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Elavil vs Tofranil
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain drugs that affect the concentrations of compounds in the brain associated with mood, known as neurotransmitters, can assist in stabilizing depressive lows and managing symptoms. Elavil and Tofranil are two such drugs commonly prescribed for depression. Both impact different neurotransmitters in the brain but have similar effects on mood stabilization in patients dealing with depression. Elavil is a tricyclic antidepressant (TCA), affecting levels of norepinephrine and serotonin by blocking their reuptake into cells in the brain. On the other hand, Tofranil also belongs to TCAs family but primarily affects levels of norepinephrine while having less effect on serotonin than Elavil does.
Elavil vs Tofranil Side By Side
| Attribute | Elavil | Tofranil |
|---|---|---|
| Brand Name | Elavil | Tofranil |
| Contraindications | Should not be taken with or recently after MAOIs. May exacerbate symptoms of depression or suicidal ideation. | Should not be taken with or recently after MAOIs. May exacerbate symptoms of depression or suicidal ideation. |
| Cost | For the brand name, around $80 for 30 tablets of 25 mg. For the generic, starting as low as $4 for thirty 10mg pills. | For the brand name, about $200 for 60 tablets of 25 mg. For the generic, starting at about $15 for thirty 10mg capsules. |
| Generic Name | Amitriptyline | Imipramine |
| Most Serious Side Effect | Worsening depression or thoughts about suicide, heart disturbances, low sodium levels in the body. | Allergic reactions, increased feelings of depression or suicidal thoughts, seizures. |
| Severe Drug Interactions | Monoamine oxidase inhibitors (MAOIs), certain heart medications, other psychiatric drugs. | Monoamine oxidase inhibitors (MAOIs), certain heart medications, other psychiatric drugs. |
| Typical Dose | 75-150 mg/day for adults, starting with a lower dose of 25-50 mg/day. | 75 mg/day for adults, can be increased to a maximum daily dose of 200 mg. |
What is Elavil?
Amitriptyline (the generic name for Elavil) and Imipramine (the generic name for Tofranil) are both first-generation antidepressants, belonging to the class of tricyclic antidepressants (TCAs). They were among the first medications developed specifically to address depression. Amitriptyline was approved by the FDA in 1961 while Imipramine received approval in 1959. Both work by increasing levels of serotonin and norepinephrine in the brain by preventing their reabsorption into nerve cells, thereby enhancing mood over time. These drugs are prescribed not only for various types of depression but also for certain kinds of chronic pain and behavioral issues. Despite their similar mechanisms, they differ somewhat in their side effect profiles; Elavil's influence is more sedative which can be beneficial for patients with insomnia related to their depression, whereas Tofranil has a stronger impact on norepinephrine than Amitriptyline resulting potentially more cardiovascular side effects.
What conditions is Elavil approved to treat?
Elavil is approved for the treatment of different variations of mental and emotional disorders:
- Major depressive disorder (MDD)
- Anxiety in adults
- Neuropathic pain, particularly from diabetic neuropathy or postherpetic neuralgia
- Migraine prevention
On the other hand, Tofranil is used for:
- Depression in both children and adults
- Enuresis (bedwetting) in children aged 6 years and above
How does Elavil help with these illnesses?
Elavil, also known as Amitriptyline, is a medication used to manage depression by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It accomplishes this by blocking their reabsorption into neurons, thereby allowing these neurotransmitters to remain at higher levels for extended periods. Serotonin and norepinephrine are both neurotransmitters that play crucial roles in mood regulation, sleep patterns, appetite control and pain perception among other things. In cases of depression, it's thought that individuals have relatively lower levels of these neurotransmitters. By increasing their availability through Elavil use, patients can limit the detrimental effects associated with depression and stabilize their mood.
On the other hand,Tofranil or imipramine works similarly but focuses more on inhibiting reuptake of norepinephrine than serotonin which might be preferable depending on individual variances in neuro-chemical balance contributing towards depressive symptoms.
