Imipramine (Tofranil): How This Tricyclic Antidepressant Works, Dosing, and When Telehealth Is Enough

Last updated: August 22, 2026

Imipramine is a tricyclic antidepressant (TCA). The historic brand is Tofranil (imipramine hydrochloride tablets). Capsules of imipramine pamoate exist as a once-daily form. Clinicians use tablets and capsules for depression. Tablets are also labeled as temporary add-on therapy for bedwetting in children 6 years and older after a clinician rules out an organic cause. It is not a controlled substance. A licensed telehealth clinician can often continue a stable course after a full history, but new starts need a cardiac review, and overdose is a medical emergency.

This guide is educational. It is not a diagnosis and it is not a promise that any clinician will prescribe imipramine.

Looking for depression care online? Klarity Health has 2,000+ licensed providers. Many visits happen by video. Coverage varies by plan. Self-pay is also an option. See online depression treatment options or browse conditions.

TLDR

• Imipramine is a tertiary-amine TCA. MedlinePlus a682389 lists tablets and capsules for depression, and tablets to help prevent bedwetting in children.
• The Tofranil tablet label on DailyMed (setid e6aba45c) describes imipramine hydrochloride as the original tricyclic antidepressant in the dibenzazepine group. Tablets: 10 mg, 25 mg, and 50 mg. It is not approved for pediatric depression (DailyMed Tofranil).
• StatPearls (NBK557656) calls it FDA-approved for depression, typically second-line because of side effects and overdose toxicity. Off-label uses in that review include chronic neuropathic pain and panic disorder. Tablets 10/25/50 mg. Capsules 75/100/125/150 mg (pamoate).
• Adult outpatients (DailyMed): start 75 mg/day, raise toward 150 mg/day. Doses over 200 mg/day are not recommended. Maintenance often 50 to 150 mg/day. Hospitalized adults: start 100 mg/day in divided doses, raise toward 200 mg/day; if no response after two weeks, 250 to 300 mg/day. Adolescents and older adults: start 30 to 40 mg/day; it is generally not necessary to exceed 100 mg/day.
• Childhood enuresis (DailyMed): start 25 mg one hour before bedtime in children 6 and older. Raise after one week if needed. Typical night dose up to 50 mg under age 12, and up to 75 mg at 12 and older. Do not exceed 2.5 mg/kg/day. A daily dose above 75 mg does not add benefit and tends to add side effects.
• Boxed warning: antidepressants raised suicidal thinking and behavior versus placebo in children, adolescents, and young adults in short-term studies. Monitor closely at start and at every dose change. Write the smallest practical quantity because TCA overdose can be fatal (DailyMed; MedlinePlus).
• Do not combine with an MAOI. Wait at least 14 days when you switch. Do not use in the acute recovery period after a myocardial infarction. Linezolid and IV methylene blue also have MAOI activity (StatPearls).
• Not a controlled substance. Telehealth can follow many stable adults. New rash with fever, fainting, chest pain, seizures, or any suspected overdose need emergency care. If you are in crisis, call or text 988.

Table of contents

• What imipramine is
• How it works
• Approved and related uses
• Imipramine dosage
• Side effects
• Warnings and who should not take it
• Interactions
• When telehealth is enough
• How a Klarity visit fits
• FAQ

What imipramine is

Imipramine hydrochloride is a sugar-coated oral tablet. DailyMed lists Tofranil 10 mg, 25 mg, and 50 mg tablets. StatPearls also lists imipramine pamoate capsules at 75, 100, 125, and 150 mg for once-daily dosing. Product names are not interchangeable without a clinician and pharmacist check. DEA schedule: none.

Historic brand: Tofranil. Many pharmacies now dispense a generic. Related Klarity TCA and mood guides: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Silenor), and trazodone.

