Imipramine, Oral Tablet

Other warnings

• Monoamine oxidase inhibitor (MAOI) use warning: Using an MAOI drug with imipramine can lead to seizures or even death. Do not take an MAOI within 2 weeks of stopping this drug unless your doctor tells you to do so. Do not start taking this drug if you stopped taking an MAOI in the last 2 weeks unless directed by your doctor. MAOIs include linezolid, selegiline, rasagiline, and tranylcypromine. Ask your doctor or pharmacist if you’re not sure if you take an MAOI.
• Serotonin syndrome warning: This drug can cause a life-threatening condition called serotonin syndrome. Symptoms include agitation, delirium, coma, fast heart rate, dizziness, and sweating. They also include flushing and hallucinations (seeing or hearing things that aren’t there). Other symptoms include stiff muscles, seizures, nausea, vomiting, diarrhea, and tremors (uncontrollable movements in one part of your body). If you have any of these symptoms, call your doctor right away.
• Dementia warning: Research has indicated that this medication, which is a drug called an anticholinergic, can raise your risk of dementia.

Imipramine is a prescription drug. It come as an oral tablet and oral capsule.

Imipramine oral tablet is available as the brand-name drug Tofranil. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Imipramine oral tablet may be used as part of a combination therapy. That means you may need to take it with other medications.

Why it’s used

Imipramine oral tablet is used to treat symptoms of depression. It’s also used as a part of treatment for enuresis (bed-wetting) in children.

How it works

Imipramine belongs to a class of drugs called tricyclic antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Imipramine works on your central nervous system to increase the levels of certain chemicals in your brain. This action improves your symptoms of depression.

It isn’t known how this drug works to stop bed-wetting. It may work by blocking certain chemicals in your child’s central nervous system.

Imipramine oral tablet may cause drowsiness. It may also cause other side effects.

More common side effects

The side effects of imipramine are slightly different for adolescents and adults than they are for children.

The more common side effects of imipramine in adolescents and adults can include:

• nausea
• constipation
• diarrhea
• vomiting
• dry mouth
• blurred vision
• trouble urinating
• breast swelling in men and women

The more common side effects of imipramine in children can include:

• nervousness
• sleep issues, such as trouble sleeping and nightmares
• tiredness
• nausea
• vomiting
• stomach pain
• diarrhea
• stomach cramps

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Thoughts about suicide or dying
• Attempts to end your life
• New or worsened depression
• New or worsened anxiety
• Feeling very agitated or restless
• Panic attacks
• Trouble sleeping
• New or worsened irritability
• Aggressive, angry, or violent behavior
• Acting on dangerous impulses
• Mania (an extreme increase in activity and talking)
• Other unusual changes in behavior or mood
• Eye problems. Symptoms can include:
  • eye pain
  • trouble seeing or blurred vision
  • swelling or redness in or around your eye

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Imipramine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with imipramine are listed below.

Drugs you should not use with imipramine

Do not take these drugs with imipramine. Doing so can cause dangerous effects in your body. Examples of these drugs include:

• Monoamine oxidase inhibitors (MAOIs). Using an MAOI drug with imipramine can lead to seizures or even death. Do not take an MAOI within 2 weeks of stopping imipramine unless your doctor tells you to do so. Do not start imipramine if you stopped taking an MAOI in the last 2 weeks unless directed by your doctor. Ask your doctor or pharmacist if you’re not sure if you take an MAOI.

Interactions that increase your risk of side effects

• Side effects from imipramine: Taking imipramine with certain medications raises your risk of side effects from imipramine. This is because the amount of imipramine in your body may be increased. Examples of these drugs include:
  • Cimetidine and quinidine
    Taking either of these drugs with imipramine can lead to seizures, coma, and even death.
  • Propafenone and flecainide
    Taking either of these drugs with imipramine can lead to seizures, coma, and even death.
  • Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, and paroxetine
    If you need to take any of these drugs with imipramine, your doctor may lower your dosage of imipramine. If you stop taking the SSRI, your doctor may increase your dosage of imipramine.
• Side effects from other drugs: Taking imipramine with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
  • Anticholinergic drugs, such as diphenhydramine, meclizine, olanzapine, oxybutynin, and tolterodine
    Taking any of these drugs with imipramine may cause blurred vision, dry eyes, trouble urinating, and nausea. Your doctor may lower your imipramine dosage if you take it with one of these drugs.
  • Decongestants and local anesthetics, such as epinephrine, phenylephrine, and oxymetazoline
    These drugs can make your heart work harder when taken with imipramine. You shouldn’t take any of these drugs with imipramine.
  • Methylphenidate
    Your doctor may decrease your dosage of imipramine if you need to take it with methylphenidate.

Interactions that can make your drugs less effective

• When other drugs are less effective: When certain drugs are used with imipramine, they may not work as well. This is because imipramine may block the effects of these drugs. Examples of these drugs include:
  • Clonidine
    You shouldn’t use this drug with imipramine since clonidine won’t work as well to treat your condition.
• When imipramine is less effective: When imipramine is used with certain drugs, it may not work as well to treat your condition. This is because the amount of imipramine in your body may be decreased. Examples of these drugs include:
  • Phenobarbital and phenytoin
    If you need to take either of these drugs with imipramine, your doctor may increase your dosage of imipramine. If you stop taking phenobarbital or phenytoin, your doctor may decrease your dosage of imipramine.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Imipramine can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it or the drug desipramine. Taking it again could be fatal (cause death).

Alcohol interaction warning

Drinking alcohol can increase your risk of suicidal thoughts from imipramine. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with bipolar disorder: You shouldn’t use this drug without using other medications to treat your bipolar disorder. Imipramine can make your mania symptoms worse.

