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Tofranil

(imipramine)

In this factsheet:
• How does Tofranil work? What will it do for me?
• How should I use Tofranil?
• What form(s) does Tofranil come in?
• Who should NOT take Tofranil?
• What side effects are possible with Tofranil?
• Are there any other precautions or warnings for Tofranil?
• What other drugs could interact with Tofranil?

DIN (Drug Identification Number)

What side effects are possible with Tofranil?

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Your health professional may be able to help you deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if they continue or become bothersome.

More common:

• dizziness
• drowsiness
• dryness of mouth
• increased appetite (may include a craving for sweets)
• nausea
• tiredness or weakness (mild)
• unpleasant taste
• weight gain

  Less common:

• diarrhea
• headache
• heartburn
• increased sweating
• trouble sleeping
• vomiting

Check with your doctor as soon as possible if any of the following side effects occur:

Less common:

• blurred vision
• confusion or delirium
• constipation (especially for seniors)
• decreased sexual ability
• difficulty speaking or swallowing
• difficulty urinating
• eye pain
• fainting
• fast or irregular heartbeat (pounding, racing, skipping)
• hallucinations
• loss of balance control
• nervousness or restlessness
• numbness or tingling sensation in arms and legs
• shakiness or trembling
• shuffling walk
• slowed movements
• stiffness of arms and legs

  Rare:

• anxiety
• breast enlargement (both males and females)
• hair loss
• inappropriate secretion of milk (females)
• increased sensitivity to sunlight
• irritability
• muscle twitching
• red or brownish spots on skin
• ringing, buzzing, or other unexplained sounds in the ears
• seizures
• skin rash and itching
• sore throat and fever
• swelling of face and tongue
• swelling of testicles
• trouble with teeth or gums
• weakness
• yellow eyes or skin

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for Tofranil?

Dizziness: Use caution (i.e., move slowly) when rising from a sitting or lying position since imipramine can cause sudden temporary low blood pressure resulting in dizziness.

Heart rhythm: Imipramine can cause abnormal heart rhythms, particularly when taken in high doses. Therefore, seniors and those with a history of heart disease should take imipramine with caution.

Medical conditions: Imipramine should be used with caution by people with a history of seizures, reduced liver function, heart conditions, glaucoma, certain blood disorders, a history of mania or bipolar disorder, and those with a history of urinary retention.

Occupational hazards: Imipramine may impair the mental or physical abilities required for the potentially hazardous tasks such as driving a car or operating machinery. Use appropriate caution until you determine how this medication affects you.

Pregnancy: The safety of this medication for pregnant women has not been established. The potential benefits of using imipramine during pregnancy must be weighed against the possible risks.

Breast-feeding: Imipramine passes into breast milk. Because imipramine may cause serious side effects for nursing infants, a decision should be made to stop nursing or stop the medication.

What other drugs could interact with Tofranil?

The following may affect how imipramine works or increase the risk of side effects:

• alcohol
• anticholinergic medications
• barbiturates
• benzodiazepines
• carbamazepine
• cimetidine
• diltiazem
• disulfiram
• MAO inhibitors
• methylphenidate
• nicotine
• phenothiazines
• phenytoin
• quinidine
• SSRI antidepressants
• thioridazine
• verapamil

Imipramine may affect how the following medications work:

• amphetamines
• clonidine
• ephedrine
• guanethidine
• methyldopa
• phenylephrine
• reserpine
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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