Imipramine (Tofranil)
Pronunciation: im-IP-ra-meen.
- Generic name
- imipramine
- Brand names
- Tofranil
- Drug class
- Tricyclic antidepressant (TCA)
- Form
- Tablet
- Route
- Oral
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: Canada
Australia: · Full directory
What imipramine is and how it works
Imipramine is a tricyclic antidepressant (TCA) originally marketed as Tofranil. Current US labeling includes relief of symptoms of depression and temporary adjunctive therapy for nocturnal enuresis in children 6 years and older. (1)
Use is prescriber-managed; the FDA boxed warning alerts to increased risk of suicidal thinking in children, adolescents, and young adults during initial treatment. It is not a first-line enuresis treatment without excluding organic causes. Abrupt discontinuation is not recommended.
Mechanism of action: how imipramine works
Imipramine is a tertiary amine tricyclic antidepressant that inhibits the reuptake of norepinephrine and serotonin, increasing their synaptic concentrations. It also has strong anticholinergic, antihistaminergic, and alpha-adrenergic blocking properties. (1)
What imipramine is used for
Depression
Imipramine is indicated for the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than other depressive states. (1)
Nocturnal enuresis (bedwetting) in children
Temporary adjunctive therapy for nocturnal enuresis in children 6 years and older after organic causes, such as urinary tract abnormalities, are excluded. The bedtime dose is low and the total daily dose should not exceed 2.5 mg/kg. (1)
Before taking imipramine
Do not take / not appropriate for
- Do not take imipramine if you are using or have recently used a monoamine oxidase inhibitor (MAOI)—hypertensive crises and severe convulsions may occur. A sufficient washout period is required as directed by the prescriber. (all products) (1)
- Do not take imipramine during the acute recovery period after a myocardial infarction. (all products) (1)
- Do not take imipramine if you have a known hypersensitivity to imipramine or any of its ingredients. (all products) (1)
Tell your clinician about
- Any history of heart problems (including arrhythmias, heart block), seizures, bipolar disorder, glaucoma, urinary retention, or thyroid disease.
- Current use of SSRIs, cimetidine, anticholinergics, or other medications that may interact.
- Pregnancy, plans for pregnancy, or breastfeeding (imipramine is not recommended during nursing).
- Any thoughts of self-harm, worsening depression, or unusual mood changes.
- Scheduled for surgery or any procedure requiring anesthesia.
How to take imipramine
- Imipramine is taken orally, usually in divided doses or once daily at bedtime depending on the regimen. The prescriber determines the exact dose based on indication, age, and clinical response.
- Do not change the dose, schedule, or discontinue the medication without the prescriber's guidance. Abrupt cessation can cause nausea, headache, and malaise; the prescriber will taper the dose gradually.
- Do not take an extra dose if one is missed.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
The current US label does not include specific missed-dose guidance. Contact the prescriber for rescheduling instructions. Do not take an extra dose without advice.
Overdose
Overdose of imipramine can be life-threatening, causing cardiac arrhythmias, seizures, coma, and other serious symptoms. Seek emergency medical attention immediately if an overdose is suspected. Do not induce vomiting unless instructed by emergency personnel. (1)
Side effects
Side effects are common with tricyclic antidepressants. Many are related to the anticholinergic effects of imipramine. The FDA boxed warning highlights increased risk of suicidal thoughts in children, adolescents, and young adults.
Dry mouth
What to notice: Persistent dry mouth, difficulty swallowing.
What to do: Use sugarless gum or candy, or a saliva substitute. Report if severely impacting eating or speaking. (1)
Constipation and urinary retention
What to notice: Infrequent or hard stools, difficulty starting urination or emptying the bladder.
What to do: Maintain hydration and dietary fiber. Report severe constipation or inability to pass urine to the prescriber. (1)
Dizziness and orthostatic hypotension
What to notice: Lightheadedness or fainting when standing up quickly.
What to do: Rise slowly from sitting or lying positions. Report if persistent or leads to falls. (1)
Fatigue, sedation, or confusion
What to notice: Unusual tiredness, mental clouding, especially in the elderly.
What to do: Avoid driving or operating machinery if affected. Discuss with the prescriber. (1)
Photosensitivity
What to notice: Increased sensitivity to sunlight, sunburn even with brief exposure.
What to do: Avoid prolonged sun exposure, use sunscreen and protective clothing. (1)
Angle-closure glaucoma attack
What to notice: Eye pain, sudden vision changes, seeing halos around lights.
