Ever wondered how older antidepressants still fit modern care? Imipramine is a tricyclic antidepressant (TCA) doctors still use for depression and bedwetting in children. It works differently from SSRIs and can help people who didn’t respond to newer drugs. But it also comes with specific side effects and safety checks you should know before starting.
Imipramine boosts levels of norepinephrine and serotonin in the brain by blocking their reuptake. That helps mood and can reduce panic symptoms. Doctors commonly prescribe it for major depressive disorder and, at lower doses, for childhood enuresis (bedwetting). It’s also used off-label for chronic pain or certain anxiety problems when other treatments haven’t worked.
Typical adult dosing for depression usually starts around 75 mg per day, often split into two doses or given at night. Many patients find relief on 75–150 mg daily; some need higher doses under close supervision. For bedwetting, pediatric doses are smaller — often 10–25 mg at bedtime or a weight-based dose (check with your child’s doctor). Never adjust doses on your own.
Expect anticholinergic side effects: dry mouth, constipation, blurred vision, and difficulty urinating are common. It can cause drowsiness, weight gain, and dizziness—watch for orthostatic hypotension (lightheadedness when standing). Heart effects matter: imipramine can change heart rhythm, so older adults or people with heart disease should get an ECG before treatment.
Be careful with drug interactions. Do not take imipramine with MAO inhibitors (dangerous reaction). Watch when combining with SSRIs, SNRIs, antihistamines, certain antipsychotics, or other drugs that lengthen QT interval. Alcohol and sedatives increase drowsiness. If you’re under 25, know that antidepressants can raise suicidal thoughts in some—your doctor will monitor you closely.
Stopping suddenly can cause withdrawal symptoms—plan a taper with your prescriber. Pregnant or breastfeeding? Discuss risks vs benefits with your provider. Blood levels aren’t checked for everyone, but clinicians may use them in complex cases or when side effects appear.
Practical tips: take it at the same time each day, often at night if it makes you sleepy. Sip water or chew sugar-free gum for dry mouth. Stand up slowly to avoid dizziness. Keep a list of all medications and share it with your doctor or pharmacist to spot interactions. If you notice fast heartbeat, fainting, severe confusion, or seizures, seek medical help right away.
Questions to ask your prescriber: Why imipramine for my condition? What dose will we start with? How will we monitor heart safety? How long until I see benefits? With clear answers you’ll feel safer and more in control while on treatment.
Tofranil, known generically as imipramine, is a tricyclic antidepressant for managing depression and nocturnal enuresis in children. Its use in ADHD and the elderly requires caution due to an unestablished safety profile. Side effects range from drowsiness to severe conditions like serotonin syndrome.