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Imipramine, sold under the brand name Trofanil is a member of the dibenzazepine group, a tricyclic antidepressant whose main action is to treat clinical depression and enuresis.

Trofanil - prescriptions and mechanism of action

In the 1950's, imipramine was the first tryciclic to be developed. During clinical studies its antidepression qualities were proven and its ability to lift even the most severe depressive episodes has been unsurpassed.

Trofanil, a tertiary amine, inhibits and blocks the re-uptake of neurotransmitters serotonin and norepinephrine almost equally well. The medicine does not act primarily by stimulation of the central nervous system. Enhancement of brain dopamine activity has been implicated in the drug's activity to stimulate motor activity. As for its metabolic action imipramine is converted to desipramine (another TCA) in the body.

It is widely known that antidepressants increase the suicidal tendencies and behavior in children and teenagers with Major Depressive Disorder (MDD) or other psychiatric disorders. That's why patients who are started on Trofanil therapy should be observed closely for unusual changes in behavior, clinical worsening, or suicidal tendencies.

For the relief of symptoms of endogenous depression, one to three weeks of treatment are needed before the therapeutic effects become evident. Trofanil may be used in reducing enuresis in children aged 6 years and older as temporary adjunctive therapy.

Extreme caution should be taken when Trofanil is given to:

* Patients with cardiovascular disease, congestive heart failure, arrythmias, strokes, myocardial infractions
* Patients with history of urinary retention, of narrow-angle glaucoma or of seizure disorder
* Hyperthyroid patients
* Patients receiving clonidine, guanethidine, methylphenidate hydrochloride

Trofanil may enhance the CNS depressant effects of alcohol so it should not be used in treating patients who use excessive amounts of alcohol.

Patients with symptoms like: aggressiveness, impulsivity, akathisia (psychomotor restlessness), insomnia, panic attacks, agitation, worsening of depression, anxiety, should avoid taking Tofranil, because it may increase the suicidal risk for them.

Tofranil may cause some side effects especially with the first few doses which may include:

* Swelling of the face, tongue or body
* Isolated changes in blood cells
* Ringing or buzzing in the ears
* Loss of appetite
* Mood swings, tremor, delusions, hallucinations, exaggerated behavior, confusion
* Disturbances in sexual function, weight gain, enlarged mammary glands, over-production of breast milk
* Irregular heart rhythms
* Hepatitis and jaundice
* Sensitivity to the sun or sun lamps, hair loss

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