What to do: Seek urgent medical evaluation; this may require emergency treatment. (1)
Cardiovascular effects
What to notice: Palpitations, fast or irregular heartbeat, fainting, chest pain.
What to do: Contact the prescriber promptly; seek emergency care if severe. (1)
Worsening depression or suicidality
What to notice: New or increased thoughts of self-harm, agitation, irritability, panic attacks.
What to do: Report to the prescriber immediately, or go to the nearest emergency department. (1)
Manic episode
What to notice: Excessive excitement, decreased need for sleep, racing thoughts, risky behavior.
What to do: Contact the prescriber; dose adjustment or discontinuation may be needed under medical supervision. (1)
Seizures
What to notice: Convulsions or episodes of altered consciousness.
What to do: Seek emergency care; this may necessitate reevaluation of therapy. (1)
Serious warnings
Suicidality (Boxed Warning) — emergency
Symptoms: New or worsening depression, thoughts of self-harm or suicide, agitation, restlessness, irritability, aggression, panic attacks, manic behavior.
Action: Seek emergency medical attention immediately. Do not change or discontinue the medication without prescriber guidance. (1)
Cardiovascular toxicity — emergency
Symptoms: Fainting, irregular or fast heartbeat, chest pain, signs of heart failure (e.g., shortness of breath, swelling).
Action: Call emergency services or go directly to an emergency department. (1)
Angle-closure glaucoma attack — emergency
Symptoms: Eye pain, sudden blurred or decreased vision, halos around lights.
Action: Seek immediate ophthalmologic evaluation or emergency care. (1)
Seizures — emergency
Symptoms: Convulsions, loss of consciousness, uncontrolled muscle jerking.
Action: Call emergency services; imipramine lowers the seizure threshold, and new-onset seizures require urgent assessment. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Monoamine oxidase inhibitors (MAOIs) | Severe hypertension and convulsions can occur. A 14-day washout is typically required between discontinuation of an MAOI and initiation of imipramine, and vice versa. | Do not combine; inform the prescriber of all current and recent medications. (1) |
| Selective serotonin reuptake inhibitors (SSRIs) and strong CYP2D6 inhibitors | These can significantly raise imipramine blood levels, increasing toxicity risk. After stopping fluoxetine, at least 5 weeks should elapse before starting a TCA. | The prescriber will typically allow a sufficient washout period and may reduce the imipramine dose. Do not combine without explicit guidance. (1) |
| Anticholinergic drugs | Additive anticholinergic effects, including severe constipation, urinary retention, hyperthermia, or ileus. | Use only under close medical supervision; report any new or worsening anticholinergic symptoms. (1) |
| Catecholamines and sympathomimetics | TCAs can sensitize the heart and blood vessels to the effects of adrenaline, noradrenaline, and related drugs, causing dangerous blood pressure and heart rhythm changes. | Inform all healthcare providers of imipramine use before any procedure requiring such agents. (1) |
| Alcohol | Enhanced central nervous system depression; excessive sedation and impaired coordination. | Avoid alcohol during treatment. Report any unusual sleepiness or dizziness. (1) |
| Cimetidine | Cimetidine can increase imipramine levels, raising the risk of side effects. | The prescriber may need to adjust the imipramine dose. Do not take both without discussion. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Children (6 years and older for enuresis only)
Imipramine is not approved for pediatric depression. For enuresis, it is a temporary adjunct at a low bedtime dose after organic causes are ruled out. The total daily dose should not exceed 2.5 mg/kg/day. Close monitoring for behavioral changes and suicidality is required. (1)
Elderly
Start at the lower end of the dosing range due to reduced hepatic, renal, or cardiac function and the greater sensitivity to anticholinergic and cardiovascular effects. Doses generally should not exceed 100 mg/day. (1)
Pregnancy
No well-controlled human studies; animal data are not definitive. Use only if the potential benefit justifies the potential risk to the fetus, as advised by the prescriber. Do not stop treatment abruptly without medical input. (1)
Breastfeeding
The label advises that a woman taking imipramine should not breastfeed, as the drug may be excreted in breast milk. Discuss alternative feeding options with the prescriber. (1)
Monitoring
Before starting
- Rule out organic causes of enuresis, cardiovascular disease, seizure disorder, and other contraindications.
- Obtain a thorough medication history, especially MAOI use, and allow adequate washout.
- Assess baseline mental state, including risk of self-harm, and obtain a baseline ECG in at-risk populations.
