DRUG INDEX
GENERIC NAME: desipramine BRAND NAME: Norpramin
DRUG CLASS AND MECHANISM: Desipramine is a medication that is used to treat depression , defined as an all-pervasive sense of sadness and gloom. Desipramine belongs to the tricyclic class of antidepressants called tricyclic antidepressants or TCAs. In some patients with depression, abnormal levels of neurotransmitters in the brain (chemicals that the nerves use to communicate with each other) may be responsible for the depression. Desipramine elevates mood and relieves depression by raising the levels of neurotransmitters in the brain. Desipramine also is responsible for the antidepressant effects of another TCA, imipramine (TOFRANIL), since imipramine is converted by the body to desipramine. Desipramine was approved by the FDA in 1964.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Capsules: 10mg, 25mg, 50mg, 100mg.
STORAGE: Desipramine should be stored below 86° F (30°C) in a tight, light resistant container.
PRESCRIBED FOR: Desipramine is used to elevate the mood of patients with depression and to prevent the fluctuations in mood of patients who are manic/depressive. 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 dose of desipramine is tailored to the patient's needs. Some physicians start with relatively low doses, such as 25 mg three times a day, to reduce the risk of excessive sedation early in treatment; doses then will be slowly increased. Other physicians prefer to give desipramine once daily, in which case it is generally given at bedtime to take advantage of the sedating properties. Elderly persons and patients with advanced liver disease may need lower doses.
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 as zolpidem (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 include propafenone (Rythmol), flecainide (Tonocard), quinidine (Quinidex, Quinaglute), and fluoxetine (Prozac).
PREGNANCY: There is very little information about the effects of desipramine on the fetus. Physicians may use desipramine if its benefits are deemed to outweigh the potential and unknown risks.
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 mouth, constipation , weight gain or loss, and low blood pressure upon arising. Rash, hives , 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.
Following prolonged therapy with high doses, abrupt discontinuation of TCAs, including desipramine, could lead to cholinergic symptoms such as nausea, vomiting, or diarrhea . Therefore, many physicians recommend a gradual reduction in dose when TCAs are discontinued.
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