Desipramine

Desipramine is a tricyclic antidepressant used to treat symptoms of depression.

Desipramine is available under the following different brand names: Norpramin.

Dosage Forms and Strengths

Tablet

• 10 mg
• 25 mg
• 50 mg
• 75 mg
• 100 mg
• 150 mg

Dosage Considerations – Should be Given as Follows:

Depression

Adults:

• 100-200 mg orally at bedtime or divided every 12 hours
• Up to 300 mg/day in severely ill

Geriatric:

• 25-100 mg orally at bedtime or divided every 12 hours
• Up to 150 mg/day in severely ill

Adolescents:

• Initial: 25-50 mg orally once/day; may gradually increase if needed to 100 mg/day orally once/day or divided every 8-12 hours
• No more than 150 mg/day
• Children under 12 years: Safety and efficacy not established

Renal Impairment

• Supplemental dose not necessary in peritoneal or hemodialysis

Other Indications and Uses

• Off-label: Postherpetic neuralgia, vulvodynia, eating disorder

Common side effects of desipramine include:

• Blurred vision
• Constipation
• Drowsiness
• Dry mouth
• Fatigue
• Lethargy
• Sedation
• Weakness

Less common side effects of desipramine include:

• Agitation
• Anxiety
• Headache
• Nausea
• Sweating
• Trouble sleeping (insomnia)
• Vomiting

Infrequent side effects of desipramine include:

• Breast swelling (in men or women)
• Confusion
• Diarrhea
• Dizziness
• Dizziness on standing
• ECG changes
• Elevated liver function tests
• Extrapyramidal symptoms (muscle spasms, restlessness, muscle rigidity, slowness of movement, tremor, and jerky movements)
• Fast heart rate
• Increased appetite
• Lack of coordination
• Nervousness
• Numbness and tingling
• Rash
• Ringing in the ears (tinnitus)
• Sexual dysfunction (decreased sex drive, impotence, difficulty having an orgasm)
• Weight gain

Rare side effects of desipramine include:

• Agranulocytosis
• Eosinophilia
• Low platelet count (thrombocytopenia)
• Low white blood cell count (leukopenia)
• Seizures
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Serious side effects of desipramine include:

• Irregular or painful menstrual periods
• Mental/mood changes (e.g., confusion, depression, hallucinations, memory problems)
• Muscle stiffness
• Numbness or tingling of the hands or feet
• Pain/redness/swelling of arms or legs
• Shakiness (tremors)
• Trouble urinating
• Unusual breast milk production

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Desipramine has severe interactions with at least 23 different drugs.
• Desipramine has serious interactions with at least 135 different drugs.
• Desipramine has moderate interactions with at least 350 different drugs.
• Desipramine has mild interactions with at least 148 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (under 24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses. This increase was not seen in patients aged over 24 years. A slight decrease in suicidal thinking was seen in adults over 65 years. In children and young adults, risks must be weighed against the benefits of taking antidepressants. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies. This should be done during initial 1-2 months of therapy and dosage adjustments. The patient's family should communicate any abrupt changes in behavior to the healthcare provider.

Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy.

This drug is not approved for use in pediatric patients.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• Severe cardiovascular disorder
• Narrow angle glaucoma
• Any drugs or conditions that prolong QT interval
• Acute recovery post-heart attack (myocardial infarction [MI])
• Coadministration with serotonergic drugs
  • Risk of serotonin syndrome when coadministered within 14 days of monoamine oxidase inhibitors (MAOIs), or coadministered with other strong serotonergic drugs (e.g., SNRIs, SSRIs)
  • Starting desipramine in a patient who is being treated with linezolid or intravenous (IV) methylene blue is contraindicated because of an increased risk of serotonin syndrome
  • If linezolid or IV methylene blue must be administered, discontinue desipramine immediately and monitor for central nervous system (CNS) toxicity; may resume clomipramine 24 hours after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

Effects of Drug Abuse

• None

Short-Term Effects

• See "What Are Side Effects Associated with Using Desipramine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Desipramine?"

Cautions

• Caution with family history of sudden death, cardiac dysrhythmias, and cardiac conduction disturbances; reports of cardiac dysrhythmias and death preceded by seizures.
• Benign prostatic hyperplasia (BPH), urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment.
• Risk of anticholinergic side effects.
• Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy.
• Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, monoamine oxidase inhibitors (MAOIs), including nonpsychiatric MAOIs, such as linezolid and IV methylene blue) (see Contraindications).

Pregnancy and Lactation

• Use desipramine with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• Desipramine is distributed in breast milk. Do not nurse. The American Academy of Pediatrics (AAP) states the effect on nursing infants is unknown but may be of concern.