Patient/caregiver was educated on precautions to be exercised while taking Tofranil as follows:
- Individuals with complaint of dehydration, secondary to history of diarrhea, vomiting, or poor fluid intake, can suffer electrolyte disturbances and be more prone to develop arrhythmias with Tofranil. Electrolyte disturbances, such as, low potassium and magnesium levels, secondary to diuretic pill intake, can also act as a precipitating factor for cardiac arrhythmias with Tofranil. Observing compliance with recommended hydration measures can help prevent development of arrhythmias in these individuals. Also, observe compliance with any periodical lab draws ordered for electrolyte levels and closely follow for development of signs and symptoms of cardiac arrhythmia, such as, episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath. Report any such findings to your physician immediately, so that, an alternative plan of care could be considered.
- Avoid using Tofranil with other antidepressant medications that act along the same line as Tofranil and increasing the serotonin levels in the body. Tofranil use along with antidepressants, such as, citalopram, fluoxetine, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome, thus resulting in nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on Tofranil, by observing a window period of atleast 2 weeks, before the transition to Tofranil is made, to prevent development of serotonin syndrome.
