Tofranil (imipramine hydrochloride) is a tricyclic antidepressant (TCA) with a well-established profile for managing major depressive disorders and nocturnal enuresis (bedwetting) in children. As a norepinephrine and serotonin reuptake inhibitor, it works by restoring the balance of key neurotransmitters in the brain, offering both mood-stabilizing and physiological benefits. Its efficacy, backed by decades of clinical use, makes it a trusted option under appropriate medical supervision.

Features

• Active ingredient: Imipramine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg tablets
• Prescription-only medication
• Long half-life supporting once-daily dosing in some cases
• Generic versions available for cost-effective treatment

Benefits

• Alleviates symptoms of depression, including low mood, fatigue, and loss of interest
• Reduces frequency of bedwetting episodes in children aged 6 years and older
• Improves sleep quality and restores normal circadian rhythms
• Enhances overall daily functioning and quality of life
• Provides a non-stimulant alternative for certain off-label uses, such as neuropathic pain
• Supported by extensive long-term clinical safety and efficacy data

Common use

Tofranil is primarily indicated for the treatment of major depressive disorder in adults. It is also approved for the management of nocturnal enuresis in children who are at least 6 years of age, after organic causes have been ruled out. Off-label, it may be used under specialist guidance for conditions such as panic disorder, attention-deficit/hyperactivity disorder (ADHD), and certain chronic pain syndromes.

Dosage and direction

Dosage must be individualized based on patient response and tolerance. For depression in adults, initial dosing often begins at 75 mg daily, which may be increased gradually to a typical maintenance range of 75–150 mg daily, though some patients may require up to 300 mg/day under close supervision. For pediatric enuresis, the recommended starting dose is 25 mg taken one hour before bedtime; this may be adjusted based on response, up to a maximum of 50 mg for children under 12 years and 75 mg for those 12 and older. Tablets should be swallowed whole with water, with or without food, though taking with meals may reduce gastrointestinal discomfort.

Precautions

Patients should be monitored for worsening depression, suicidal ideation, or unusual changes in behavior, especially at the beginning of treatment or after dosage adjustments. Use with caution in patients with a history of cardiovascular disease, glaucoma, urinary retention, or seizure disorders. Regular liver function tests and blood counts may be advised during long-term therapy. Avoid abrupt discontinuation to prevent withdrawal symptoms.

Contraindications

Tofranil is contraindicated in patients with known hypersensitivity to imipramine or other tricyclic antidepressants. It must not be used during the acute recovery phase after myocardial infarction or in those who have taken monoamine oxidase inhibitors (MAOIs) within the past 14 days. Concomitant use with MAOIs is prohibited due to risk of serotonin syndrome.

Possible side effect

Common side effects may include dry mouth, drowsiness, dizziness, constipation, blurred vision, and weight gain. Less frequently, orthostatic hypotension, increased heart rate, urinary retention, or sweating may occur. Serious side effects, though rare, include arrhythmias, seizures, jaundice, or blood dyscrasias. Patients should report any persistent or severe reactions to their healthcare provider.

Drug interaction

Tofranil may interact with MAOIs, SSRIs, SNRIs, triptans, antihypertensives, anticonvulsants, and CNS depressants including alcohol. It can potentiate the effects of sympathomimetics and may reduce the efficacy of guanethidine and similar agents. Always inform your prescriber of all medications, including over-the-counter drugs and supplements.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. Consistent daily use at the same time is recommended to maintain steady blood levels.

Overdose

Overdose symptoms may include severe drowsiness, agitation, confusion, seizures, hallucinations, irregular heartbeat, and coma. Overdose is a medical emergency; seek immediate help or contact a poison control center. Treatment is supportive and may include gastric lavage, activated charcoal, and ECG monitoring.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis, treatment decisions, and personalized dosage recommendations. Do not start, stop, or change your dosage without medical supervision.

Reviews

Clinical studies and patient reports consistently note Tofranil’s effectiveness in alleviating depressive symptoms and reducing bedwitting frequency, particularly when other treatments have failed. Many users appreciate its non-addictive profile, though some report side effects like dry mouth and drowsiness, which often diminish over time. Overall, it remains a valued option within its therapeutic class.