Searching for the right depression medication to treat your depression symptoms can take some time and effort, especially when first-line depression treatments like selective serotonin reuptake inhibitors (SSRIs) fail to treat symptoms and improve your mental health.
Pamelor and Tofranil are two commonly prescribed tricyclic antidepressants (TCAs) that are a bit different from other antidepressants. In this post, we’ll give a side-by-side comparison guide of these two antidepressants. We’ll discuss—
- What tricyclic antidepressants are
- How these antidepressants are used to treat symptoms
- What are the costs, forms, and doses of these antidepressants
- What are potential drug warnings, interactions, and common side effects
- Plus, we’ll answer some FAQs the medical providers on Klarity often receive from patients
Don’t be overwhelmed by all the depression treatment options on the market! If you want fast and effective relief, book an appointment on Klarity today, and we’ll connect you with a board-certified mental health provider who can diagnose and prescribe depression treatments online.
Book now and get seen within 48 hours.
Disclaimer: this article discusses suicide. If you or someone you know is experiencing thoughts of suicide or self-harm, it is crucial to seek help immediately by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
|Drug Class||Tricyclic antidepressant||Tricyclic antidepressant|
|Brand / Generic Status||Brand name for nortriptyline||Generic (Brand name: Silenor)
|Form(s) of the Drug||• Immediate-release capsules|
• Clear, cherry-flavored liquid suspension
• Shapes indicate dosage
|Standard Dosage||Capsules: |
• 10mg per dose
• 10mg triangular tablet
• 25mg small round tablet
• 50mg large round tablet
|Conditions Treated||FDA-approved uses:|
• Major depressive disorder
• Diabetic neuropathy
• Postherpetic neuralgia or post-shingles skin pain
• Neurogenic cough
• Chronic pain
• Persistent myofascial pain
• rigeminal neuralgia or painful shock sensations on the face
• Major depressive disorder
• Nerve Pain
• Panic Disorder
• Irritable bowel syndrome (IBS)
• Enuresis in children
|Cost||Generic form (nortriptyline): |
• $13 for a 30-day supply
• $1250 for a 30-day supply (no insurance)
• $10 for a 30-day supply (with insurance)
|Generic form (imipramine):
• $10 for a 30-day supply
• $430 for a 30-day supply
|Side-Effects||Common side effects: |
• Blurred vision
• Impaired coordination
• Physical weakness
• Nausea and vomiting
• Sensitivity to sunlight
• Xerostomia or dry mouth
• Excessive sweating
• Breast gland tissue growth
• Increased need to urinate
• Abnormal sensations
• Urinary retention
• Changes in blood sugar levels
• Galactorrhea or nipple discharge
• Skin rash
• Itchy skin
|Common side effects:
• Mood/behavior changes
• Difficulty sleeping
• Agitation, hostility, and aggression
• Increased depression and suicidal thoughts
• Blurred vision
• Pain or difficulty urinating
• Difficulties with sex
• Nausea and vomiting
|Warnings For Use||Drug interactions: |
• Blood thinning medications like Warfarin
• Thyroid Supplements
• Anticholinergic drugs
• Blood pressure medication
• Valproic acid
• Thyroid supplements
Tofranil and Pamelor Are the Same Class of Drugs (Tricyclics)
Tofranil and Pamelor are two tricyclic antidepressants (TCAs). This class of drugs was among the first to treat depression and is still prescribed today when first-line treatments do not improve symptoms of depression.
TCAs also have several different “off-label” uses that we will discuss below. The term “off-label” does not mean the medication is ineffective for the given condition but simply that the drug manufacturer has not received FDA approval.
Tofranil and Pamelor Are Both Used To Treat Major Depressive Disorder
Tofranil and Pamelor are two prescription tricyclics approved by the FDA for treating symptoms of major depressive disorder, which is categorized by feelings of sadness and loss of interest in pleasurable activities.
Major Depressive Disorder, also known as clinical depression, is a mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. Symptoms can vary from person to person, but they generally affect a person’s thoughts, emotions, and behaviors. Common symptoms include:
- Persistent sadness or low mood, which may be accompanied by frequent crying or tearfulness.
- Loss of interest or pleasure in activities that were once enjoyable, including hobbies, social activities, and even sex.
- Changes in appetite or weight, which can involve significant weight gain or loss without intentional dieting.
- Sleep disturbances, such as insomnia (difficulty falling asleep or staying asleep) or hypersomnia (excessive sleeping).
- Fatigue or loss of energy, leading to a reduced ability to engage in daily activities or work.
- Feelings of worthlessness or excessive guilt, which may involve self-blame or rumination over past events.
- Difficulty concentrating, making decisions, or remembering things, which can affect work or school performance.
- Psychomotor agitation (restlessness or fidgeting) or psychomotor retardation (slowed movements or speech).