How it works

MedlinePlus says imipramine raises certain natural brain chemicals that help keep mood in balance. DailyMed hypothesizes potentiation of adrenergic synapses by blocking norepinephrine reuptake at nerve endings. The way it reduces childhood bedwetting is thought to be separate from the antidepressant effect.

StatPearls describes a tertiary amine that blocks reuptake of both norepinephrine and serotonin, with relatively more serotonin affinity and more anticholinergic effect than secondary-amine TCAs. It also blocks muscarinic, alpha-adrenergic, H1, and D2 receptors. Those extra receptor effects explain dry mouth, constipation, dizziness, sedation, and some of the cardiac risk.

MedlinePlus notes it may take 1 to 3 weeks or longer to feel the full benefit. StatPearls cites about 4 to 5 weeks for a solid response. Keep taking it unless your clinician tapers you. Sudden stop after long use can cause nausea, headache, and malaise (DailyMed).

Approved and related uses

Per MedlinePlus and the Tofranil label:

• Depression in adults (tablets and capsules)
• Childhood enuresis as temporary adjunctive therapy in children 6 years and older, after organic causes are excluded (tablets)

DailyMed is explicit: imipramine hydrochloride is not approved for pediatric patients for depression. Bedwetting use is short-term. Effectiveness can fade with continued use.

StatPearls lists off-label use for chronic neuropathic pain and panic disorder. Off-label means the FDA has not approved that use. Only your prescriber can decide if the evidence and your history support it.

Imipramine dosage

Always follow the dose on your prescription. Label ranges from DailyMed Tofranil and StatPearls:

• How to take it: with or without food. Depression: one or more times a day. Bedwetting: usually one hour before bedtime (MedlinePlus)
• Adult outpatients: start 75 mg/day; raise to 150 mg/day. Do not go above 200 mg/day. Maintenance 50 to 150 mg/day
• Hospitalized adults: start 100 mg/day divided; raise to 200 mg/day. If no response after two weeks, 250 to 300 mg/day
• Adolescents and geriatric patients: start 30 to 40 mg/day; usually stay at or below 100 mg/day
• Childhood enuresis (age 6+): start 25 mg one hour before bed. After one week, raise if needed. Under 12: up to 50 mg at night. Age 12+: up to 75 mg at night. Early-night wetters may do better with 25 mg mid-afternoon plus a bedtime dose. Do not exceed 2.5 mg/kg/day. ECG changes of unknown meaning have shown up at about twice that amount
• Tablet strengths: 10, 25, 50 mg. Pamoate capsules (StatPearls): 75, 100, 125, 150 mg

StatPearls notes a narrow therapeutic index. One cited research finding: levels above about 300 ng/mL treated some severe depression but also raised the chance of serious side effects. Only a clinician should order levels and interpret them.

Side effects

DailyMed groups common and serious effects this way:

• Anticholinergic: dry mouth, blurred vision, constipation, urinary retention
• Cardiovascular: orthostatic hypotension, tachycardia, arrhythmias, heart block, ECG changes, rare heart attack or stroke
• Central: drowsiness, dizziness, confusion (especially in older adults), insomnia, tremor, seizures
• Other: weight change, sweating, sexual dysfunction, rare blood-count drop or liver injury
• In enuretic children: nervousness, sleep problems, tiredness, mild stomach upset; these often ease if the dose drops

Call emergency services for chest pain, fainting, a seizure, high fever with rigidity (possible NMS-like crisis is less typical than with antipsychotics, but TCA overdose is its own emergency), or signs of serotonin syndrome (agitation, fever, tremor, rigidity) when combined with other serotonergic drugs (StatPearls).

Warnings and who should not take it

Boxed suicidality warning. Antidepressants increased suicidal thinking and behavior versus placebo in people 24 and under in short-term trials. Watch for new or worse depression, agitation, panic, insomnia, aggression, or mania, especially in the first months and after dose changes. Families should observe daily. DailyMed asks prescribers to write the smallest quantity that still treats the person, because TCA overdose kills (QRS widening, seizures, hypotension, coma).

