Desipramine

What is desipramine prescribed for?

Desipramine is prescribed to treat depression. It is used to improve:

• Mood
• Interest in daily living
• Sleep
• Appetite
• Energy levels

Desipramine may also be used to treat symptoms of attention-deficit hyperactivity disorder (ADHD). Its off-label uses include treating neuropathic pain, i.e., pain associated with nervous system damage. Doctors may also prescribe desipramine for bulimia nervosa, irritable bowel syndrome, overactive bladder, and pain associated with the complications of shingles. ^[1]

How does desipramine work?

Desipramine is classed as a tricyclic anti-depressant (TCA). Although experts have not confirmed its mechanism of action, the primary function is blocking the reuptake of norepinephrine at the synapse level. It also acts to block serotonin, but to a lesser degree than it does norepinephrine.

Norepinephrine and serotonin are monoamines, naturally occurring chemicals that affect mood. By having more of them available in the brain, the individual's mood is elevated.

Norepinephrine, also known as noradrenaline, is a stimulating neurotransmitter vital to the flight-or-fight response. Blocking its reuptake can have a sedative effect on the brain. It also has some functions as a stress hormone, affecting blood pressure, nervousness, and stress.

Serotonin controls excitement, and inhibiting its reuptake helps maintain a balance in digestion, mood, sleep, and the immune system. Its principal function is to stabilize the mood, maintaining feelings of happiness and well-being.

A synapse is a gap between two nerve cells in the brain through which messages or impulses pass. The action of desipramine results in norepinephrine and serotonin being more available at the synapse level, where they are needed to regulate mood. ^[2]

How is desipramine usually taken?

Desipramine is only available in tablet form to be taken orally. It is available in 10mg, 25mg, 50mg, 75mg, 100mg, and 150mg doses.

For adults with depression, the usual dose is 100 to 200mg daily, up to a maximum of 300mg in one day.

The geriatric dose for elderly patients with depression is usually 25 to 100mg daily, up to a maximum of 150mg in one day.

At the start of treatment, a lower drug dose is used and increased according to response and tolerance. This initial treatment may be given all at once or in multiple doses throughout the day. In patients with severe illness, daily doses are increased up to 300mg/day in adults and 100mg/day in the elderly. However, most patients are not given amounts that exceed these limits. ^[3]

How long does desipramine stay in your system?

Desipramine has a half-life of between 12 and 54 hours, depending on the person.^[4] The length of the half-life depends on a few factors, such as genetics and liver function.

It is generally accepted that a drug will be fully excreted after around 5.5 half lifes.^[9] Therefore, desipramine could generally remain in someone's system for between 66 hour (just under 3 days) and 297 hours (just over 12 days).

Desipramine side effects

Desipramine is not often used as the first line of treatment because of its toxicity profile. It can cause adverse effects that are not tolerated by some patients.

As with most anti-depressants, desipramine increases the risk of suicide in patients with depression. This risk is significantly increased in patients younger than 24 years. Therefore, it is considered the most critical side effect to remember, especially in this age group.

The more common side effects can usually be resolved with an over-the-counter product from your pharmacist. These may also subside as the body gets accustomed to the drug:

• Dry mouth
• Headache
• Nausea
• Dizziness
• Blurred vision
• Changes in appetite
• Constipation
• Drowsiness
• Slight breast pain and tenderness
• Nervousness
• Trouble sleeping

Although allergic reactions to desipramine are rare, seek professional help in you notice any of the following symptoms:

• Rash
• Itching and swelling, especially of the face, tongue, or throat
• Severe dizziness
• Trouble breathing

Seek professional help if you have serious side effects, such as:

• Muscle spasms in the jaw, neck, or back
• Difficulty speaking
• A fever
• Skin or eyes yellowing
• Difficulty walking
• Sudden and uncontrollable shaking
• Sore thoat or other signs of infection

The following are signs of an overdose. If you or someone you know experiences them, you should call the poison control helpline on 1-800-222-1222. If it is an emergency call 911.