For people with history of trouble urinating: Talk with your doctor before starting this drug if you have trouble urinating. This drug may make your symptoms worse.

For people with open-angle glaucoma: This drug may make your open-angle glaucoma worse. Your doctor may monitor your vision while you’re taking this medication.

For people with history of seizure disorder: This drug may increase the number of seizures you have. Your doctor may give you a different drug if you have a seizure disorder.

For people with history of heart disease: If you have a history of heart failure, heart attack, stroke, or a fast heart rate, this drug may make your condition worse. Your doctor may watch you more closely while you’re taking this medication. You shouldn’t use this drug if you’ve had a heart attack very recently.

For people with plans to have surgery: If you plan to have surgery, your doctor may tell you to stop taking this drug for a short time. This medication may increase your blood pressure. This may cause problems during your surgery.

For people with a fever and sore throat: If you develop a fever and sore throat while you’re on this drug, your doctor may do blood tests. If the blood tests show you have low white blood cell levels, your doctor may have you stop taking this drug.

For people with diabetes: This drug may cause changes in your blood sugar levels. Your doctor may ask you to test your blood sugar more often when you start taking this medication.

For people with kidney problems: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of imipramine in your body and cause more side effects.

For people with liver problems: If you have liver problems or a history of liver disease, this drug can make your condition worse. You doctor may give you a lower dosage of imipramine.

Warnings for other groups

For pregnant women: The Food and Drug Administration (FDA) hasn’t assigned a pregnancy category to imipramine. It is not known if imipramine is safe and effective for use in pregnant women.

Tell your doctor if you’re pregnant or plan to become pregnant. Imipramine should be used during pregnancy only if the potential benefit justifies the potential risk.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: Imipramine may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

For children: It hasn’t been confirmed that this drug is safe and effective to treat depression in children younger than 18 years of age.

This drug hasn’t been studied in children younger than 6 years for the treatment of bed-wetting. It shouldn’t be used in children younger than 6 years.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Imipramine

• Form: oral tablet
• Strengths: 10 mg, 25 mg, 50 mg

Brand: Tofranil

• Form: oral tablet
• Strengths: 50 mg

Dosage for depression

Adult dosage (ages 18–64 years)

• Typical starting dosage: 75 mg per day.
• Dosage increases: Your doctor may increase your dosage slowly. They may usually increase it up to 150 mg per day.
• Maximum dosage: 200 mg per day. If you were in the hospital for your symptoms, your doctor may increase your dosage to 300 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for the treatment of depression in children younger than 18 years of age.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

• Typical starting dosage: 30–40 mg per day.
• Dosage increases: Your doctor may increase your dose slowly.
• Maximum dosage: 100 mg per day.

Dosage for enuresis (bed-wetting)

Adult dosage (ages 18 years and older)

This drug shouldn’t be used in adults for the treatment of this condition.

Child dosage (ages 12–17 years)

• Typical starting dosage: 25 mg per day taken 1 hour before bedtime. If your child wets the bed early in the night, they may benefit from taking half of their dose in the afternoon and the other half at bedtime.
• Dosage increases: If the starting dosage isn’t effective after 1 week, your doctor may increase the dosage to 75 mg.

Child dosage (ages 6–11 years)

• Typical starting dosage: 25 mg per day taken 1 hour before bedtime. If your child wets the bed early in the night, they may benefit from taking half of their dose in the afternoon and the other half at bedtime.
• Dosage increases: If the starting dosage isn’t effective after 1 week, your doctor may increase your child’s dosage to 50 mg.

Child dosage (ages 0–5 years)

Imipramine shouldn’t be used in children younger than 6 years.

Dosage warnings

• Children shouldn’t take a dosage higher than 2.5 mg per kg of body weight per day. Doing so could harm your child’s heart.
• Taking doses higher than 75 mg hasn’t been shown to be more effective. It only causes more side effects.
• After your child has been taking the drug for a while, their doctor may take them off of the drug to see if they still need it.
• Your child’s doctor should reduce your child’s dosage of this drug slowly. If your child stops taking it too fast, their symptoms may come back. Also, imipramine may not work to treat their bed-wetting anymore.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Imipramine oral tablet is used for long-term treatment of depression and short-term treatment of bed-wetting. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: For depression, stopping this drug suddenly can make your depression symptoms worse. It may also cause nausea, headaches, and a generally sick feeling.

For bed-wetting, stopping this drug suddenly can cause your child’s symptoms to come back. Also, imipramine may not work to treat their condition anymore.

Don’t stop taking this drug without talking to your doctor.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• drowsiness
• low blood pressure, with symptoms such as feeling dizzy or faint
• uncontrollable body movements
• confusion or feeling like you’re in a daze
• seizure
• coma

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: For depression: Your symptoms of depression should improve.

For bed-wetting: Your child should wet the bed less often.

Keep these considerations in mind if your doctor prescribes imipramine for you.

General

• You can take this drug with or without food.
• You can cut or crush the tablet.
• Take this drug before bedtime. This will reduce your risk of side effects.

Storage

• Store imipramine at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

• Kidney function: Your doctor will do blood tests to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may lower your dosage of this drug.
• Mental health and behavioral problems: This drug can cause new mental health and behavior problems. It can also worsen problems you already have. You and your doctor should watch for any unusual changes in your behavior and mood.
• Heart function: If you are a senior, have an increased risk of heart problems, or take large doses of this drug, your doctor may do an electrocardiogram (EKG) to check your heart rhythm.

Sun sensitivity

This drug can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid being in the sun if you can. If you can’t, be sure to wear protective clothing and apply sunscreen.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.