Tofranil: Restoring Neurochemical Balance for Depression Relief
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Synonyms | |||
Tofranil (imipramine hydrochloride) is a tricyclic antidepressant (TCA) with a well-established clinical profile for managing major depressive disorders. As a norepinephrine and serotonin reuptake inhibitor, it modulates key neurotransmitter systems implicated in mood regulation. Its efficacy is supported by decades of use and numerous clinical studies, making it a trusted option for physicians specializing in psychiatric and neurological care. This agent is particularly noted for its dual action on both mood and certain comorbid conditions, offering a multifaceted therapeutic approach.
Features
- Active ingredient: Imipramine hydrochloride
- Drug class: Tricyclic antidepressant (TCA)
- Available formulations: 10 mg, 25 mg, and 50 mg tablets
- Mechanism of action: Inhibits reuptake of norepinephrine and serotonin
- Half-life: Approximately 8–16 hours
- Bioavailability: High oral absorption with extensive hepatic metabolism
Benefits
- Effectively alleviates symptoms of major depressive disorder by enhancing neurotransmitter activity.
- Provides relief for certain anxiety disorders and panic attacks due to its noradrenergic effects.
- Can be used off-label for managing neuropathic pain and migraine prophylaxis.
- Supports long-term remission when used as part of a comprehensive treatment plan.
- May improve sleep architecture and reduce nocturnal awakenings in depressed patients.
- Often effective in treatment-resistant cases where SSRIs have failed.
Common use
Tofranil is primarily indicated for the treatment of major depressive disorder in adults. It is also used in the management of childhood enuresis (bedwetting) due to its anticholinergic effects on the bladder. Off-label applications include panic disorder, neuropathic pain syndromes, and migraine prophylaxis. Its use is generally reserved for cases where first-line treatments such as SSRIs are ineffective or poorly tolerated, reflecting its role as a second-line agent with a distinct side effect profile.
Dosage and direction
Dosage must be individualized based on patient response and tolerance. For depression in adults, initial dosing typically starts at 75 mg daily, administered in divided doses or as a single nightly dose to minimize daytime sedation. This may be gradually increased to a therapeutic range of 150–300 mg per day, under close medical supervision. For elderly patients or those with hepatic impairment, lower starting doses (e.g., 30–40 mg daily) are recommended. For childhood enuresis, doses usually range from 25–75 mg taken once daily at bedtime, not exceeding 2.5 mg/kg. Always titrate slowly and monitor for adverse effects.
Precautions
Patients should be monitored for worsening depression, suicidal ideation, or unusual changes in behavior, especially during initial treatment or dose adjustments. Use with caution in individuals with a history of cardiovascular disease, as TCAs can affect conduction and heart rate. Regular ECGs may be advised in at-risk populations. Due to anticholinergic effects, Tofranil should be used cautiously in patients with glaucoma, urinary retention, or gastrointestinal motility disorders. Avoid abrupt discontinuation to prevent withdrawal symptoms.
Contraindications
Tofranil is contraindicated in patients with known hypersensitivity to imipramine or other TCAs. It must not be used concomitantly with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Additional contraindications include recent myocardial infarction, arrhythmias, and severe liver impairment. Use during the acute recovery phase after MI is not recommended.
Possible side effect
Common side effects include dry mouth, constipation, blurred vision, dizziness, drowsiness, and weight gain. Orthostatic hypotension may occur, particularly in elderly patients. Less frequently, patients may experience urinary retention, increased intraocular pressure, or sexual dysfunction. Serious adverse effects include arrhythmias, seizures, leukopenia, and jaundice. Any signs of allergic reaction (e.g., rash, swelling) require immediate medical attention.
Drug interaction
Tofranil interacts with multiple drug classes. Concomitant use with SSRIs, SNRIs, or triptans increases serotonin syndrome risk. Anticholinergic drugs may exacerbate side effects like dry mouth and constipation. CYP2D6 inhibitors (e.g., fluoxetine, quinidine) can elevate imipramine levels. Barbiturates may reduce Tofranil efficacy through enzyme induction. Use with antihypertensives may potentiate hypotension. Always review the patient’s full medication list before prescribing.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to catch up. Consistent daily dosing is important to maintain steady-state plasma concentrations and therapeutic effect.
Overdose
Tofranil overdose can be life-threatening, presenting with symptoms such as severe drowsiness, agitation, confusion, tachycardia, hypotension, seizures, and cardiac arrhythmias. Management includes gastric lavage (if presented early), activated charcoal, and supportive care with continuous ECG monitoring. Sodium bicarbonate may be used to correct acidosis and stabilize cardiac membranes. Immediate medical attention is critical.
Storage
Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis, treatment decisions, and personalized dosing. Do not initiate or discontinue Tofranil without medical supervision.
Reviews
Clinical studies and long-term use support Tofranil’s efficacy in treatment-resistant depression, though its side effect profile necessitates careful patient selection. Many experts value its dual action on norepinephrine and serotonin, particularly in cases with comorbid chronic pain. Patient experiences vary; some report significant improvement in mood and functionality, while others note tolerability issues such as sedation and anticholinergic effects. Overall, it remains a valuable tool in psychopharmacology when used judiciously.