ADHD Medication & Treatment

Tofranil

Generic Name: Imipramine pamoate, imipramine hydrochloride

What is Tofranil?

Tofranil (Generic Name: imipramine pamoate, imipramine hydrochloride) is a tricyclic antidepressant taken orally that is primarily used to treat depression in adolescents and adults. It can also be used to treat bed-wetting in children age six and older. It is not considered a controlled substance by the FDA.

Tricyclic antidepressants are also prescribed by some clinicians for the treatment of ADHD symptoms in patients who don’t tolerate first-line stimulant and non-stimulant medications. According to the journal Psychiatry, “To date, tricyclic antidepressants have the most evidence for the treatment of ADHD in the non-stimulant category. Out of 33 studies (21 controlled, 12 open) evaluating in children and adolescents (n=1139), and adults (n=78), 91 percent reported improvement in ADHD symptoms.¹”

The safety and effectiveness for patients over age 65 has not been established.

How to Use Tofranil

Before starting or refilling a Tofranil prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage for Tofranil

As with all medications, follow your Tofranil prescription instructions exactly.

Do not drink alcohol, or take barbituates or other central nervous system depressants while taking this drug.

Tofranil is available in two formulations:

Capsules (Tofranil-PM): Taken orally once daily, usually at bedtime with water or another liquid. Capsules are available in 75mg, 100mg, 125mg, and 150mg dosages.
Tablets: Taken orally with water or another liquid several times daily or once daily at bedtime. Tablets are available in 10mg, 25mg, and 50mg dosages.

The optimal dosage varies patient by patient. Tofranil is processed very slowly by the body. After deciding on an initial dose, your doctor may adjust your daily dosage by increments until you experience the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping Tofranil suddenly can create withdrawal symptoms including nausea, headache, and malaise.

Side Effects Associated with Tofranil

The most common side effects of Tofranil are similar to those associated with other tricyclic antidepressants, like Amoxapine, and are as follows: blurred vision, constipation, headache, dizziness, drowsiness, dizziness, weight gain, dry mouth, constipation, upset stomach, and excessive sweating.

Tofranil can increase sensitivity to the sun, and result in burns or blisters after prolonged exposure.

Other serious side effects include increased risk of suicide or suicidal thoughts, seizure, and vision problems.

Taking Tofranil may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.

Most people taking this medication do not experience any of these side effects. Patients should be monitored and observed closely for worsening depression, changes in behavior, or suicidality.

Tell your doctor about a history of heart disease, narrow-angle glaucoma, hyperthyroid, or a seizure disorder. Physicians should use extra caution prescribing Tofranil to patients with these conditions.

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, or depression. Tofranil may create new or exacerbate existing mental health problems including psychosis. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms. This drug may trigger a manic or hypomanic episode for patients with previously undiagnosed bipolar disorder. Treatment with Tofranil can increase the risk of simultaneous treatment for depression with electroconvulsive therapy.

Talk with your doctor about any liver function problems or blood conditions. Tofranil rarely can have dangerous side effects for patients with liver disease.

Tofranil may make it more difficult for patients with diabetes to control blood sugar levels.

Tofranil-PM can rarely lead to life-threatening serotonin syndrome, or toxicity, especially when co-administered with serotonergic agents like SSRIs, SNRIs, or St. John’s Wort. If you experience changes in mental status, coordination problems, muscle twitching, racing heartbeat, high or low blood pressure, sweating, vomiting or diarrhea, seek medical help immediately.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions Associated with Tofranil

You should use caution when taking any tricyclic antidepressants, including Tofranil, if you have any of the following conditions: heart disease, thyroid problems, narrow-angle glaucoma, urinary retention, diabetes, or a seizure disorder.

If you’re thinking of becoming pregnant, discuss the use of Tofranil with your doctor. It is unknown if Tofranil is harmful, but clinical reports suggest risk to the fetus. Tofranil is likely to be passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety and effectiveness for patients over age 65 has not been established.

Interactions Associated with Tofranil

Before taking Tofranil, discuss all other active prescription medications with your doctor.

You should not take Tofranil if you are taking monoamine oxidase inhibitors (MAOIs) within 14 days because of increased risk of serotonin syndrome.

Do not drink alcohol while taking this medication.

Use caution when taking Tofranil with anticholinergics like atropine, certain medications used to treat high blood pressure, guanethidine, clonidine, methylphenidate hydrochloride, thyroid mediation, and blood thinners like warfarin.

Drugs that cause drowsiness can impact heart rate and blood pressure when taken with Tofranil. Drugs that increase serotonin production can increase risk for serotonin toxicity when taken with Tofranil.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, especially any drugs that cause drowsiness. Let all doctors and physicians know you are taking Tofranil before having any surgery or laboratory tests.

The above is not a complete list of all possible drug interactions.

¹Budur K, Mathews M, Adetunji B, Mathews M, Mahmud J. “Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder.” Psychiatry (Edgmont). 2005;2(7):44-48.