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In general, dose selection for the elderly should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. PRECAUTIONS General An ECG recording should be taken prior to the initiation of larger-than-usual doses of Tofranil and at appropriate intervals thereafter until steady state is achieved. It is unknown whether the farmacia imipramine suicidality risk extends to longer-term use,. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large 8-fold increase in plasma AUC of the TCA.
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