imipramine

Adjunctive therapy

Brands: Tofranil

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is imipramine?
Imipramine is a tertiary amine tricyclic antidepressant used in treatment-resistant depression and pediatric nocturnal enuresis; its active metabolite desipramine adds potent noradrenergic activity.
What is Tofranil?
Tofranil is a brand name for imipramine.
What is Tofranil (imipramine) used for?
Label indications include: Depression; nocturnal enuresis in children (lower doses).
What drug class is Tofranil (imipramine)?
Tricyclic antidepressant; blocks serotonin and norepinephrine reuptake with anticholinergic effects.
What strengths does Tofranil (imipramine) come in?
Tablets: 10 mg, 25 mg, 50 mg; capsules (pamoate) 75 mg, 100 mg, 125 mg, 150 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Tofranil
Therapeutic drug monitoring recommended; reference range 150–300 ng/mL.
Last reviewed: 2025-12-29

Label indications

Depression; nocturnal enuresis in children (lower doses).

View labelExact

Clinical Highlights

Imipramine is a tertiary amine tricyclic antidepressant used in treatment-resistant depression and pediatric nocturnal enuresis; its active metabolite desipramine adds potent noradrenergic activity. Therapeutic benefit correlates with combined imipramine + desipramine concentrations (goal 150–300 ng/mL) guided by TDM; higher levels markedly increase anticholinergic and cardiac toxicity.

Substantial anticholinergic, antihistamine, and α-adrenergic blockade drive sedation, orthostasis, weight gain, constipation, and urinary retention; baseline ECG is advisable before initiating therapy in adults >40 years or those with cardiovascular disease.
Because of overdose lethality and cardiovascular risks, prescribers often restrict quantities and reserve imipramine for patients who fail SSRIs/SNRIs.
Major depressive disorder (FDA 1959)
Nocturnal enuresis (children ≥6 years) (FDA 1965)
The compare tool and the evidence library, along with the Bipolar hub, support side-by-side TCA comparisons and augmentation discussions.

Dosing & Formulations

Tablets: 10 mg, 25 mg, 50 mg; capsules (pamoate) 75 mg, 100 mg, 125 mg, 150 mg. Depression (adult): typical starting doses are 25–50 mg at bedtime, with increases of 25–50 mg every 3–7 days to 150–200 mg/day (single bedtime dose or divided). Maximum 300 mg/day is typically reserved for inpatient settings with monitoring.

Nocturnal enuresis (children ≥6 years): typical starting doses are 10–25 mg at bedtime, titrated by 10 mg weekly to 50 mg (ages 6–12) or 75 mg (≥12 years); tapers after 2–3 months are often used to reassess need.
Starting and target doses are often reduced in older adults, hepatic impairment, or when co-administered with strong CYP2D6 inhibitors; slower titrations are common when tolerability issues arise.
Tapers are typically gradual (≥4 weeks) to reduce cholinergic rebound, anxiety, and insomnia.

Monitoring & Risks

Boxed warning: Antidepressants increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults; close monitoring is typically advised. Anticholinergic effects: Dry mouth, blurred vision, constipation, urinary retention—prophylactic bowel regimens are sometimes considered.

Sedation and fatigue: Dosing is often weighted toward bedtime; daytime drowsiness is a common limitation.
Orthostatic hypotension: Education often includes slow position changes and adequate hydration.
Weight gain: Weight/BMI are commonly tracked; lifestyle interventions may help.
Sexual dysfunction: Discussions often cover expectations and management strategies.

Drug Interactions

Contraindicated with MAOIs or within 14 days of MAOI therapy (hypertensive crisis/serotonin syndrome). Strong CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine, bupropion) elevate imipramine/desipramine levels—dose reductions may be needed, and TDM can help guide dosing.

CYP3A4 inducers (carbamazepine, rifampin) and smoking can lower exposure; adjust dose based on response.
Serotonergic agents increase serotonin syndrome risk; closer follow-up is often used when combinations occur.
Additive QTc prolongation with antiarrhythmics, certain antipsychotics, or macrolide antibiotics—ECG monitoring is often considered when combining.
Alcohol and CNS depressants exaggerate sedation; anticholinergics amplify cognitive impairment and urinary retention.

Practice Notes

Baseline ECG/electrolytes and periodic monitoring are often considered, particularly when doses exceed 150 mg/day. Therapeutic drug monitoring is valuable for poor response, suspected nonadherence, or signs of toxicity.

Counseling often covers overdose risks and safe storage; limited dispensing with close follow-up is sometimes used.

References

Imipramine prescribing information — DailyMed (2025)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)
NICE clinical guideline: nocturnal enuresis in children and young people
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical

Quick answers

What is imipramine?

Imipramine is a tertiary amine tricyclic antidepressant used in treatment-resistant depression and pediatric nocturnal enuresis; its active metabolite desipramine adds potent noradrenergic activity.

What is Tofranil?

Tofranil is a brand name for imipramine.

What is Tofranil (imipramine) used for?

Label indications include: Depression; nocturnal enuresis in children (lower doses).

What drug class is Tofranil (imipramine)?

Tricyclic antidepressant; blocks serotonin and norepinephrine reuptake with anticholinergic effects.

What strengths does Tofranil (imipramine) come in?

Tablets: 10 mg, 25 mg, 50 mg; capsules (pamoate) 75 mg, 100 mg, 125 mg, 150 mg.

Clinical Highlights

Substantial anticholinergic, antihistamine, and α-adrenergic blockade drive sedation, orthostasis, weight gain, constipation, and urinary retention; baseline ECG is advisable before initiating therapy in adults >40 years or those with cardiovascular disease.
Because of overdose lethality and cardiovascular risks, prescribers often restrict quantities and reserve imipramine for patients who fail SSRIs/SNRIs.
Major depressive disorder (FDA 1959)
Nocturnal enuresis (children ≥6 years) (FDA 1965)
The compare tool and the evidence library, along with the Bipolar hub, support side-by-side TCA comparisons and augmentation discussions.

Dosing & Formulations

Nocturnal enuresis (children ≥6 years): typical starting doses are 10–25 mg at bedtime, titrated by 10 mg weekly to 50 mg (ages 6–12) or 75 mg (≥12 years); tapers after 2–3 months are often used to reassess need.
Starting and target doses are often reduced in older adults, hepatic impairment, or when co-administered with strong CYP2D6 inhibitors; slower titrations are common when tolerability issues arise.
Tapers are typically gradual (≥4 weeks) to reduce cholinergic rebound, anxiety, and insomnia.

Monitoring & Risks

Sedation and fatigue: Dosing is often weighted toward bedtime; daytime drowsiness is a common limitation.
Orthostatic hypotension: Education often includes slow position changes and adequate hydration.
Weight gain: Weight/BMI are commonly tracked; lifestyle interventions may help.
Sexual dysfunction: Discussions often cover expectations and management strategies.

Drug Interactions

CYP3A4 inducers (carbamazepine, rifampin) and smoking can lower exposure; adjust dose based on response.
Serotonergic agents increase serotonin syndrome risk; closer follow-up is often used when combinations occur.
Additive QTc prolongation with antiarrhythmics, certain antipsychotics, or macrolide antibiotics—ECG monitoring is often considered when combining.
Alcohol and CNS depressants exaggerate sedation; anticholinergics amplify cognitive impairment and urinary retention.

Practice Notes

Counseling often covers overdose risks and safe storage; limited dispensing with close follow-up is sometimes used.