Select therapeutic use:
Indications for TOFRANIL-PM:
Outpatients: initially 75mg/day; max 200mg/day. Inpatients: initially 100–150mg/day, max 300mg/day. Adolescents or elderly: start with Tofranil 25–50mg/day; usual max 100mg/day. For maintenance doses >75mg, may substitute Tofranil-PM for divided or bedtime dosing.
During or within 14 days of MAOIs. Concomitant linezolid or IV methylene blue. Acute post-MI.
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.
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.
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.
Tabs—30, 100; Caps—30