- Recurrent thoughts of death or suicide, including suicidal ideation, plans, or attempts.
What Else Does Tofranil Treat?
In addition to the treatment of major depressive disorder, Tofranil is also FDA-approved for the treatment of childhood enuresis or bedwetting in children over the age of 6 years old.
Off-label Uses for Tofranil
Common off-label uses for Tofranil include:
- Bulimia nervosa
- Neuropathic pain
- Pain or anxiety disorders
- Irritable bowel syndrome
What Else Does Pamelor Treat?
Unlike Tofranil, Pamelor is only FDA-approved for the treatment of major depressive disorder.
Off-label Uses for Pamelor
Common off-label uses for Pamelor include:
- Headache prevention
- Irritable bowel syndrome
- Cyclical vomiting syndrome
- Neuropathic pain
- Smoking cessation
Doses, Dosage Form, and Side Effects of Pamelor
Dose and Form of Pamelor
Pamelor or generic Nortriptyline is available in capsules with different dosing ranging between 10 mg and 75 mg. There is also an oral solution available in a single concentration of 10mg/5mL and is primarily reserved for those who have difficulty swallowing pills.
Like most psychiatric medications, Pamelor is started at a low dose around 25 mg, and can be titrated up weekly until the desired dose is reached. The maximum dose of Pamelor is 150 mg per day.
Your healthcare provider will instruct you on how to take your medication based on your individual needs. Remember to take your medication as directed, as several adverse health outcomes may result from improper use of your TCA medication.
Common Pamelor Side Effects
When starting a new medication, there is always a risk of developing side effects. TCAs are associated with several adverse effects, and it’s important to monitor yourself when starting a new medication.
Common side effects of Pamelor include:
- Dry mouth
- Nausea or vomiting
- Abdominal pain or constipation
- Increased anxiety, agitation, or restlessness
- Sensitivity to light
- Blurred vision
- Dizziness, which can lead to a loss of coordination
- Confusion or disorientation
Common Pamelor Drug Interactions
There are many interactions associated with Pamelor, including:
- Anticholinergic medications
- MAO inhibitors should be avoided two weeks before and after taking Pamelor
- Thyroid treatments
- Muscle relaxers
- Nerve pain medications
- Some antihypertensives, including Clonidine or Lisinopril
- Drugs that increase serotonin levels: SSRIs, SNRIs, ADHD medications, St. John’s Wort, and recreational drugs like MDMA
How Much Does Pamelor Cost?
The cost of your monthly Pamelor script will depend on many factors, including your health insurance policy, which pharmacy you use, and your dosing. Pamelor is covered by the majority of health insurance plans, and if you are uninsured, the use of coupon codes at major pharmacies will dramatically lower your cost.
The retail price of a 30-day supply of name brand Pamelor is over $1200 on average, but with the assistance of coupons and generic Nortriptyline formulary, the price is significantly lowered to under $15 per month.
Doses, Dosage Form, and Side Effects of Tofranil
Dose and Form of Tofranil
Tofranil or generic Imipramine is available in capsules and tablets. Capsules are available in the following dosage forms: 75 mg, 100 mg, 150 mg, and 150 mg, and the tablets are available in 10 mg, 25 mg, and 50 mg dosing.
Typical initial dosing begins low, around 50-75 mg per day, and can slowly be titrated up weekly until the desired dosing is achieved, but does not exceed 200 mg per day.
Common Tofranil Side Effects
Like Pamelor and other TCAs, Tofranil is associated with several side effects, including:
- Nausea, vomiting
- GI upset, constipation, or diarrhea
- Increased anxiety, agitation, or aggression
- Mood or behavioral changes, including worsening depressive symptoms
- Blurred vision
- Sexual dysfunction or loss of libido
Common Tofranil Drug Interactions
Pamelor and Tofranil share many interactions, and as always, it is important to discuss all drugs you are currently taking with your healthcare provider, including all over-the-counter medications and supplements.
Drug interactions with Tofranil:
- Anticholinergic drugs
- MAO inhibitors should be avoided two weeks before and after taking Tofranil
- Thyroid supplements
- Certain antihypertensives, such as Clonidine or Lisinopril
- Muscle relaxers
- Other medications or drugs that increase serotonin levels, including SSRIs, SNRIs, ADHD treatments, and recreational drugs like MDMA
How Much Does Tofranil Cost?
As with Tofranil, the cost of your monthly prescription will depend on your insurance coverage, dosing, and which pharmacy you use. Tofranil remains to be affordable for those without insurance, thanks to generic formulas and coupon codes, which drop the 30-day supply of name-brand Tofranil from $430 to about $10.
Do I Need A Prescription for Tofranil or Pamelor?
Yes, both Tofranil and Pamelor are prescription medicine, and you will need to have a licensed healthcare provider to get started on either antidepressant. These medications are not available over the counter for good reason, as many side effects and interactions could be potentially fatal. Your healthcare provider will determine if Tofranil or Pamelor may be a good option for you.
