Tofranil (imipramine): what it is and who it helps

Tofranil is the trade name for imipramine, an older antidepressant that's still used today. It works differently from newer drugs: it raises certain brain chemicals (norepinephrine and serotonin) to lift mood and calm panic. Doctors prescribe it for major depression, panic disorder, and sometimes for bedwetting in children. It's also used off-label for some chronic pain and nerve pain problems.

Because it’s a tricyclic antidepressant (TCA), Tofranil can be powerful but also brings more side effects than many modern options. That makes it useful when other meds haven’t worked, but also means you and your prescriber need to watch for issues closely.

Typical dosing and what to expect

Adults usually start low and increase slowly. A common starting dose for depression is 25–50 mg per day, often raised to 100–200 mg daily depending on response. Some people need up to 300 mg, but higher doses raise risk of side effects. For childhood bedwetting, lower single nighttime doses (often 10–50 mg) are used under strict medical guidance. Always follow your doctor’s plan — dosing varies by age, weight, and health.

Tofranil often causes tiredness and drowsiness at first, so many people take it at night. It can take 2–4 weeks to notice improvement in mood, and up to 8–12 weeks for full benefit.

Common side effects and red flags

Typical side effects are dry mouth, constipation, blurred vision, dizziness when standing up, weight gain, and drowsiness. Some people notice faster heart rate, sweating, or sexual side effects. Serious problems include irregular heartbeat, fainting, severe confusion, or seizures. If you feel chest pain, sudden fainting, extreme shortness of breath, or sudden vision changes, get emergency help.

Younger adults and teens on antidepressants can have increased thoughts of self-harm when starting treatment. Watch mood closely and call your prescriber if you notice worsening depression, agitation, or suicidal thoughts.

Interactions and safety tips

Tofranil mixes badly with MAO inhibitors — that combo can be life-threatening. It also interacts with many other drugs: SSRIs, certain pain meds, antihistamines, blood pressure meds, and some heart drugs. Alcohol and other sedatives add to drowsiness and fall risk. Tell your doctor about all medicines and supplements you take.

Older adults and people with heart disease, glaucoma, urine retention, or bipolar disorder need special care. Your doctor may order an ECG before or during treatment if you’re older or on high doses.

Simple tips: take it at the same time each day (often at night), don’t stop suddenly — taper under a doctor’s guidance, and avoid driving until you know how it affects you. If side effects are troublesome, talk to your prescriber about dose changes or alternatives.

This page gives general info, not medical advice. Talk with your doctor or pharmacist for personal guidance about Tofranil and whether it’s right for you.