What is Tofranil?
Tofranil, a brand name for imipramine, is a tricyclic antidepressant (TCA) that increases the concentration of norepinephrine and serotonin in the brain by inhibiting their reuptake. It also exhibits anticholinergic activity which means it blocks the action of another neurotransmitter, acetylcholine at muscarinic receptors. Imipramine was first approved by the FDA in 1959.
As Tofranil is not an SSRI antidepressant like Elavil (amitriptyline), it does not solely inhibit the reuptake of serotonin but rather acts on both norepinephrine and serotonin. This dual action can provide greater relief from depressive symptoms for some patients who do not respond well to typical SSRIs such as Elavil.
Its side-effect profile differs from that of SSRIs; while it may cause dry mouth, blurred vision and constipation due to its anticholinergic effects, it's less associated with weight gain and sexual dysfunction - common side effects seen with many SSRIs like Elavil. The balance between its benefits and potential side effects should be considered when choosing between these two medications.
What conditions is Tofranil approved to treat?
Tofranil, a tricyclic antidepressant, has received approval from the FDA for treating:
- Major depressive disorder (MDD)
- Enuresis in children (involuntary urination), particularly at night. The medication is designed to balance chemicals in the brain that people with depression may have in unbalanced amounts.
How does Tofranil help with these illnesses?
Tofranil, like Elavil, is a tricyclic antidepressant and it works by increasing the activity of certain chemicals in the brain such as norepinephrine and serotonin which help elevate mood. Tofranil has been particularly noted for its efficacy in treating major depression and enuresis (involuntary urination). It's worth noting that while both medications increase levels of norepinephrine and serotonin in the brain to alleviate symptoms of depression, Tofranil additionally has a notable effect on acetylcholine receptors which can lead to side effects such as dry mouth or constipation. Just as Wellbutrin sometimes serves as an alternative or addition to typical SSRI antidepressants like Prozac when patients do not respond adequately, Tofranil also may be used when other treatments have failed or cannot be tolerated due to side effects.
How effective are both Elavil and Tofranil?
Both amitriptyline (Elavil) and imipramine (Tofranil) have established histories of success in treating patients with depression, and they were both introduced around the same time in the late 1950s. Both are tricyclic antidepressants and act by inhibiting reuptake of norepinephrine and serotonin, but their side effect profiles differ due to their secondary actions on various receptors.
The effectiveness of Elavil and Tofranil has been directly studied; for example, a double-blind clinical trial conducted in 1970 found that both drugs had similar efficacy levels when it came to managing symptoms of depression. In this study, there was no significant difference between the two groups receiving either Elavil or Tofranil regarding their depressive symptom scores.
A review published in 2007 demonstrated that amitriptyline is effective from the first week of treatment at reducing symptoms of depression. Its side effect profile shows more sedation compared to many other antidepressants which can be useful for patients suffering from insomnia as well. Further research indicates that it is also beneficial for chronic pain conditions such as fibromyalgia.
A meta-analysis completed in 2018 showed that imipramine seems to be better than placebo at treating major depressive disorder while having comparable efficacy with other common antidepressants. However, because imipramine is associated with numerous potential side effects including dry mouth, constipation, urinary retention etc., it's typically considered only after SSRIs or other first-line treatments have failed or haven't been tolerated well by the patient.
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At what dose is Elavil typically prescribed?
Oral dosages of Elavil range from 75-150 mg/day, but research suggests that starting with a lower dose of 25-50 mg/day can be sufficient for treating depression in most adults. Dosage can then gradually be increased every week if needed. Children and adolescents may initially receive smaller doses, which are determined by their healthcare provider. For any age group, the dosage should not exceed 300 mg/day under any circumstances. On the other hand, Tofranil typically starts at an oral dosage of 75 mg/day for adults, and this could increase to up to 200mg per day as needed or tolerated over time. The maximum recommended dose is generally around 200mg per day.