- Confirm that the patient or caregiver understands the need for gradual dose adjustments and monitoring.
During treatment
- Monitor for clinical worsening, suicidality, or unusual changes in behavior, particularly at initiation and after dose changes.
- Check for orthostatic hypotension, heart rate changes, and signs of cardiac conduction issues.
- Evaluate for anticholinergic burden (dry mouth, constipation, urinary hesitancy, confusion).
- For enuresis, periodically reassess the continued need and rule out emerging organic pathology.
- Do not discontinue abruptly; withdrawal symptoms (nausea, headache, malaise) require a prescriber-directed taper.
Storage
Store at room temperature, away from moisture and light. Keep the container tightly closed. Keep out of reach of children. The current label does not specify additional special storage conditions.
Professional information
Clinician-facing context only. Use the current local product labeling and clinical guidelines to guide treatment decisions, especially given the narrow therapeutic index and risk of cardiotoxicity.
United States
Indication: Depression
Dose summary: Adult outpatients: start 75 mg/day, usual up to 150 mg/day, maximum 200 mg/day. Hospitalized adults: up to 250–300 mg/day. Adolescents/elderly: start 30–40 mg/day, generally not above 100 mg/day. Administer in divided doses or once daily at bedtime.
Renal context: The label does not provide specific renal dosing adjustments. Reduced doses and careful monitoring are prudent in renal impairment. (1)
United States
Indication: Nocturnal enuresis (6 years and older)
Dose summary: Start 25 mg orally 1 hour before bedtime. If inadequate response, increase to 50 mg (under 12 years) or 75 mg (over 12 years). Maximum total daily dose: 2.5 mg/kg/day.
Renal context: No dose adjustment provided; use with caution in renal impairment. (1)
Hepatic guidance
Imipramine is extensively metabolized by the liver; the label does not provide specific dose adjustments for hepatic impairment. Use with caution and consider lower starting doses, guided by clinical response and tolerability.
Overdose note
Overdose is a medical emergency, often marked by cardiac arrhythmias (wide QRS, prolonged QT), hypotension, seizures, coma, and respiratory depression. Management is supportive with ECG monitoring, and intravenous sodium bicarbonate may be indicated for cardiac toxicity. Activated charcoal may be considered within 1 hour of ingestion. Do not use physostigmine for anticholinergic delirium due to risk of severe bradycardia and asystole. (1)
Frequently asked questions
Why does my child take this for bedwetting?
Imipramine is approved as temporary adjunctive therapy for nocturnal enuresis (bedwetting) from age 6, at a low bedtime dose, after medical causes have been ruled out by the prescriber. It is not a first-line treatment and requires periodic reassessment. (1)
Why can't imipramine be stopped suddenly?
Prolonged therapy ended abruptly can cause withdrawal symptoms such as nausea, headache, and malaise. The prescriber tapers treatment gradually to minimize these effects. (1)
What symptoms require urgent medical attention?
Seek help for eye pain or sudden vision change (possible angle-closure attack), fainting or irregular heartbeat, new agitation or suicidal thoughts, severe constipation or inability to pass urine, and seizures. (1)
Does imipramine increase sensitivity to the sun?
Yes, it can cause photosensitivity. Avoid excessive sun exposure, wear protective clothing, and use sunscreen while taking this medication. (1)
What is the mechanism of action of imipramine?
Imipramine is a tertiary amine tricyclic antidepressant that inhibits the reuptake of norepinephrine and serotonin, increasing their synaptic concentrations. It also has strong anticholinergic, antihistaminergic, and alpha-adrenergic blocking properties. (1)
What is the generic name of Imipramine (Tofranil)?
The generic name is imipramine. It is sold under brand names including Tofranil. (1)
What class of drug is imipramine?
Imipramine (Tofranil) is classed as: Tricyclic antidepressant (TCA). (1)
References
- IMIPRAMINE HYDROCHLORIDE tablets (Lupin Pharmaceuticals), label revised 2016-04U.S. National Library of Medicine (DailyMed) · United States · dated 2016-04 · accessed 2026-08-08 · source 1
- IMIPRAMINE HYDROCHLORIDE TABLET, FILM COATED [LEADING PHARMA, LLC] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- Imipramine — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 3
- Imipramine Hydrochloride — FDA approval record (Drugs@FDA ANDA040751)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- imipramine — RxNorm normalized drug concept (RXCUI 150816)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient imipramine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
Canada
- NOVO-PRAMINE