Drug Notebook

FDA Alerts

    Suicidality
  • Antidepressants may increase risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (18–24 years of age) with major depressive disorder and other psychiatric disorders; balance this risk with clinical need. Imipramine is not approved for use in pediatric patients except patients ≥6 years of age with enuresis. (See Pediatric Use under Cautions.)
  • In pooled data analyses, risk of suicidality was not increased in adults >24 years of age and apparently was reduced in adults ≥65 years of age with antidepressant therapy compared with placebo.
  • Depression and certain other psychiatric disorders are themselves associated with an increased risk of suicide.
  • Appropriately monitor and closely observe all patients who are started on imipramine therapy for clinical worsening, suicidality, or unusual changes in behavior; involve family members and/or caregivers in this process. (See Worsening of Depression and Suicidality Risk under Cautions.)

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imipramine
(im IP ra meen)

What is imipramine?
Imipramine is in a group of drugs called tricyclic antidepressants. Imipramine affects chemicals in the brain that may become unbalanced. Imipramine is used to treat symptoms of depression. Imipramine may also be used for purposes other than those listed in this medication guide.

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What is the price of this medication and similar alternatives?

This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

Imipramine HCl 50MG Tablets PAR30/$17.64 or 90/$35.3
Imipramine Pamoate 75MG Capsules MALLINCKRODT30/$333.02 or 90/$948.94
Tofranil 25MG Tablets MALLINCKRODT30/$155.99 or 90/$361.95
Tofranil 50MG Tablets MALLINCKRODT30/$128.24 or 90/$370.47
Tofranil-PM 100MG Capsules MALLINCKRODT30/$399.98 or 90/$1159.91
Tofranil-PM 125MG Capsules MALLINCKRODT30/$479.58 or 90/$1319.85
Tofranil-PM 150MG Capsules MALLINCKRODT30/$473.08 or 90/$1318.97
Tofranil-PM 75MG Capsules MALLINCKRODT30/$459.98 or 90/$1254.91

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What are the possible side effects of imipramine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

  • fast, pounding, or uneven heart rate;

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  • sudden numbness or weakness, especially on one side of the body;

  • sudden headache, confusion, problems with vision, speech, or balance;

  • feeling short of breath, even with mild exertion;

  • swelling, rapid weight gain;

  • confusion, hallucinations, or seizure (convulsions);

  • easy bruising or bleeding, unusual weakness;

  • restless muscle movements in your eyes, tongue, jaw, or neck;

  • urinating more or less than usual;

  • extreme thirst with headache, nausea, vomiting, and weakness;

  • skin rash, bruising, severe tingling, numbness, pain, or muscle weakness.

Less serious side effects may be more likely to occur, such as:

  • nausea, vomiting, stomach pain, loss of appetite;

  • constipation or diarrhea;

  • dry mouth, unpleasant taste;

  • weight changes;

  • weakness, lack of coordination;

  • feeling dizzy, drowsy, or tired;

  • nightmares;

  • blurred vision, headache, ringing in your ears;

  • breast swelling (in men or women); or

  • decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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How should I take imipramine?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label. If you need to have any type of surgery, tell the surgeon ahead of time that you are taking imipramine. You may need to stop using the medicine for a short time. Do not stop using imipramine without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects.

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What is the most important information I should know about imipramine?
Do not use imipramine if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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What other drugs will affect imipramine?
Before taking imipramine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Before taking imipramine, tell your doctor if you are currently using any of the following drugs: cimetidine (Tagamet); clonidine (Catapres); guanethidine (Ismelin); methylphenidate (Concerta, Ritalin, Daytrana); or heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Imipramine has not been formally assigned to a pregnancy category by the FDA. Several cases of congenital malformations, including limb reduction defects, in infants whose mothers took imipramine during pregnancy have been reported, although no firm association has been established. Neonatal withdrawal symptoms have also been reported. There are no controlled data in human pregnancy. Imipramine should only be given during pregnancy when there are no alternatives and benefit outweighs risk.

Imipramine and its active metabolite desipramine are excreted into human milk in small amounts. The American Academy of Pediatrics classifies imipramine as a drug "whose effect on nursing infants is unknown but may be of concern".

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Who should NOT use this medication?

  • Concurrent or recent (i.e., within 2 weeks) therapy with an MAO inhibitor. (See Specific Drugs under Interactions.)
  • During the acute recovery phase following MI.
  • Known hypersensitivity to imipramine, other dibenzazepine-derivative TCAs, or any ingredient in the formulation.

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What does my medication look like?
Imipramine is available with a prescription generically and under the brand name Tofranil. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. Tofranil 10 mg--triangular, coral, sugar-coated tablets Tofranil 25 mg--round, coral, sugar-coated tablets Tofranil 50 mg--round, coral, sugar-coated tablets

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of imipramine can be fatal. Symptoms of an imipramine overdose may include uneven heartbeats, extreme drowsiness, agitation, vomiting, blurred vision, sweating, muscle stiffness, swelling, shortness of breath, blue lips or fingernails, feeling light-headed, fainting, seizure (convulsions), or coma.

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What should I discuss with my healthcare provider before taking imipramine?
Do not use this medication if you are allergic to imipramine, or if you have recently had a heart attack. Do not use imipramine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take imipramine before the MAO inhibitor has cleared from your body. Before taking imipramine, tell your doctor if you are allergic to any drugs, or if you have:

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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Where can I get more information?
More Information

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