At what dose is Tofranil typically prescribed?
Tofranil treatment typically begins with a dosage of 75 mg/day for adults in divided doses or at bedtime. The dose can then be increased to a maximum daily dose of 200 mg, divided into several smaller doses or taken all at once at bedtime depending on the patient's response and ability to tolerate the medication. For elderly patients, the starting dose is often lower, around 30-40 mg per day. This may be tested if there is no response to treatment after a few weeks. Always remember that adjustments should only be made under medical supervision due to potential side effects and interactions with other medications.
What are the most common side effects for Elavil?
Common side effects of Elavil and Tofranil are somewhat similar due to their classifications as tricyclic antidepressants. They include:
- Drowsiness (somnolence)
- Dry mouth
- Constipation
- Blurred vision
- Disorientation or confusion
- Nervousness, restlessness (anxiety)
- Trouble sleeping (insomnia)
- Unintentional trembling or shaking (tremors)
- Decreased sex drive, impotence or difficulty having an orgasm.
Less common but more serious side effects can involve heart palpitations, changes in appetite leading to weight gain or loss, painful or swollen breasts, unusual bleeding or bruising and flu-like symptoms such as fever and chills.
Remember that it's crucial to report any concerning symptoms to your healthcare provider promptly. Also note that this list may not include all possible side effects; individual experiences with these medications can vary significantly.
Are there any potential serious side effects for Elavil?
While both Elavil and Tofranil are antidepressants, they can potentially lead to different side effects. Some serious side effects that may be associated with Elavil include:
- Worsening depression or thoughts about suicide
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Changes in vision such as blurred vision or seeing halos around lights
- Heart disturbances - fast or pounding heartbeats, chest discomfort, shortness of breath, sudden dizziness
- Low sodium levels in the body which may manifest as headache, confusion, slurred speech, severe weakness and unsteadiness
- Severe nervous system reactions like muscle rigidity or spasms
On the other hand for Tofranil you should watch out for:
- Symptoms suggestive of serotonin syndrome: restlessness (agitation), hallucinations (seeing things that aren't there), fever sweating excessively (hyperhidrosis), rapid heartbeat , muscle stiffness/twitching/coordination loss
- Any gastrointestinal distress including nausea/vomiting/diarrhea
These symptoms could be indicative of a medical emergency so if any are experienced while on either medication it is important to contact a healthcare professional immediately.
What are the most common side effects for Tofranil?
Tofranil, also known as imipramine, may cause a variety of side effects:
- Dry mouth and throat
- Blurred vision or trouble focusing
- Nausea, vomiting, loss of appetite or constipation
- Insomnia or sleep disturbances
- Increased sweating and feelings of anxiety or nervousness
- A faster than normal heartbeat
- Confusion, agitation, increased hostility
- Skin rash
- Changes in weight (both weight gain and loss have been reported)
-Increased frequency of urination
-Mild to severe headaches and dizziness
-Stiffness in muscles or joint pain
These side effects can vary widely among individuals. Always consult with your healthcare provider if you experience any concerning symptoms while taking Tofranil.
Are there any potential serious side effects for Tofranil?
In some cases, Tofranil can cause serious side effects. These may include:
- Allergic reactions such as skin rash, itching or hives, swelling of the face, lips, or tongue
- Behavioral changes like increased feelings of depression or suicidal thoughts
- Seizures
- Confusion and disorientation
- Vision problems including blurred vision and dilated pupils
- Rapid heartbeat or palpitations
- Signs consistent with manic episodes such as excessive energy levels, impulsivity, talking more than usual and decreased need for sleep
If you experience any of these symptoms while taking Tofranil it is important to seek immediate medical attention.
Contraindications for Elavil and Tofranil?
Both Elavil (amitriptyline) and Tofranil (imipramine), like most tricyclic antidepressants, can potentially exacerbate symptoms of depression in some individuals. If you notice your depressive symptoms worsening or an increase in suicidal ideation, thoughts, or behaviors while taking either medication, seek immediate medical attention.
