Imipramine is a prescription antidepressant approved to treat depression, panic disorder, and nighttime bedwetting in children older than five. It works by increasing levels of norepinephrine and serotonin in the brain, helping to relieve symptoms associated with these conditions.

You can find this medication at pharmacies in tablet form under the brand name Tofranil or as a generic option. It is not sold over the counter and requires a valid prescription from a healthcare provider.

The specific dosage and length of treatment depend entirely on the medical condition being addressed. You should always use this medication under the strict guidance of a psychiatrist or pediatrician.

What it is used for

Imipramine is indicated for:

Endogenous, organic, or psychogenic depression.
Depression associated with personality disorders or alcoholism.
nocturnal childhood urinary incontinence (bedwetting)

Additionally, healthcare providers frequently prescribe imipramine off-label for other conditions such as panic disorder and chronic pain.. While not FDA-approved for these specific uses, they are common in clinical practice.

Is imipramine used for ADHD?

Imipramine is not officially approved for the treatment of attention deficit hyperactivity disorder (ADHD). However, a psychiatrist or pediatrician may prescribe it off-label to help manage specific symptoms associated with ADHD, such as irritability or impulsivity.

Does imipramine calm you down?

Imipramine is not a sedative, so it is not primarily prescribed to treat general anxiety.

However, drowsiness is a common side effect, which may give the impression that the medication has a calming effect. Conversely, it can also cause restlessness, agitation, mental confusion, hallucinations, or insomnia in some people.

Does imipramine cause weight loss?

Imipramine is not indicated for weight loss.

In fact, weight gain is a possible side effect for some people. Others may experience a loss of appetite, leading to weight loss, but this varies by individual.

Dosage and administration

The dosage of imipramine should always be determined by a doctor. Doses vary significantly based on the patient's age and the specific condition being treated.

1. Depression

The standard recommendations for treating depression are:

Adults: The initial dose is usually 25 mg, taken 1 to 3 times per day. The doctor may gradually increase this to a maximum of 100 to 200 mg per day until symptoms improve. Once improvement is stable, the doctor may lower the dose to a maintenance level, typically 50 to 100 mg per day.
Elderly: The initial dose is typically 10 mg per day. The doctor may gradually increase this over about 10 days to reach an ideal dose of 30 to 50 mg per day, which is maintained through the end of treatment.

Initially, the doctor may recommend divided doses to check how well you tolerate side effects. Later, they may switch you to a single daily dose taken at bedtime.

2. Panic disorder

For adults, the starting dose for panic disorder is typically 10 mg per day.

Depending on how well the medication is tolerated, the doctor may increase the amount until the treatment is effective. The daily dose required varies from person to person but generally falls between 75 and 150 mg.

3. Chronic pain

For chronic pain in adults, doses generally range from 25 to 75 mg per day. This varies by individual and should always be guided by a physician.

4. Nocturnal childhood urinary incontinence

For bedwetting in children over five, the dose is calculated as 1.7 mg of imipramine per kilogram (kg) of body weight. Dosing guidelines by age group include:

Children 5 to 8 years: 20 to 30 mg per day.
Children 9 to 12 years: 25 to 50 mg per day.
Children over 12 years: 25 to 75 mg per day.

Ideally, the medication is taken as a single dose with food, one hour before bedtime. However, for children who wet the bed early in the night, the doctor may recommend splitting the dose, administering part of it around 4:00 PM. Treatment duration typically lasts 3 to 6 months, as indicated by the doctor.

How to take

Imipramine should be taken orally with a glass of water at the times set by your doctor.

For depression: It can be taken with or without food.
For bedwetting (children 5+): It is generally taken one hour before bedtime. If the child wets the bed early in the night, part of the dose may be taken in the mid-afternoon (around 4:00 PM) and the rest before sleep, or as directed by the pediatrician. It is best taken with food to reduce stomach upset.

It is important to take imipramine at the same time every day to maintain consistent levels in your body.

Possible side effects

The most common side effects of imipramine include blurred vision, tremors, excessive sweating, constipation, dry mouth, and weight gain. You may also experience orthostatic hypotension (a drop in blood pressure when standing up) or tachycardia (rapid heartbeat).

Other potential side effects include loss of appetite, mental confusion, nervousness, euphoria, anxiety, agitation, aggression, or mood swings.

Some people also report changes in libido, drowsiness, tingling or burning sensations on the skin, vertigo, nausea, vomiting, dizziness, fatigue, skin rashes, hives, headaches, or changes in urinary frequency.

Discontinuation symptoms: Stopping the medication abruptly can cause withdrawal symptoms such as vomiting, dizziness, abdominal pain, diarrhea, insomnia, intense headache, nervousness, irritability, and malaise.

When to see a doctor

You should seek urgent medical attention if you experience:

Hallucinations (hearing or seeing things that are not there).
Skin reactions like intense itching or redness.
Frequent infections accompanied by fever and sore throat.

Additionally, seek immediate emergency care if you show signs of a severe allergic reaction or anaphylaxis.

Who should not use

Imipramine should not be used by people who are allergic to tricyclic antidepressants. It is also contraindicated for those with narrow-angle glaucoma, prostate inflammation, diabetes, kidney or liver failure, myocardial infarction (heart attack), asthma, bipolar depression, schizophrenia, epilepsy, hyperthyroidism, or heart disease.

Imipramine is not recommended during pregnancy unless the benefits clearly outweigh the potential risks to the fetus. Women who are breastfeeding should consult their doctor before using this medication.

Drug Interactions: Imipramine must not be used by people taking monoamine oxidase inhibitors (MAOIs). This includes medications such as selegiline, isocarboxazid, phenelzine, or tranylcypromine.

If you have been taking an MAOI, you must wait at least 14 days after stopping it before beginning treatment with imipramine. Always inform your doctor of all medications you use to avoid dangerous interactions.

Imipramine (Tofranil): Uses, How to Take, Dosing & Side Effects