• Seizures
• Hallucinations and delusions
• Extreme confusions
• Drowsiness
• A high fever
• Cold or low body temperature
• Being sick or vomiting
• Dilated pupils
• Loss of consciousness
• Irregular heartbeat ^[5]

This is not a complete list of side effects possible with desipramine. You should contact your doctor if you are experiencing any side effects from the drug.

Desipramine precautions

Before taking this medication, tell your pharmacist or doctor if you have experienced allergies or bad reactions to this or any other tricyclic anti-depressant. This medication is contraindicated in anyone who has taken or stopped monoamine oxidase inhibitors (e.g. Marplan, Zyvox, Nardil) in the last 14 days.

Tell your doctor or pharmacist about any medicines you take, including non-prescription and over-the-counter formulations. Be sure to mention anti-depressants, sedatives, sleeping pills; antihistamines, blood thinners, thyroid medications; medications for high blood pressure, diabetes, mental illness, asthma, colds; contraceptives and other hormones; as well as any vitamins, supplements, or herbal preparations you might be taking.

Desipramine should not be given to those who have had a recent myocardial infarction and are in the acute recovery period. Inform your doctor if you or anyone in your family has had an irregular heartbeat or has died suddenly from heart problems.

Inform your doctor if you plan to get pregnant, are pregnant, get pregnant during therapy with desipramine, or are breastfeeding.

Always mention any medical concerns or conditions to your doctor, particularly when prescribed a new medication. ^[6]

Desipramine interactions

Cross interactions are possible between desipramine and other drugs.

Some drugs can cause dangerous reactions in the body and should not be taken with desipramine. The following medications and drug classes raise the risk of developing serotonin syndrome:

• Monoamine oxidase inhibitors (MAOI)
• Linezolid or IV methylene blue

Other drugs increase the risk of side effects from these drugs when taken with desipramine:

• Tranquillizers, sedatives, or benzodiazepines
• Triptans, tricyclic anti-depressants, fentanyl, tramadol, St. John’s wort, lithium, or buspirone
• Oxybutynin and other anticholinergic drugs
• Sympathomimetic medications such as decongestants

Some medicines increase the risk of side effects from desipramine:

• Cimetidine
• Other anti-depressants such as fluoxetine, paroxetine, or citalopram
• Anti-arrhythmic medicines such as quinidine
• Antipsychotics such as fluphenazine ^[7]

Desipramine storage

Desipramine should be stored in a closed container at room temperature (between 59 F and 86 F) in a dry area and away from heat sources or direct light. It should be kept from freezing. Medications should always be kept out of reach of children.

What to do if you overdose on Desipramine

Signs of overdose include: irregular heartbeat, drop in blood pressure, convulsions, confusion, loss of focus, visual hallucinations, agitation, drowsiness, muscle rigidity, vomiting, and other symptoms listed under side effects.

If you suspect that you, or someone you know, has taken an overdose or ingested an interacting drug that might cause an overdose of desipramine, you should seek immediate medical help. Overdose may lead to coma and death. ^[8]

Frequently asked questions about desipramine

Are there any withdrawal symptoms if you stop taking desipramine?

You should not stop taking desipramine without consulting your doctor as there may be withdrawal symptoms. These may be:

• Motor function impairment, e.g., tremors
• Gastrointestinal effects, e.g. nausea and vomiting
• Neurological effects, e.g. dizziness and headaches
• Psychological symptoms, e.g. worsened depression

Desipramine vs Amitriptyline: What's the difference?

Desipramine and amitriptyline are both tricyclic anti-depressants. While desipramine is not a first choice for the treatment of depression due to its cardiac side effects, it can be effective when other medications have not worked. Amitriptyline causes more side effects than its alternatives, even though it helps to regulate mood. Desipramine and amitriptyline are both available in cheaper, generic formulations. They both take time to work, but amitriptyline can take up to 4 weeks for the full effects of the medication to be felt.