Select therapeutic use:

Mood disorders:

Indications for TOFRANIL:

Depression.

Adult:

Outpatients: initially 75mg/day, may increase to 150mg/day; max 200mg/day. Maintenance: 50–150mg/day. Inpatients: initially 100mg/day, may increase to 200mg/day as needed; max 300mg/day. Adolescents or elderly: initially 30–40mg/day; max 100mg/day.

Children:

Not established.

Contraindications:

During or within 14 days of MAOIs. Concomitant linezolid or IV methylene blue. Acute post-MI.

Boxed Warning:

Suicidality and antidepressant drugs.

Warnings/Precautions:

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Monitor for emergence of serotonin syndrome; discontinue if occurs. Screen for bipolar disorder. Cardiovascular disease. Increased intraocular pressure. Urinary retention. Hyperthyroidism. Seizure disorder. Angle-closure glaucoma. Mania/hypomania. Psychosis. ECT. Diabetes. Renal or hepatic impairment. Perform leukocyte and blood counts if fever and sore throat develops. Discontinue prior to surgery or evidence of pathological neutrophil depression. Write ℞ for smallest amount feasible. Elderly. Pregnancy. Nursing mothers: not recommended.

Pharmacologic Class:

Tricyclic.

Interactions:

See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiates alcohol, sympathomimetics (eg, epinephrine, norepinephrine), CNS depressants. Potentiated by methylphenidate, CYP2D6 inhibitors; monitor plasma levels with cimetidine, fluoxetine, quinidine, SSRIs, phenothiazines, type 1C antiarrhythmics (eg, propafenone, flecainide). Antagonized by barbiturates, phenytoin. Paralytic ileus with anticholinergics. Blocks guanethidine, clonidine. Possible cardiotoxicity with concomitant thyroid medications.

Adverse Reactions:

Drowsiness, anticholinergic effects, CNS overstimulation, arrhythmias, extrapyramidal symptoms, hypo- or hypertension, nausea, fatigue, rash, increased perspiration, headache, changes in blood sugar, photosensitivity, edema, blood dyscrasias (discontinue if occurs), jaundice.

How Supplied:

Tabs—30, 100; Caps—30

Pricing for TOFRANIL

50mg tablet (Qty: 30)
Appx. price $14
GoodRx

Overactive bladder/enuresis:

Indications for TOFRANIL:

Childhood enuresis.

Children:

12yrs. Early night bedwetters: give 25mg in afternoon and repeat at bedtime. Max 2.5mg/kg per day. Attempt drug-free periods after gradual tapering of dose if drug response favorable.

Contraindications:

During or within 14 days of MAOIs. Concomitant linezolid or IV methylene blue. Acute post-MI.

Boxed Warning:

Suicidality and antidepressant drugs.

Warnings/Precautions:

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Monitor for emergence of serotonin syndrome; discontinue if occurs. Screen for bipolar disorder. Cardiovascular disease. Increased intraocular pressure. Urinary retention. Hyperthyroidism. Seizure disorder. Angle-closure glaucoma. Mania/hypomania. Psychosis. ECT. Diabetes. Renal or hepatic impairment. Perform leukocyte and blood counts if fever and sore throat develops. Discontinue prior to surgery or evidence of pathological neutrophil depression. Write ℞ for smallest amount feasible. Elderly. Pregnancy. Nursing mothers: not recommended.

Pharmacologic Class:

Anticholinergic.

Interactions:

See Contraindications. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiates alcohol, sympathomimetics (eg, epinephrine, norepinephrine), CNS depressants. Potentiated by methylphenidate, CYP2D6 inhibitors; monitor plasma levels with cimetidine, fluoxetine, quinidine, SSRIs, phenothiazines, type 1C antiarrhythmics (eg, propafenone, flecainide). Antagonized by barbiturates, phenytoin. Paralytic ileus with anticholinergics. Blocks guanethidine, clonidine. Possible cardiotoxicity with concomitant thyroid medications.

Adverse Reactions:

Nervousness, sleep disorders, tiredness, GI disturbances, constipation, convulsions, anxiety, emotional instability, syncope, collapse, drowsiness, orthostatic hypotension, ECG changes, restlessness, insomnia, anticholinergic effects, CNS overstimulation, extrapyramidal symptoms, rash, headache, changes in blood sugar, photosensitivity, edema, bone marrow depression (discontinue if occurs), jaundice, urinary frequency.

How Supplied:

Tabs—30, 100

Pricing for TOFRANIL

50mg tablet (Qty: 30)
Appx. price $14
GoodRx