Tofranil
Generic Name
Imipramine Hydrochloride
Manufacturer
Novartis (Original)
Country
Switzerland (Original)
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| tofranil 25 mg tablet | ৳ 5.60 | ৳ 56.00 |
Description
Overview of the medicine
Imipramine is a tricyclic antidepressant (TCA) primarily used for treating major depressive disorder and nocturnal enuresis (bedwetting) in children. It works by affecting certain chemical messengers in the brain.
Uses & Indications
Dosage
Adults
For depression: Initially 25-75 mg daily in divided doses, gradually increasing to 75-150 mg daily. Max 300 mg/day for hospitalized patients. For panic disorder: Starting 10-25 mg, titrate slowly up to 100-200 mg/day.
Elderly
Lower starting dose recommended, e.g., 10-25 mg daily, gradually increased under close supervision. Maximum 100-150 mg/day.
Renal_impairment
Use with caution. Dose adjustment may be necessary based on clinical response and side effects, as drug elimination may be reduced.
How to Take
Tofranil 25 mg tablet is taken orally, with or without food. It can be taken once daily at bedtime to minimize daytime sedation, or in divided doses.
Mechanism of Action
Imipramine primarily acts by blocking the reuptake of norepinephrine and serotonin in the central nervous system, thereby increasing the concentration of these neurotransmitters in the synaptic cleft. It also has anticholinergic, antihistaminic, and alpha-adrenergic blocking effects.
Pharmacokinetics
Onset
Antidepressant effects typically begin in 2-4 weeks, though some patients may experience benefits earlier. Full therapeutic effects may take longer.
Excretion
Primarily excreted in the urine (approximately 80%) as metabolites, with a small amount excreted in feces.
Half life
Imipramine: 9-28 hours. Desipramine (active metabolite): 12-54 hours.
Absorption
Well absorbed orally, but undergoes significant first-pass metabolism in the liver. Peak plasma concentrations are reached within 1-2 hours.
Metabolism
Extensively metabolized in the liver, primarily by demethylation to its active metabolite desipramine, and by hydroxylation. Involves CYP2D6, CYP1A2, and CYP3A4 enzymes.
Side Effects
Contraindications
- Hypersensitivity to imipramine or other TCAs
- Concomitant use with Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of stopping an MAOI
- Recent myocardial infarction (heart attack)
- Severe liver disease
- Angle-closure glaucoma
- Urinary retention
Drug Interactions
MAOIs
Concurrent use is contraindicated due to risk of serotonin syndrome, hyperpyretic crises, convulsions, and death.
SSRIs
May increase imipramine plasma concentrations due to inhibition of CYP2D6. Dose adjustment may be necessary.
Anticholinergics
Increased risk of severe anticholinergic side effects (e.g., paralytic ileus, hyperpyrexia).
Thyroid hormones
Increased risk of cardiac arrhythmias and toxicity.
Antihypertensives
May antagonize the hypotensive effects of clonidine and guanethidine.
Cimetidine, Methylphenidate
Can increase imipramine levels by inhibiting its metabolism.
CNS Depressants (alcohol, sedatives, hypnotics)
Potentiation of sedative effects, increased CNS depression.
Storage
Store below 30°C in a cool, dry place. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe drowsiness, confusion, hallucinations, agitation, fever, rigid muscles, severe dry mouth, dilated pupils, fast/irregular heartbeat, seizures, severe low blood pressure, and coma. Seek immediate medical attention. Treatment is supportive and symptomatic.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Imipramine is excreted in breast milk; therefore, caution is advised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to imipramine or other TCAs
- Concomitant use with Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of stopping an MAOI
- Recent myocardial infarction (heart attack)
- Severe liver disease
- Angle-closure glaucoma
- Urinary retention
Drug Interactions
MAOIs
Concurrent use is contraindicated due to risk of serotonin syndrome, hyperpyretic crises, convulsions, and death.
SSRIs
May increase imipramine plasma concentrations due to inhibition of CYP2D6. Dose adjustment may be necessary.
Anticholinergics
Increased risk of severe anticholinergic side effects (e.g., paralytic ileus, hyperpyrexia).
Thyroid hormones
Increased risk of cardiac arrhythmias and toxicity.
Antihypertensives
May antagonize the hypotensive effects of clonidine and guanethidine.
Cimetidine, Methylphenidate
Can increase imipramine levels by inhibiting its metabolism.
CNS Depressants (alcohol, sedatives, hypnotics)
Potentiation of sedative effects, increased CNS depression.
Storage
Store below 30°C in a cool, dry place. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe drowsiness, confusion, hallucinations, agitation, fever, rigid muscles, severe dry mouth, dilated pupils, fast/irregular heartbeat, seizures, severe low blood pressure, and coma. Seek immediate medical attention. Treatment is supportive and symptomatic.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. Imipramine is excreted in breast milk; therefore, caution is advised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture, specific to lot.
Availability
Pharmacies nationwide
Approval Status
FDA Approved
Patent Status
Expired
Clinical Trials
Imipramine has been extensively studied since its discovery in the 1950s, with numerous clinical trials establishing its efficacy in major depressive disorder, panic disorder, and nocturnal enuresis. Ongoing research explores its use in other conditions and its pharmacogenomic aspects.
Lab Monitoring
- Electrocardiogram (ECG) for cardiac effects, especially in elderly or patients with pre-existing heart conditions
- Liver function tests (LFTs) periodically
- Complete Blood Count (CBC) with differential, especially if fever or sore throat develops
- Plasma drug levels (therapeutic drug monitoring) may be useful in certain clinical situations
Doctor Notes
- Prior to initiation, conduct a thorough cardiovascular evaluation, especially in elderly patients or those with pre-existing cardiac conditions.
- Monitor for suicidal ideation, particularly in pediatric and young adult patients, at the beginning of treatment and during dose changes.
- Educate patients on the potential for anticholinergic side effects and strategies for management (e.g., hydration for dry mouth, fiber for constipation).
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking Imipramine abruptly, as it can lead to withdrawal symptoms. Always consult your doctor to gradually reduce the dose.
- Avoid alcohol while taking this medicine.
- Report any worsening depression, suicidal thoughts, or unusual changes in mood or behavior to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.
Driving Precautions
Imipramine can cause drowsiness, dizziness, and blurred vision. Avoid driving, operating machinery, or performing any activities requiring alertness until you know how this medication affects you.
Lifestyle Advice
- Maintain a healthy and balanced diet.
- Engage in regular physical activity as advised by your doctor.
- Ensure adequate sleep and manage stress effectively.
- Avoid sudden changes in position to minimize dizziness due to orthostatic hypotension.
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