Can't fill your Imipramine prescription? Learn about alternative tricyclic antidepressants like Amitriptyline, Nortriptyline, and Desipramine.
If you've been prescribed Imipramine and can't find it at your pharmacy, you may be wondering whether there are other medications that could work for you. The short answer is yes — but switching medications should always be done with your doctor's guidance.
In this article, we'll cover what Imipramine is, how it works, and walk through four alternative medications that your doctor might consider if Imipramine isn't available.
Important: Never switch or stop medications on your own. Always talk to your prescriber before making any changes. If you haven't tried finding Imipramine yet, start with our guide on how to find Imipramine in stock near you.
Imipramine (brand names Tofranil and Tofranil-PM) is a tricyclic antidepressant (TCA) that has been used since the 1950s. It is one of the oldest antidepressants still in use and remains a valuable option for certain patients.
Imipramine is FDA-approved for:
It is also commonly prescribed off-label for panic disorder, chronic neuropathic pain, anxiety disorders, and PTSD. For a full overview, see our article on what Imipramine is and how it's used.
Imipramine works by blocking the reuptake of two key neurotransmitters in the brain: serotonin and norepinephrine. By preventing these chemicals from being reabsorbed, Imipramine increases their availability in the brain, which helps regulate mood, reduce anxiety, and relieve pain signals.
Imipramine has a slightly higher affinity for the serotonin transporter compared to the norepinephrine transporter. It also has anticholinergic and antihistaminic properties, which account for some of its side effects like dry mouth, drowsiness, and weight gain.
For a deeper explanation, check out how Imipramine works: mechanism of action explained.
The following medications belong to the same class as Imipramine (tricyclic antidepressants) or have similar therapeutic effects. Your doctor will consider your specific condition, medical history, and other medications before recommending a switch.
Amitriptyline is one of the most commonly prescribed tricyclic antidepressants. Like Imipramine, it blocks the reuptake of serotonin and norepinephrine, but it tends to be more sedating due to stronger antihistaminic effects.
Used for: Depression, neuropathic pain, migraine prevention, fibromyalgia, insomnia
Availability: Amitriptyline is widely available as an inexpensive generic. A 30-day supply of generic Amitriptyline typically costs $4 to $15 with a discount coupon.
Key differences from Imipramine: More sedating, often preferred when sleep is a problem. May cause more weight gain and dry mouth. Generally more readily available than Imipramine.
Nortriptyline is actually a metabolite of Amitriptyline and is considered one of the better-tolerated TCAs. It has a more favorable side effect profile than Imipramine, with less sedation and fewer anticholinergic effects.
Used for: Depression, neuropathic pain, migraine prevention, smoking cessation (off-label)
Availability: Widely available as a generic. Typical cost is $8 to $20 for a 30-day supply with a coupon.
Key differences from Imipramine: Better tolerated overall, especially in elderly patients. Less orthostatic hypotension (dizziness upon standing). Often the first-choice TCA when switching from Imipramine.
Desipramine is the active metabolite of Imipramine itself. It is more selective for norepinephrine reuptake inhibition than Imipramine, which means it tends to be less sedating and has fewer anticholinergic side effects.
Used for: Depression, neuropathic pain, ADHD (off-label)
Availability: Available as a generic, though slightly less common than Amitriptyline or Nortriptyline. Typical cost is $15 to $40 for a 30-day supply.
Key differences from Imipramine: Less sedating and fewer anticholinergic effects. More activating, which can be helpful for patients with fatigue. Since it's Imipramine's own metabolite, the pharmacological transition may be smoother.
Clomipramine is another TCA that is most notable for being the gold-standard treatment for obsessive-compulsive disorder (OCD). It has the strongest serotonin reuptake inhibition of all the TCAs.
Used for: OCD (FDA-approved), depression, panic disorder, chronic pain (off-label)
Availability: Available as a generic, though less commonly stocked than other TCAs. Typical cost is $10 to $30 for a 30-day supply with a coupon.
Key differences from Imipramine: Stronger serotonin effects make it particularly useful for OCD and anxiety-predominant conditions. May have more sexual side effects. Not typically used as a first-line alternative for depression unless OCD is also present.
If your doctor wants to move away from tricyclic antidepressants entirely, there are several other classes of medication that may be appropriate:
The right choice depends on why you're taking Imipramine in the first place. Your doctor will help you weigh the pros and cons.
If you can't find Imipramine, don't panic. There are several effective alternatives available, and your doctor can help you find the best fit. Before switching, try using Medfinder to locate Imipramine in stock at a pharmacy near you — it may still be available somewhere in your area.
For more information, check out these related articles:
You focus on staying healthy. We'll handle the rest.
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