Dosing and uses of Norpramin (desipramine)
Adult dosage forms and strengths
tablet
- 10mg
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
Depression
100-200 mg PO qHS or divided q12hr
Up to 300 mg/day in severely ilL
Renal Impairment
Supplemental dose not necessary in peritoneal or hemodialysis
Other Indications & Uses
Off-label: Postherpetic neuralgia, vulvodynia, eating disorder
Pediatric dosage forms and strengths
tablet
- 10mg
- 25mg
- 50mg
- 75mg
- 100mg
- 150mg
Adolescents
<12 years: Safety and efficacy not established
Initial: 25-50 mg PO qDay; may gradually increase if needed to 100 mg/day PO qDay or divided q8-12hr
No more than 150 mg/day
Geriatric dosage forms and strengths
Depression
25-100 mg PO qHS or divided q12hr
Up to 150 mg/day in severely ilL
Norpramin (desipramine) adverse (side) effects
Frequency not defined
Common
- Fatigue
- Lethargy
- Sedation
- Weakness
- Constipation
- Dry mouth
- Blurred vision
Less Common
- Agitation
- Anxiety
- Headache
- Insomnia
- Nausea
- Vomiting
- Sweating
Infrequent
- ECG changes, orthostatic hypotension, tachycardia
- Confusion, dizziness, paresthesia
- Extrapyramidal symptoms
- Rash
- Elevated LFTs
- Sexual dysfunction
- Tinnitus
Rare
- Seizure
- Agranulocytosis
- Eosinophilia
- Leukopenia
- Thrombocytopenia
- SIADH
Warnings
Black box warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses. This increase was not seen in patients aged >24 years. A slight decrease in suicidal thinking was seen in adults >65 years. In children and young adults, risks must be weighed against the benefits of taking antidepressants. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies. This should be done during initial 1-2 months of therapy and dosage adjustments. The patient’s family should communicate any abrupt changes in behavior to the healthcare provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
This drug is not approved for use in pediatric patients
Contraindications
Hypersensitivity
Severe cardiovascular disorder
Narrow angle glaucoma
Any drugs or conditions that prolong QT intervaL
Acute recovery post-MI
Coadministration with serotonergic drugs
- Risk of serotonin syndrome when coadministered within 14 days of MAOIs, or coadministered with other strong serotonergic drugs (eg, SNRIs, SSRIs)
- Starting desipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
- If linezolid or IV methylene blue must be administered, discontinue desipramine immediately and monitor for CNS toxicity; may resume clomipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first
Cautions
Caution with family history of sudden death, cardiac dysrhythmias, and cardiac conduction disturbances; reports of cardiac dysrhythmias and death preceded by seizures
BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment
Risk of anticholinergic side effects
Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy
Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue) (see Contraindications)
Pregnancy and lactation
Pregnancy category: C
Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Norpramin (desipramine)
Mechanism of action
Neurotransmitter (esp NE & serotonin) reuptake inhibitor; inhibits reuptake by neuronal membrane; may also downregulate beta-adrenergic receptors and serotonin receptors
Pharmacokinetics
Half-Life elimination: 15-24hr
Onset: 2-5 days (initial therapeutic effect); 2-3 wk (full effect)
Peak Plasma Time: 4-6 hr
Excretion: Urine (70%)
Metabolism: Hepatic CYP2D6
Metabolites: 2-hydroxydesipramine
