Imipramine can be harmful in large amounts.

Imipramine is sold under many brand names. Some of these are:

• Norpramin
• Tofranil

Medicines with other names may also contain imipramine.

Below are symptoms of an imipramine overdose in different parts of the body. These symptoms may occur more often or be more severe in people who also take certain other medicines that affect serotonin, a chemical in the brain.

AIRWAYS AND LUNGS

• Slow, labored breathing

BLADDER AND KIDNEYS

• Cannot urinate
• Hard to start urinating, or weak urine stream

EYES, EARS, MOUTH, NOSE, AND THROAT

• Blurred vision
• Dry mouth
• Enlarged pupils
• Eye pain in people at risk for a type of glaucoma
• Dry eyes
• Ringing in the ears

HEART AND BLOOD VESSELS

• Low blood pressure
• Irregular heartbeat
• Pounding heartbeat (palpitations)
• Rapid heartbeat
• Shock

NERVOUS SYSTEM

• Agitation
• Coma (lack of responsiveness)
• Confusion
• Seizures
• Delirium
• Depression
• Drowsiness
• Hallucinations
• Inability to concentrate
• Nervousness
• Tremor
• Unsteadiness
• Rigidity or stiffness of the limbs

SKIN

• Dry, red skin

STOMACH AND INTESTINES

• Constipation
• Vomiting

This can be a very serious overdose. Seek medical help right away. Do not make the person throw up unless poison control or a health care provider tells you to.

Have this information ready:

• Person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medicine was prescribed for the person

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container to the hospital with you, if possible.

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may done include:

• Blood and urine tests
• Chest x-ray
• CT scan
• Electrocardiogram (ECG)

Treatment may include:

• Fluids through a vein (by IV)
• Medicine called an antidote to reverse the effects of the poison and treat symptoms, such as sodium bicarbonate or lidocaine
• Activated charcoal
• Laxatives
• Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator)

An imipramine overdose can be very serious.

People who swallow too much of this medicine are almost always admitted to the hospital.

How well someone does depends on how much of the medicine was swallowed and how quickly treatment is given. The faster a person gets medical help, the better the chance of recovery. Complications such as heart rhythm disturbances, pneumonia, muscle damage from lying on a hard surface for a long period of time, or brain damage from lack of oxygen may result in permanent disability. Death can occur.

Tofranil overdose, Norpramin overdose

Aronson JK. Tricyclic antidepressants. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:146-169.

Levine MD, Ruha A-M. Antidepressants. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 141.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.