Tofranil 25 Mg 20X10 Tablets
Brand : novartis pharmaceuticals
How it works
The pharmacological properties of imipramine are similar to those of other tricyclic antidepressants. The pharmacological profile of imipramine includes reversal of reserpine and tetrabenazine effects, slight depressant effects on the central nervous system as manifested by behavioral, motor and electrocortical visceral activity, anticholinergic and antihistaminic effects, and potentiation of adrenergic and serotonergic functions.
TOFRANIL TAB 25 MG 20X10'S
Requires Prescription (YES/NO)
It is indicated for the relief of symptoms of depression.
Behavioral Common: Somnolence, fatigue, insomnia, confusional states with hallucinations (particularly in geriatric patients and patients suffering from Parkinson’s disease), anxiety, agitation, restlessness, nightmares, hypomania, mania, decrease in memory, feeling of unreality, disorientation. Rare: psychotic disorders. Very rare: Aggression. Anticholinergic Very common: Dry mouth and rarely associated sublingual adenitis, blurred vision, disturbances of visual accommodation, lacrimation decreased, constipation, hyperhidrosis, hot flushes. Common: micturition disorders, dilation of the urinary tract. Very rare: mydriasis, glaucoma, paralytic ileus, urinary retention. Cardiovascular Very common: hypotension, particularly orthostatic hypotension with associated vertigo, sinus tachycardia, electrocardiogram abnormalities (including flattening or inversion of T wave, depressed S-T segments). Common: Arrhythmia, disturbances in cardiac conduction (e.g., widening of QRS complex, PQ changes, bundle-branch block), palpitation, syncope. Very rare: hypertension, congestive heart failure, myocardial infarction, heart block, asystole, stroke, vasospams, QT interval prolongation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsades de pointes. Hematologic Very rare: agranulocytosis, eosinophilia, leukopenia, purpura and thrombocytopenia may occur as an idiosyncratic response. Gastrointestinal Common: nausea, vomiting, anorexia, abdominal cramps, liver function test abnormal. Rare: diarrhea .
When not to Use
It is contraindicated in patients who have known or suspected hypersensitivity to the drug or its excipients, or have known or suspected hypersensitivity to tricyclic antidepressants belonging to the dibenzazepine group ; It should not be given in conjunction with, or within fourteen days before or after treatment with a monoamine oxidase (MAO) inhibitor ; The concomitant treatment with selective, reversible MAO-A inhibitors, such as moclobemide, is also contraindicated ; Symptoms such as hypertensive crises, hyperactivity, hyperpyrexia, spasticity, severe convulsions, and those consistent with serotonin syndrome, e.g. myoclonus, agitation, seizures, delirium or coma and death have been reported in patients receiving such combinations ; It is contraindicated for use during the acute recovery phase following a myocardial infarction and in the presence of acute congestive heart failure ; It is contraindicated in patients with existing liver or kidney damage and should not be administered to patients with a history of blood dyscrasias ; It is contraindicated in patients with glaucoma, as the condition may be aggravated due to the atropine-like effects of the drug .
Adults : The recommended initial dosage is 25 mg three times daily. This should be increased gradually as required and tolerated, up to 150 mg/day. Dosages over 200 mg/day are not recommended . Children : Nocturnal enuresis : 6-8 yr , 25mg at bedtime ; 8-11 yr , 25-50mg at bedtime ; 11-18yr , 50-75mg at bedtime . Initial period of treatment ( including gradual withdrawal ) 3 mnth , full physical examination before further course OR As directed by your physician.
Storage yes or /no
Store this medicine at room temperature, away from direct light and heat.
The possibility of a suicide attempt is inherent in depression. These patients should be carefully supervised during treatment with imipramine hydrochloride and hospitalization or concomitant electroconvulsive therapy may be required. Prescriptions for Imipramine Hydrochloride should be written for the smallest possible quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.
Tricyclic agents are known to lower the convulsive threshold and imipramine hydrochloride should, therefore, be used with extreme caution in patients with a history of convulsive disorders and other predisposing factors, e.g., brain damage of varying etiology, concomitant use of neuroleptics, alcoholism and withdrawal from alcohol, and concomitant use with other drugs that lower the seizure threshold. It appears that the occurrence of seizures is dose dependent. Therefore, the recommended total daily doses should not be exceeded .
Due to the risk of serotonergic toxicity, it is advisable to adhere to recommended doses and any increase in dose should be made with caution if other serotonergic agents are co-administered. Serotonin syndrome, with symptoms such as hyperpyrexia, myoclonus, agitation, seizures, delirium and coma, can possibly occur when imipramine is administered with serotonergic co- medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants or lithium .
Caution should be observed when prescribing Imipramine Hydrochloride for hyperthyroid patients or for patients receiving thyroid medication. Transient cardiac arrhythmias have occurred in rare instances in patients who have been receiving other tricyclic compounds concomitantly with thyroid medication.
Always consult your physician before using any medicine.
CNS depressants (e.g., barbiturates, benzodiazepines or general anesthetics) or anticholinergic agents (e.g., atropine, antihistamines, biperiden, levodopa) , anti-arrhythmic agents , antihypertensives ( e.g. guanethidine, bethanidine, clonidine, reserpine or alpha-methyldopa, diuretics, vasodilators, beta-blockers) , noradrenaline or adrenaline, amphetamine ,cardiovascular drugs like noradrenaline or adrenaline,amphetamine , as well as nasal drops and local anesthetics containing sympathomimetics (e.g., isoprenaline, ephedrine, phenylephrine) , SSRIs such as fluoxetine, paroxetine, sertraline or citalopram are inhibitors of CYP2D6. Fluvoxamine is a potent inhibitor of CYP1A2 and a moderate inhibitor of CYP2D6 , serotonergic co-medications such as SSRIs, SNRIs, tricyclic antidepressants or lithium ; cimetidine or methylphenidate , Substances which activate the hepatic mono-oxygenase enzyme system (e.g., barbiturates, carbamazepine, phenytoin, nicotine and oral contraceptives , MAO-inhibitors , neuroleptic agents (e.g., phenothiazines and butyrophenones) , Oral antifungal, terbinafine.
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