Neither Elavil nor Tofranil should be taken if you are currently using or have recently used monoamine oxidase inhibitors (MAOIs). Always inform your healthcare provider about all medications that you're taking. MAOIs need roughly 2 weeks to completely clear from the system to prevent dangerous interactions with both amitriptyline and imipramine. It's also important to remember that these drugs may interact negatively with certain heart medications as well as other psychiatric drugs.
How much do Elavil and Tofranil cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Elavil (25 mg) averages around $80, which works out to approximately $2.66/day.
- The price of 60 tablets of Tofranil (25 mg) is about $200, working out to a cost per day treatment basis around $3.33.
Thus, if you are in the higher dosage range for Tofranil (i.e.,100 mg/day or higher), then brand-name Elavil could be less expensive on a per-day treatment basis. However, please note that cost should not be your only consideration when choosing between these two medications.
For the generic versions — amitriptyline (Elavil) and imipramine hydrochloride (Tofranil):
- Amitriptyline comes in packs ranging from 30 to 90 tablets with costs starting as low as $4 for thirty 10mg pills ($0.13/day at this dose).
- Imipramine Hydrochloride is available also in multiples of thirty with prices beginning at about $15 for thirty 10mg capsules ($0.50/day).
The savings can be substantial when using generic options instead of their branded counterparts: both offer similar effects but come at different price points depending on dosages and manufacturers.
Popularity of Elavil and Tofranil
Amitriptyline, commercially known as Elavil, was prescribed to approximately 2.3 million people in the US in 2020. This tricyclic antidepressant (TCA) accounts for roughly 15% of TCA prescriptions within the country and is well-known for its effectiveness not only against depression but also chronic pain conditions such as fibromyalgia and neuropathic pain.
Imipramine, sold under brand names like Tofranil, saw fewer than half a million prescriptions filled in the same year. Despite being the first TCA developed and once a cornerstone of depression treatment, it now represents less than 5% of all TCA prescriptions due to concerns about side effects and toxicity at high doses or during overdose.
The use of both these drugs has generally decreased over time with an increasing preference for SSRI/SNRI antidepressants that tend to have more tolerable side effect profiles. However, they remain valuable tools particularly when dealing with specific forms of depression or certain types of pain where other treatments are ineffective.
Conclusion
Both Elavil (amitriptyline) and Tofranil (imipramine) have a long history of usage in patients with depression and are supported by numerous clinical studies indicating that they are more effective than placebo treatments. As tricyclic antidepressants, they work primarily by inhibiting the reuptake of norepinephrine and serotonin. However, their mechanisms differ slightly - Elavil has stronger effects on serotonin while Tofranil is more active on norepinephrine.
In some cases, these drugs may be combined or used as alternative options to one another based on patient-specific factors. Both Elavil and Tofranil tend to be prescribed when other first-line antidepressant medications have failed due to their potential side effects.
While both drugs come in generic forms representing significant cost savings for patients who must pay out-of-pocket, there is a required adjustment period meaning that the full therapeutic benefits might not be noticeable immediately.
Side effect profiles between the two drugs are similar but can vary among individuals; common ones include dry mouth, blurred vision, constipation, dizziness and weight gain. Of note is that both carry risk of cardiac toxicity especially in overdose situations which makes them less favored compared to newer classes of antidepressants like SSRIs. Patients starting treatment should closely monitor their moods and seek immediate medical help if depressive symptoms worsen or suicidal thoughts emerge.
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Refrences
- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Scharfetter, C. (1965). Vergiftung mit einem Antidepressivum. Archiv f�r Psychiatrie und Nervenkrankheiten Vereinigt mit Zeitschrift f�r die Gesamte Neurologie und Psychiatrie. Springer Science and Business Media LLC.http://doi.org/10.1007/bf00343771