Tofranil (imipramine)

US Brand Names: Tofranil-PM, Imiprin, Janimine
Other Brand Names: Antidep (India)
Apo-Imipramine (Canada)
Chrytemin (Japan)
Daypress (Japan)
Depsol (India)Depsonil (India)
Ethipramine (South Africa)
Fronil (Taiwan)
Imidol (Japan)
Imiprex (Bahrain; Cyprus; Egypt; Iran; Iraq; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates)
Melipramine (Australia)
Primonil (Israel)
Pryleugan (Germany)
Sermonil (Thailand)
Talpramin (Mexico)
Tofranil-PM (Colombia; Mexico)
Venefon (Greece)
Generic Names: imipramine pamoate, imipramine hydrochloride
Other Forms: Intramuscular injection, oral solution.
FDA Approved Uses: Depression. The odds favor relief for endogenous depression – i.e. being depressed for no good reason. Although this study shows Zoloft (sertraline) to be more effective and to suck less for non-melancholic depression. It’s also approved for childhood enuresis (you know, never being able to hold it in and constant bedwetting).
Off-Label Uses: Neuropathic and chronic pain (compare it to codeine in this study). Somatoform pain disorder (where they think it’s all in your head). Migraines, although other TCAs might work better, presuming anticonvulsants don’t do it for you. Post traumatic stress disorder. Panic/Anxiety disorders.
Tofranil’s pro’s & cons:
Pros: It’s been since forever, so doctors are familiar with its uses and effects.
Cons: It’s been since forever, so non-psychiatric doctors are too willing to turn to it first when other meds may be more appropriate.
Tofranil’s Typical Side Effects: The anticholinergic typical when starting TCAs – headache, nausea, sweating, dry mouth, sleepiness or insomnia, and diarrhea or constipation and blurry vision. If you get any, or all, of these, expect them to pass in a week or two. Maybe. Weight gain and sedation are common and constant.

Tofranil’s Not So Common Side Effects: Heart palpitations, no libido and other sexual dysfunctions. Agitation. Memory loss. Urinary hesitancy is something that meds that hit your norepinephrine receptors will just do randomly through the course of treatment. Given that this med is approved to treat incontinence, specifically bedwetting, I’d kind of expect the urinary hesitancy to be a long-lasting side effect.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

Tofranil’s Freaky Rare Side Effects: Painful ejaculation. “Proneness to falling.”
You aren’t going to get these. I promise.

Tofranil’s Suicide Risk: Despite all the hype about SSRIs and multiple reuptake inhibitors (e.g. Cymbalta) and suicide, all of the TCAs have carried suicide precautions in their PI sheets for a long time. “It should be kept in mind that the possibility of suicide in seriously depressed patients is inherent in the illness and may persist until significant remission occurs. Such patients should be carefully supervised during the early phase of treatment with imipramine HCl, and may require hospitalization. Prescriptions should be written for the smallest amount feasible. Hypomanic or manic episodes may occur, particularly in patients with cyclic disorders. Such reactions may necessitate discontinuation of the drug. If needed, imipramine HCl may be resumed in lower dosage when these episodes are relieved.” But all psychiatric and neurological meds have a potential suicide risk. Eventually all of the modern antidepressants will carry similar warnings. While there have been some documented cases of people committing suicide under the influence of Tofranil (imipramine pamoate), unmedicated major depressive disorder is a far greater suicide risk. Hell, TCAs can work when all seems hopeless!

Interesting Stuff Your Doctor Probably Won’t Tell You: Norpramin (desipramine hydrochloride) is an active intermediate metabolite of Tofranil (imipramine pamoate). So just as Lexapro (escitalopram oxalate) has fewer side effects than Celexa (citalopram hydrobromide), the same may apply to Norpramin (desipramine hyrochloride).

Tofranil’s Dosage: Initial dose for outpatients should be 75mg a day. Try it at bedtime first and see if it makes you either tired or wired, but the odds are going to be tired. You can go up to 150mg a day. The maintenance dosage will be in the range of 50-150mg a day. With that in mind I’d suggest starting at 50mg a day just so your liver can get used to the med before working up to 75mg. Hospitalized patients can go up to 300mg a day, but I wouldn’t trust this med over 200mg a day for most people, unless they have livers made of titanium or just process meds really efficiently.

Days to Reach a Steady State: None is published in the PI sheet, and as it has non-linear properties I can’t say that I blame Novartis for leaving out that data. However I did find one study of adults that put it at 19 days.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Tofranil Takes to Work: TCAs generally take 14 to 28 days to kick in. Given the long time to reach a steady state, 21-28 days is more likely.

Tofranil’s Half-Life & Average Time to Clear Out of Your System: Nothing published because it’s not a linear med (i.e. It’s wacky). One study puts the range at 4 to 17.6 hours. Another states 21 hours. So that means it’ll take anywhere from one to five days to be out of your system.
If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
How to Stop Taking Tofranil: Your doctor should be recommending that you reduce your dosage by 25-50mg a day every five days if you need to discontinue it, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds. You shouldn’t be tapering off any faster than that unless it’s an emergency.
So if you’re at 200mg a day you take 175mg a day for five days, then 150mg a day for the next five days and so forth until you’re done.

Comments: Be sure to read the sections on antidepressants and TCAs if you haven’t done so already. As TCAs work on serotonin and norepinephrine reuptake inhibition, reading up on SSRIs and SNRIs would help, too.
Approved by the FDA to treat depression in 1959, this drug is somewhat more potent than Elavil (amitriptyline) in it’s reuptake inhibition of serotonin and norepinephrine. But it’s also somewhat less selective, so the side effects may suck more. You may want to inquire about Norpramin (desipramine hydrochloride), as that might be a bit more selective and have better effect and fewer side effects.

Tofranil-PM has replaced pretty much replaced Tofranil as the brand-name product in the US, and the difference is imipramine pamoate vs. imipramine hydrochloride. What does that mean to you? Two things. The first is that the brand is really different from the generic now. As for the difference between a hydrochloride form and pamoate form, you’ll have to ask your pharmacist, because I sure as shit don’t know.

I had accidentally uploaded a partially completed version of this page without knowing it, so there was a lot of information here about Elavil (amitriptyline) that had nothing to do with Tofranil (imipramine pamoate). As usual you really should depend on your doctors and pharmacist for information about meds, and not some stupid website put together by a nutjob like me. I suck. Sorry about any confusion that may have resulted.

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