Text Size :
A A A

Desipramine

Brands and Forms

  • Norpramin
    • tablet: 10mg, 25mg, 50mg, 75mg, 100mg, 150mg

Uses of Desipramine

Desipramine can be used for treating Major Depressive Disorder and Dysthymia, Anxiety Disorders, ADHD, and it is also used at times for alleviating neuropathic pain.

How Desipramine Works

Desipramine is a Tricyclic Antidepressant. It blocks norepinephrine reuptake in the central nervous system and thus boosts norepinephrine neurotransmission. At high doses it also boosts serotonin neurotransmission. Its anticholinergic and antihistimine properties account for some of the side-effects of this medication.

Cautions when Using Desipramine

Desipramine can induce Manic or Mixed Episodes and Rapid Cycling in people with Bipolar Disorder.

Children and adolescents who use antidepressants like Desipramine may develop self-injurious or suicidal behaviors (for more information, see here).

Use caution in people with a known seizure disorder, heart disease, urinary retention, or hyperthyroidism.

Tricyclic Antidepressants such as Desipramine have been shown to increase the risk of cardiovascular disease [ref]. Furthermore, because of the risk of cardiac arrhythmias and other cardiovascular side-effects, the risk/benefit ratio may not justify the use of this medication in individuals with heart disease.

Long-term use of Desipramine may increase the risk of osteoporosis and bone fractures in individuals over age 50.

Desipramine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.

Dosing of Desipramine

The usual therapeutic range of Desipramine is 100-200mg/day. The maximum dose is 300mg/day. It can be given once daily at bedtime, as it tends to be sedating.

Initial dose is usually 25mg/day, and it can be increased by 25mg no quicker than every 3 days. Once at 75-100mg/day, it is generally recommended to wait at least 4 weeks to see if therapeutic effects occur before increasing the dose further.

When wanting to stop this medication, the dose should be decreased gradually over a period of 6-8 weeks. A sudden cessation of the medication can result in a discontinuation syndrome.

Onset of action

Therapeutic effects are not expected before 2-4 weeks at a dose of 75-100mg/day. If no significant effects are seen after 6-8 weeks of use, including at least 2 weeks at a dose above 100mg/day, then the medication may not work at all.

Kidney impairment

Use with caution. May need to lower dose and to monitor blood levels of the medication.

Liver impairment

Use with caution. May need to lower dose and to monitor blood levels of the medication.

Elderly

May be more sensitive to the anticholinergic, cardiovascular, hypotensive and sedative effects. Initial dose is 25-50mg/day, and maximum dose is 150mg/day.

Side-effects of Desipramine

Below is a list of most of the reported side-effects of Desipramine. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: arrhythmias; flushing; hypertension; hypotension; palpitations; tachycardia; QTc prolongation; stroke; heart block; congestive heart failure.

Central Nervous System: agitation; alterations in EEG patterns; unsteadiness; confusion; drowsiness; extrapyramidal symptoms; fatigue; headache; incoordination; insomnia; nightmares; serotonin syndrome; numbness; paresthesias of extremities; peripheral nephropathy; restlessness; seizures; tingling; tremors; weakness.

Dermatologic: itching; excessive sweating; petechiae; photosensitization; skin rash; hair loss; urticaria.

Endocrine/Metabolic: elevation or depression of blood glucose levels; SIADH; weight gain or loss; abnormal breast milk secretion; breast enlargement in men and women; breast pain.

Eyes, Ears, Nose and Throat: blurred vision; disturbances in accommodation; increased intraocular pressure; mydriasis; tinnitus.

Gastrointestinal: abdominal cramps; loss of appetite; black tongue; constipation; diarrhea; dry mouth; increased pancreatic enzymes; nausea; taste changes; stomatitis; sublingual adenitis; vomiting; paralytic ileus (rare); elevated liver enzymes; hepatitis (rare).

Genitourinary: decreased or increased libido; delayed micturition; dilation of the urinary tract; gynecomastia in men; impotence; nocturia; painful ejaculation; testicular swelling; urinary frequency; urinary retention.

Hematologic: bone marrow depression, including agranulocytosis; eosinophilia; purpura; thrombocytopenia.

Muskuloskeletal: risk of osteoporosis and bone fractures with long-term use.

Psychiatric: anxiety; agitation; apathy; irritability; worsening depression; depersonalization; suicidal thoughts; self-injurious behaviors among children and adolescents; can induce Manic or Mixed Episodes and Rapid Cycling in people with Bipolar Disorder.

Common side-effects of Desipramine

Dizziness, sedation/fatigue, tremor, headache, blurred vision, constipation, urinary retention, ejaculation failure; impotence; increased appetite, weight gain, dry mouth, nausea, diarrhea, heartburn, unusual taste in mouth, weakness, anxiety, restlessness, sweating, sexual dysfunction.

Rare but serious side-effects of note of Desipramine

  • Children and adolescents who use antidepressants like Desipramine may develop self-injurious or suicidal behaviors (for more information, see here).
  • Seizures
  • QTc prolongation, which can lead to serious heart arrhythmias
  • Heart attack and stroke
  • Acute angle glaucoma
  • Paralytic ileus
  • Liver failure
  • Bone marrow depression

Desipramine discontinuation syndrome

Individuals who suddenly stop using Desipramine after taking the medication at moderate or high doses over a significant period of time are at risk of developing a discontinuation syndrome, which can include the following symptoms: dizziness, electric shock-like sensations, sweating, nausea, insomnia, tremor, anxiety, restlessness, agitation, depressed mood, irritability, confusion, lethargy, and vertigo. These symptoms usually start anywhere from one day to one week after the medication was stopped, and can persists for days or even weeks.

This syndrome can be treated by restarting the medication at its prior dose. It can be prevented by decreasing the dose gradually over a period of 6-8 weeks when wanting to stop the medication. In rare cases, individuals may experience the discontinuation syndrome even when the medication is being tapered gradually; in such cases, an extremely slow and gradual taper will be necessary.

Desipramine overdose

Convulsions, heart arrhythmias, severe hypotension, CNS depression, coma. Death may occur.

Desipramine and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; should only be used in pregnancy if clearly needed and if benefits outweigh potential risks. For further information, see the section on treating Depression in pregnancy.

Medical Monitoring for Desipramine

Monitor blood counts (CBC with differential), body mass index; blood sugars (in patients with diabetes), electrocardiogram, and liver function tests as needed.

Drug Interactions with Desipramine

  • Combining Imipramine with other anticholinergic drugs can increase the risk of paralytic ileus or hyperthermia.
  • Cisapride and Sparfloxacin are contraindicated in patients receiving Desipramine because of the increased risk of life-threatening cardiac arrhythmias resulting from QTc prolongation.
  • Gatifloxacin, Levofloxacin, and Moxifloxacin should also be combined with caution, as these may also cause QTc prolongation.
  • Desipramine blood concentrations can be increased by Cimetidine, Flecainide, Fluoxetine, Haloperidol, oral contraceptives, Paroxetine, Phenothiazines, Propafenone, Quinidine, Sertraline, Terbinafine, Venlafaxine, and Valproic Acid.
  • Desipramine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.