, and dosage may be increased at that point if no there are no significant improvements.

Patients taking Tofranil report:

• More stabilized mood
• Fewer and milder mood swings
• Improved focus and control of thoughts
• Less anxiety
• Increased energy

Some patients struggle with the first few months of treatment, especially if it is the first time taking an antidepressant; depression and other symptoms may briefly worsen. This is why antidepressants come with a warning about possibly increasing risk of suicide. Worsening symptoms are more likely to happen with patients who are under age 25, and most likely to happen during the first month of treatment. Younger patients or those with a history of suicide attempts or self-harm should be monitored closely for the first few weeks of treatment with Tofranil or any antidepressant.

Dosage should always be determined by a doctor, particularly in patients under 25. Standard treatment for adults is:

• Start with 75 mg per day, increased up to 200 mg per day after two weeks of treatment if 75 mg proves insufficient.
• Once symptoms are under control, a lower daily maintenance dose of 50 to 150 mg can be established.
• Patients should not exceed 200 mg per outside of hospital settings.
• Smaller doses may be taken once per day. Larger doses are often divided into 2, 3, or 4 smaller doses taken throughout the day.
• Treatment should not end abruptly, especially at higher doses. A doctor can help with a discontinuation plan that gradually reduces dosage.

Treatment typically lasts 6 to 9 months, though this can vary.

Tofranil for Bedwetting

Tofranil can be used in patients age 6 and up for bedwetting when there is no known cause; other causes, such as physical complications or medication side effects should be ruled out first. Dosage should be determined by a doctor according the child's weight.

Treatment typically starts with low doses, increased in weekly increments if improvements are not seen. Tablets are typically administered about an hour prior to bed, though some have better results giving a half-dose in the afternoon and the other half before bed.

Duration of treatment should be established by a doctor.

Potential Complications

Patients with preexisting medical conditions are at increased risk of experiencing serious side effects. Speak with a doctor about risks and warning signs before taking Tofranil if there is any history of:

• Liver or kidney problems
• Heart or cardiovascular issues
• Diabetes

At higher doses Tofranil is associated with a risk of heart problems. Warning signs include:

• Feeling faint and/or dizzy
• Rapid or irregular heartbeat
• Pain or discomfort in chest

Tofranil can interact with a wide range of other medications, particularly other antidepressants. Always check with a doctor or pharmacist before mixing medications.