Other Tricyclic Side Effects
There are a few rare but serious negative effects that are associated with all TCA medications, including Tofranil and Pamelor, that we will take a deeper look at.
What is Serotonin Syndrome?
Serotonin syndrome is an uncommon but serious condition that occurs when there are elevated levels of serotonin in the body. This most commonly occurs in people who are taking more than one medication that increases the level of serotonin within the body. It is important to seek immediate medical attention if you begin to experience any of the following side effects.
Common signs of serotonin syndrome include:
- High fever
- Fast heart rate
- High blood pressure
- Muscle rigidity or tremors
Pregnancy and Breastfeeding on Tricyclics
TCA medications are typically avoided throughout pregnancy due to potential adverse outcomes with the pregnancy, such as preterm delivery, spontaneous abortion, or postpartum hemorrhage. If you are on a TCA medication and become pregnant, your doctor will adjust your medications for optimal safety for you and your baby.
TCA medications are considered to be generally safe to take while breastfeeding because only trace amounts of the drug are found within breast milk.
Caution with Misuse
It is important to note that TCA medications should be avoided in those with past suicidal attempts or who are actively suicidal because overdosing on these medications is fatal. TCAs should be used with caution in the elderly population as well, as accidental overdose is a serious concern as well.
Remember to always take your medication as prescribed by your healthcare provider.
Black Box Warning With Antidepressants
As with most antidepressants, there is a black box warning for worsening depression and suicidal ideation when starting a new medication. This is rare and is commonly seen in those young adults under the age of 24 years old.
It is important to monitor yourself for worsening symptoms, as well as suicidal ideations or self-harm behaviors.
Pamelor and Tofranil Frequently Asked Questions
Comparing two medications from the same class of drugs can be confusing, and we went over a lot of information. Below we have listed some of the most commonly asked questions about Pamelor and Tofranil:
What is Pamelor?
Pamelor or Nortriptyline is a tricyclic antidepressant that is FDA-approved to treat major depressive disorder and childhood bedwetting. Pamelor is also commonly used for some off-label uses, including nerve pain, migraine headache prevention, and smoking cessation.
What is Tofranil?
Tofranil or Imipramine is also a tricyclic antidepressant that is only FDA-approved to treat major depressive disorder but is also used to treat nerve pain, ADHD, and anxiety disorders.
Are Pamelor and Tofranil the same drug?
No, although they belong to the same class of drugs called tricyclics, Pamelor and Tofranil are two separate medications with unique properties.
Why is Pamelor an off-label treatment for anxiety?
Pamelor is considered off-label use for anxiety because other newer and safer medications are more effective than TCA medications. With such a negative side effect profile and serious adverse effects, they are no longer considered first-line treatments.
TCAs are indicated in those who cannot take first-line medications due to drug interactions, comorbid conditions, or if they cannot tolerate the medications.
What’s better for anxiety? Pamelor or Tofranil?
As stated above, TCAs are not considered first-line treatments for anxiety, but when comparing the two medications, Tofranil is more effective.
What’s better for depression? Pamelor or Tofranil?
Pamelor and Tofranil are relatively equal in effectiveness in treating depressive symptoms.
Can I drive on antidepressants like Pamelor or Tofranil?
Due to the sedative effects of TCA medications, driving or operating heavy machinery should be avoided while taking either Pamelor or Tofranil, at least until you understand how you tolerate the medication.
Can I drink alcohol on Pamelor or Tofranil?
You should avoid drinking alcohol while taking any TCA medication due to its sedating effects.
Does it matter what time of day I take Pamelor or Tofranil?
Generally, TCA medication is prescribed to be taken in the evening or at night before bedtime because of the sedative effect of the drugs. Your healthcare provider will instruct you when to take your medication.
How Klarity Helps You Access Depression Treatment
When you have treatment resistant depression, finding the right depression treatment can be challenging. Cut out the hassle and wait time by booking an appointment on Klarity.
We’ll connect you to a licensed healthcare provider in your state who can diagnose and prescribe treatment online so you never need to leave the comfort of your own home.
Book an appointment today and get seen within 48 hours.
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“Imipramine: Drug information” UpToDate. https://www.uptodate.com/contents/imipramine-drug-information?search=tofranil&source=panel_search_result&selectedTitle=1~77&usage_type=panel&kp_tab=drug_general&display_rank=1#F182116
“Nortriptyline: Drug Information” UpToDate. https://www.uptodate.com/contents/nortriptyline-drug-information?source=auto_suggest&selectedTitle=1~1—1~4—nortri&search=nortriptyline
“Generic Pamelor” GoodRx. https://www.goodrx.com/pamelor
“Generic Tofranil” GoodRx