DrugindexOnline^{2nd edition}

Pronouncation: (dess-IPP-ruh-meen HIGH-droe-KLOR-ide)
Class: Tricyclic compound

Trade Names:
Norpramin
- Tablets 10 mg
- Tablets 25 mg
- Tablets 50 mg
- Tablets 75 mg
- Tablets 100 mg
- Tablets 150 mg

Apo-Desipramine (Canada)
Novo-Desipramine (Canada)
Nu-Desipramine (Canada)
PMS-Desipramine (Canada)
ratio-Desipramine (Canada)

Mechanism of Action

Pharmacology

Inhibits reuptake of norepinephrine and serotonin in CNS.

Pharmacokinetics

Absorption

Rapidly absorbed.

Metabolism

Metabolized in the liver.

Elimination

Approximately 70% excreted in the urine. t _½ is 12 to 24 h.

Onset

2 to 5 days.

Peak

2 to 3 wk.

Special Populations

Elderly

Rate of metabolism is slower. Dosage adjustment recommended.

Indications and Usage

Relief of symptoms of depression.

Unlabeled Uses

Facilitation of cocaine withdrawal; treatment of panic and eating disorders (eg, bulimia nervosa).

Contraindications

Hypersensitivity to any tricyclic antidepressant. Not to be given in combination with or within 14 days of treatment with an MAOI; cross-sensitivity may occur across the dibenzazepines. Do not give during acute recovery phases of MI.

Dosage and Administration

Adults

PO 100 to 300 mg/day. May be given in divided doses or once daily at bedtime.

Elderly and Adolescent Patients

PO 25 to 150 mg/day.

Storage/Stability

Store at room temperature, preferably below 30°C (86°F). Protect from excessive heat. Dispense in tight container.

Drug Interactions

Barbiturates, carbamazepine, charcoal

May decrease desipramine effects.

Cimetidine, fluoxetine, haloperidol, quinidine, oral contraceptives, phenothiazine antipsychotics

May increase desipramine effects.

Clonidine

May result in hypertensive crisis.

CNS depressants

CNS and respiratory effects may be increased.

MAOIs

Hyperpyretic crises, severe convulsions and death may occur if administered together or within 14 days of each other.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes; hypertensive episodes during surgery; stroke; heartblock; CHF.

CNS

Confusion; disturbed concentration; hallucinations; delusions; nervousness; numbness; tremors; extrapyramidal symptoms (pseudoparkinsonism; movement disorders; akathisia); restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; fatigue; emotional lability; seizures.

Dermatologic

Rash; pruritus; photosensitivity reaction; dry skin; acne; itching; sweating.

EENT

Conjunctivitis; blurred vision; increased intraocular pressure; mydriasis; tinnitus; nasal congestion; peculiar taste in mouth.

GI

Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; dry mouth; constipation.

Genitourinary

Impotence; sexual dysfunction; nocturia; urinary frequency; urinary tract infection; vaginitis; cystitis; urinary retention or hesitancy.

Hepatic

Hepatitis; jaundice.

Hematologic

Bone marrow depression including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia.

Metabolic

Elevation or depression of blood sugar levels.

Respiratory

Pharyngitis, rhinitis; sinusitis; bronchospasm; cough.

Miscellaneous

Breast enlargement.

Precautions

Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Not recommended in children younger than 12 yr of age.

Special Risk Patients

Use drug with caution in patients with history of seizures, urinary retention, urethral or ureteral spasm, angle-closure glaucoma, increased intraocular pressure, or CV disorders; in patients receiving thyroid medication and in patients who have hepatic or renal function impairment, schizophrenia, or paranoia.

Overdosage

Symptoms

Confusion, agitation, hallucinations, seizures, status epilepticus, clonus, choreoathetosis, hyperactive reflexes, positive Babinski signs, coma, cardiac arrhythmias, renal failure, flushing, dry mouth, dilated pupils, hyperpyrexia.

Patient Information

• Warn patient of risk of seizure.
• Instruct patient to keep weekly record of weight.
• Teach patient how to take BP and heart rate.
• Explain missed medication procedure: less than 2 h, take medication; longer than 2 h, wait until next scheduled dose. Do not double doses.
• Teach proper techniques for oral hygiene to help prevent/treat dry mucous membranes.
• Tell patient to increase fluid intake.
• Inform men of possible sexual dysfunction.
• Tell patient of possible difficult urination.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Advise patient to complete full course of therapy; may take 4 to 6 wk to see full benefits.