Desipramine (Pertofrane, Norpramin)

Desipramine is a tricyclic antidepressant. It was derived from imipramine and has been in use since 1964. Although many other antidepressants have been developed since 1964, desipramine remains a useful medication for the treatment of several conditions.

The Bottom Line: What You Really Need to Know

Desipramine (Pertofrane, Norpramine) is used to treat depression, neuropathic pain, ADHD and other problems.
The usual dose of desipramine is 100-200 mg/day. You usually begin with a smaller dose and it is gradually increased over several weeks.
Desipramine interacts with many different medications. Make sure you tell your physician and pharmacist about all medications that you take, including herbal remedies and teas, over the counter medications, homeopathic and alternative treatments, vitamins, supplements and medications you only take occasionally.
If you have surgery, make sure your surgeon knows you take desipramine. It can interact with anesthetics.
It may take two weeks or more before you start feeling better.
Talk to your doctor before you stop taking desipramine. Your dose may need to be tapered down slowly to prevent uncomfortable withdrawal symptoms.
Most people experience a few mild side effects, like dry mouth or constipation, when they begin taking desipramine. They usually go away with time.
If you get dizzy or faint when you stand up suddenly, change positions slowly. Come to a sitting position for a few seconds before you stand.
If you experience loss of interest in sex or diminished sexual ability, talk to your doctor about it.
Desipramine is not recommended for children.
Have a friend or family member check in with you every day for the first few weeks that you take desipramine. Ask him or her to help you monitor your condition for:

Worsening depression
Restlessness, irritability, agitation, hostility or aggression
Unusual thoughts or thoughts of suicide

Report any serious or unusual side effects to your doctor.

Uses

Desipramine may still be used to treat depression, especially if other medications have not worked. It is also used to treat "neuropathic" pain-chronic pain from shingles, diabetes, cancer and other causes, ADHD, cocaine addiction, resistant malaria and bulimia.

Dosage and instructions

Although people may feel brighter and more active within a few days of starting desipramine, the full effect may take two weeks to develop.

The usual dose is 100-200 mg/day either in divided doses or as a single daily dose. Some people may require up to 300 mg/day, but they should be hospitalized and monitored while increasing the dose above 200 mg/day. The earliest indications of desipramine toxicity are changes in the electrocardiogram-prolongation of the PR, QRS and QT intervals.

Most people start taking desipramine with a low dose and the dose is increased gradually until the full dose is reached. This minimizes side effects.

Older people usually require smaller doses, 25-100 mg/day.

Most people take desipramine for 6 months to a year.

How desipramine works

Antidepressants work by affecting the levels of various neurotransmitter chemicals in the junction between nerve cells. Desipramine works primarily to keep norepinephrine from being reabsorbed, thereby increasing the amount of norepinephrine available.

Desipramine is quickly absorbed from the stomach and attaches itself to protein molecules in the bloodstream. It is broken down in the liver and mostly excreted in urine.

People vary widely in the rate at which they metabolize desipramine because of genetic differences. People who are "poor metabolizers" will need less medication. The dose of desipramine has to be individualized; the best dose is the one that gives the desired response.

Side effects

Many people experience some transient, mild side effects when they first start to take desipramine. The most common ones are dry mouth, visual changes, constipation, mild difficulty urinating, light headedness, drowsiness, sweating, tremors or insomnia.

Other side effects that occur are:

Blood pressure changes
Heart blocks, palpitations, rapid rhythms and fatal dysrhythmias
Heart attack or stroke
Confusion (especially in the elderly)
Hallucinations, delusions, restlessness, agitation
Tremors, muscle jerks and movements, seizures
Malignant neuroleptic syndrome-may occur without other medications-characterized by very high fever, muscle rigidity, seizures, death.
Allergic reactions
Decrease in sexual desire and function

Interactions

Desipramine interacts with several other medications, especially those that affect the central nervous system or the cardiovascular system. Some of the medications that interact with desipramine are:

Alcohol
Heart and blood pressure medications
Asthma medications
Narcotics and sedatives
Anesthetics-desipramine should be discontinued several days before surgery.

Withdrawal

Desipramine should not be stopped suddenly; the dose should be gradually tapered down first. If it is not tapered you can experience "discontinuation" symptoms such as nausea, dizziness, headache, feeling unwell, stomach cramps and vivid dreams.

Warnings, precautions and contraindications

Suicide: Antidepressants can increase the risk of suicide, especially early in treatment. Close monitoring is important during the first several weeks that you take any antidepressant. This includes weekly visits to the doctor or therapist and checking in with friends or family members every day. Notify the physician immediately if you or anyone else notices deepening depression, other mood changes, agitation, unusual thoughts or behaviors or thoughts of harming yourself or others.

Mania: Desipramine can trigger mania in bipolar individuals. Manic episodes can be severe and there can also be rapid cycling between depression and mania.

Schizophrenia: Desipramine can trigger psychotic episodes in schizophrenics.

Other conditions: Desipramine should be used cautiously in people who have enlarged prostate, glaucoma, thyroid disease, seizures or diabetes.

Use in children: Desipramine is not recommended for young children. Rare instances of sudden death have occurred in children who were taking desipramine.

Anti-Depressants.com