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.
Last Editorial Review: 5/11/1998
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