Generic Name: imipramine (im-IP-ra-meen)
Brand Names: Tofranil®, Tofranil-PM®
Classification: Antidepressant
Issue Date: 1952

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. In smaller doses Imipramine is used to treat FM and CFS/ME.

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®)
• tranylcypromine (Parnate®)

within the past 14 days.

You may have suicidal thoughts or behavior when you start taking an antidepressant, especially if you are under 18 years old. You will need to be monitored for worsening symptoms of depression or suicidal thoughts. Your doctor should check you at regular visits during the first 12 weeks of treatment, or whenever your dose is changed.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

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.

It may take up to 3 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment.

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®)
• 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:

• heart disease
• history of heart attack, stroke, or seizures
• bipolar disorder (manic-depression)
• kidney or liver disease
• overactive thyroid
• diabetes (imipramine may raise or lower blood sugar)
• adrenal gland tumor (pheochromocytoma)
• glaucoma
• problems with urination

If you have any of these conditions, you may not be able to use imipramine, or you may need a dosage adjustment or special tests during treatment.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. While you are taking imipramine, you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed.

In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor PROMPTLY if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Imipramine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more likely to have side effects from this medication. Do not give this medication to anyone under 18 years old without the advice of a doctor.

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)
• coma

Side Effects

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 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 anxious, restless, dizzy, drowsy, or tired
• sleep problems (insomnia), nightmares
• blurred vision, headache, ringing in your ears
• breast swelling (in men or women)
• 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.

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®)
• 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®)
• flecainide (Tambocor®)
• propafenone (Rhythmo®l)
• quinidine (Cardioquin®, Quinidex®, Quinaglute®)

If you are using any of these drugs, you may not be able to use imipramine, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with imipramine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.