Depression Home > Tofranil Warnings and Precautions

Specific Tofranil Warnings and Precautions

Precautions and warnings to be aware of prior to taking Tofranil include the following:
  • Antidepressants (including Tofranil) may increase the risk of suicidal thinking or behavior (see Depression and Suicide). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include:
    • Anxiety
    • Hostility
    • Agitation
    • Panic
    • Restlessness
    • Hallucinations
    • Extreme hyperactivity
  • Before prescribing Tofranil for depression, your healthcare provider should make sure that you do not have bipolar disorder instead. The symptoms of bipolar disorder and depression can be similar at times, and Tofranil can cause problems in people with bipolar disorder.
  • Tofranil may cause a worsening of schizophrenia. If you have schizophrenia, discuss this with your healthcare provider before taking the drug.
  • People taking the medication should use care when driving, operating heavy machinery, or performing other tasks that require concentration, especially when first starting Tofranil or when switching dosages. Tofranil may affect a person's mental or physical ability to perform these tasks. Know how the drug affects you before performing any tasks that require mental or physical concentration.
  • Tofranil can interact with certain medications (see Tofranil Drug Interactions).
  • Tofranil may enhance the effects of alcohol, barbiturates, and other medicines that affect the brain. This can lead to an increased risk for drowsiness, dizziness, suicidal thoughts, and other overdose symptoms. Make sure to talk with your healthcare provider about drinking alcohol while taking the drug.
  • Tofranil may not be safe for use during pregnancy. Ask your healthcare provider about the benefits and risks of using it while pregnant (see Imipramine and Pregnancy).
  • Tofranil passes through breast milk and may cause harm to your baby. Therefore, if you are breastfeeding or plan to start, talk with your healthcare provider about what makes most sense for your particular situation (see Imipramine and Breastfeeding).
  • Special care should be used when taking the drug if you have a history of seizures, bladder problems, or glaucoma. Tofranil can make these conditions worse.
  • Talk to your healthcare provider before taking Tofranil if you have any heart problems, as the medication can affect the heart and its electrical system. Your healthcare provider should check your heart rhythm using an electrocardiogram (EKG or ECG) if you are taking high doses.
  • Talk to your healthcare provider before taking Tofranil if you have hyperthyroidism (overactive thyroid) or take thyroid medication.
  • The medication can decrease your level of white blood cells, which can increase your risk of infections. Let your healthcare provider know if you have signs of an infection, such as a fever or sore throat, while taking Tofranil.
  • Taking Tofranil while receiving electroshock or electroconvulsive therapy (ECT) can increase your risk of side effects. Talk to your healthcare provider about these risks.
  • Tofranil may cause a dry mouth. Sucking on hard candy, chewing gum, or melting bits of ice in your mouth can provide relief.
  • Elderly people appear to be more sensitive to Tofranil, which can increase their risk of side effects (such as delirium and confusion). In these particular situations, a healthcare provider will likely start people on lower doses of the drug and monitor them more closely.
  • When used in children, the maximum dose of Tofranil is 2.5 mg per kg each day (about 1.1 mg per pound each day). Higher doses may put your child at increased risk for an irregular heart rhythm (arrhythmia).
  • If you have diabetes, when starting Tofranil or changing dosages, make sure to check your blood sugar levels more often. There have been reports of increased or decreased blood sugar levels in people who take the medication.
  • Do not treat yourself for the common cold, a cough, or allergies without first talking to your healthcare provider. Some of these medicines can increase the risk for developing side effects of Tofranil.
  • Do not stop taking the medication without first discussing it with your healthcare provider. Stopping it abruptly may increase the risk for withdrawal symptoms (see Imipramine Withdrawal).
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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