imipramine TOFRANIL

Class: TCA/​Dihydrodibenzazepine
FDA Indications: MDD
Off-Label Use: Enuresis, Anxiety, Chronic Pain, Sleep Terrors, Somnambulism, ADHD, Migraines, Neuropathic Pain, Eating Disorders, PTSD
Forms: 10, 25, 50mg tablet; 75, 100, 125, 150 mg Tofranil-PM™ capsule
Dose Range: 75-300 mg/day
Starting: 25 mg qd qhs, ↑ by 25 mg q3-7 days, max dose 300 mg qd
Stopping: ↓ 50% x3 days, then ↓ another 50% x3 days, then D/C entirely.
Monitoring: Suggested plasma level 500-800 nmol/L (recommended for MDD)

NAMI drug fact sheet

Contraindications: Concomitant use of MAOIs; patient s/p MI; coadministration of other QT-prolonging agents; h/o QT ↑ or arrhythmia; caution in patients with hypo-K+ or hypo-Mg2+
Serious Side Effects: 5HT syndrome; ↓ seizure threshold; QT↑, arrhythmias, tachycardia, orthostatic hypotension
Possible Risk of TdP
Side Effects: anticholinergic side effects, weight gain, sexual dysfunction
1° MOA: Tricyclic antidepressant
Target: SERT, NET, H1, α1, M1, 5HT2A
t½: 32 (11-25)° TMAX: 1-2°
Substrate of: 2D6, 2C19; 1A2, 3A4
Inhibits: ∅ ; Induces:
Active Metabolites: desipramine
  • - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
  • - caution combining with other CNS depressants & anticholingerics
  • - the first antidepressant, first approved in 1959
  • - its 2° metabolite, desipramine, is the most noradrenergic of all the TCAs
  • - most preferred TCA for treating enuresis in children
Special Populations

Category C—A case-control study showed ∅ ↑ congenital malformations with 1st trimester use & a review (n=209) showed ∅ assoc with congenital malformations or developmental delay.

RID 0.15%

Avoid due to its anticholinergicity and high sedation, especially when combining with other CNS depressants and/or anticholingerics. Caution regarding orthostatic hypotension (fall risk!). Can impair cognition.

2019 BEE℞S Recommendation: Avoid. Highly anticholinergic, sedating, and cause orthostatic hypotension.

No dosage adjustment necessary.

All TCAs are hepatically metabolzed, highly protein bound and will accumulate, and associated with ↑ LFTs.


Developed & Designed by Kevin M. Nasky, D.O. • Built with Bootstrap, PHP & MySQL • Hosted by SiteGround
Last updated February 29 2024 20:54:18. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.