Bed Wetting and Treatment with Imipramine (Tofranil)

There are at least 5-7 million children who have problems with bed wetting. This social problem is quite difficult to treat. Over the years many types of non-medical and medical treatments have been approved for enuresis. One should understand first that there is no medication that is 100% effective or can cure enuresis. All medications currently used to treat enuresis only work for a short time and many have potent side effects.

Medications are not first line of therapy for bed wetting. In most cases medications are only started after behavior therapy and alarms have failed. Among the drugs, imipramine (tofranil) is often used to treat both children and adults with enuresis. The drug goes by several names including Imiprex, tofranil and Sermonil.

Imipramine is a good drug for the treatment of depression, various pain syndromes, insomnia and neuropathy. Tofranil has been used to treat enuresis for more than 3 decades. The lowest dosage of Tofranil is usually administered and the response to bed wetting is observed. Most people begin to see a response in a few days. The dose is usually increased if no response is seen after 2 weeks. The initial success rates of tofranil are low. Only 10%-20% of children and about 25% of adults respond to this therapy. However, for some unknown reason with continued long-term treatment, its effectiveness disappears. The exact manner in which Tofranil controls bed wetting is unknown but its action are thought to be related to its anti-cholinergic activity and potentiation of the sympathetic system. The dose of imipramine is based on the body weight.

The drug is also given to adult patients with bed wetting but only if there is no evidence of any heart problems like congestive heart failure, history of palpitation or strokes. Because the drug can lower seizure threshold, it is usually not given to patients with such a history.

Tofranil is available as tablets of 10 mg, 25 mg and 50 mg. In most cases the children are treated for 3-6 months and then the drug is weaned slowly by decreasing the dosage every few weeks. Relapses are quite common when the drug is discontinued. Even though tofranil is widely prescribed with modest results, it frequently has to be discontinued because of persistent side effects.

Side effects of Tofranil include:

* fast heart rate
* blurred vision
* dry mouth
* constipation
* weight gain
* low blood pressure

Tofranil has also been associated with accidental overdose and thus, precaution is required during dispensing this medication to children.

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