Do not take imipramine if:

• You take an MAOI, or you stopped one less than 14 days ago
• You are in the acute recovery period after a heart attack
• You have known hypersensitivity, including cross-sensitivity to other dibenzazepine compounds such as desipramine (DailyMed)
• You need linezolid or IV methylene blue (StatPearls)

Use extreme caution with cardiovascular disease at any dose. DailyMed also flags caution with methylphenidate, because methylphenidate can raise imipramine levels. Children should not exceed 2.5 mg/kg/day.

Screen for bipolar disorder before you start. Antidepressants can flip a person into mania (StatPearls; MedlinePlus family-history warning).

Interactions

Key combinations from DailyMed, MedlinePlus, and StatPearls:

• MAOIs, linezolid, IV methylene blue: contraindicated (hypertensive crisis, seizures)
• Other serotonergic drugs (SSRIs, SNRIs, triptans, tramadol, lithium, St. John’s wort, tryptophan): serotonin syndrome risk
• Methylphenidate: may raise imipramine levels
• Alcohol and other CNS depressants: more sedation and overdose risk
• Anticholinergic drugs: more constipation, urinary retention, confusion
• Drugs that affect heart rhythm: extra ECG caution

Give your clinician a full list of prescriptions, OTC sleep aids, and supplements. Do not start or stop anything on a blog’s advice.

When telehealth is enough

Imipramine is not a controlled substance, so a video visit can often refill a stable adult who already has labs and an ECG on file. Telehealth is a poor fit when:

• You need a first-time start and you have known heart disease, unexplained syncope, or no recent ECG
• A child needs enuresis treatment (Klarity adult psychiatry is not a substitute for pediatric urology and in-person exam)
• You have new chest pain, collapse, seizure, or suspected overdose. Go to an emergency department. DailyMed requires hospital monitoring after overdose; children are more sensitive than adults
• Mood is rapidly cycling or psychosis is new. You may need a higher level of care

How a Klarity visit fits

Klarity Health connects adults with 2,000+ licensed providers for online evaluation of depression, anxiety, and related conditions. A visit may include history, medication review, and a plan that could include an SSRI, SNRI, bupropion, a TCA such as imipramine, therapy referral, or no medicine at all. No article can promise a specific prescription.

Insurance may help pay for visits. Coverage varies by plan and state. Verify benefits before you book. Self-pay is also an option.

See if online depression treatment may be a fit →

Browse Klarity condition pages →

FAQ

Is imipramine the same as Tofranil?

Tofranil is a brand of imipramine hydrochloride tablets. Generics contain the same active ingredient. Imipramine pamoate is a different salt sold in capsules for once-daily use. Do not switch forms on your own.

Is imipramine a controlled substance?

No. It still needs a prescription because of cardiac risk, anticholinergic effects, and overdose danger.

How long does imipramine take to work?

MedlinePlus: 1 to 3 weeks or longer for depression. StatPearls: about 4 to 5 weeks for a solid response. Bedwetting response, if it happens, is often judged within about a week at a given dose (DailyMed titration language).

Can I get imipramine through telehealth?

A licensed clinician who is allowed to treat you in your state may prescribe it after a real evaluation. Many people start a newer antidepressant first. Klarity cannot guarantee that imipramine will be the chosen medicine.

What if I miss a dose?

MedlinePlus: take it when you remember, unless it is almost time for the next dose. Do not double up.

Disclaimer

This article is for education. It does not diagnose, treat, or replace care from a licensed clinician. Medication choices depend on your history, other drugs, heart health, and lab data. Insurance coverage for visits or prescriptions may vary by plan. Confirm benefits with your insurer. If you have thoughts of suicide or self-harm, call or text 988, or go to the nearest emergency department.

Sources: MedlinePlus imipramine; DailyMed Tofranil (setid e6aba45c); StatPearls Imipramine NBK557656.