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  • Brand Name: Norpramin
  • DRUG CLASS AND MECHANISM: Desipramine is an oral antidepressant, a member of the tricyclic antidepressant (TCA) family which also includesamitriptyline (Elavil, Endep), and imipramine (Tofranil). Depression is an all-pervasive sense of sadness and gloom. It is believed that in some patients with depression, abnormal levels of neurotransmitters (chemicals that nerves use to communicate with each other) may be the cause of their depression. Desipramine elevates mood by raising the level of neurotransmitters in nerves of the brain. Desipramine also is responsible for the antidepressant effects of imipramine because imipramine is converted by the body to desipramine. The FDA approved desipramine in 1964.
  • PREPARATIONS: Tablets: 10, 25, 50, 75, 100, and 150 mg.
  • STORAGE: Desipramine should be stored at room temperature, below 86 F (30 C), in a tight, light resistant container.
  • PRESCRIBED FOR: Desipramine is used to elevate the mood of patients with depression. Non-FDA approved (off-label) uses include anxiety,attention-deficit hyperactivity disorderbulimia nervosacataplexy syndrome,chronic itching, depression caused by traumatic brain injuryneuropathic pain (due to injury of nerves), and panic disorder. Desipramine also has sedative properties although less than most other TCAs. Therefore, it is useful in depressed patients with insomnia, restlessness, and nervousness.
  • DOSING: The usual adult dose is 100-200 mg daily. The maximum dose is 300 mg daily.
  • DRUG INTERACTIONS: Desipramine interacts with other medications and drugs that slow the brain’s function, such as alcohol, barbiturates,benzodiazepines, for example, lorazepam (Ativan), diazepam (Valium),temazepam (Restoril), oxazepam (Serax), clonazepam (Klonopin) as well aszolpidem (Ambien) and narcotics. Reserpine has a stimulatory effect on patients taking TCAs.

    Desipramine and other TCAs should not be used with monoamine oxidase inhibiting drugs, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) since high fever, convulsions and even death can occur when these drugs are used together.

    Cimetidine (Tagamet) can increase desipramine blood levels, possibly causing side effects. Other drugs which share this effect includepropafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).

    TCAs may inhibit the antihypertensive effect of clonidine (Catapres). Therefore, combining TCAs with clonidine may lead to dangerous elevations in blood pressure.

  • PREGNANCY: There are no adequate studies in pregnant women.
  • NURSING MOTHERS: It is not known if desipramine is secreted in breast milk.
  • SIDE EFFECTS: The most commonly encountered side effects associated with desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouthconstipationweight gain or loss, and low blood pressure upon arising that may cause light-headedness. Rashhives,seizures, and hepatitis are rare side effects. Desipramine also causes elevated pressure in the eyes of some patients with glaucoma. Overdoses of desipramine can cause life-threatening abnormal heart rhythms or seizures. Sexual dysfunction also has been associated with desipramine.

    Following prolonged therapy with high doses, abrupt discontinuation of TCAs, including desipramine, could lead to symptoms such as nausea,vomiting, or diarrhea. Therefore, many physicians recommend a gradual reduction in dose when TCAs are discontinued.

    Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of desipramine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thinking or behavior, and unusual changes in behavior.

    Reference: FDA Prescribing Information

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