paresthesia Extrapyramidal symptoms Rash Elevated LFTs Sexual dysfunction Tinnitus Rare Seizure Agranulocytosis Eosinophilia Leukopenia Thrombocytopenia SIADH 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 patientsContraindications Hypersensitivity Acute recovery post-MI Within 14 days of taking MAO inhibitor Cautions Use caution in BPH and respiratory impairment Risk of anticholinergic side effects Clinical studies did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects; other reported clinical experience has not identified differences in responses between the elderly and younger patients This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function; because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function Use caution in patients with cardiovascular disease, because of possibility of conduction defects, arrhythmias, tachycardias, strokes, and acute myocardial infarction Caution in patients who have a family history of sudden death, cardiac dysrhythmias, or cardiac conduction disturbances Use caution in patients with a history of urinary retention or glaucoma, because of the anticholinergic properties of the drug Caution in patients with thyroid disease or those taking thyroid medication, because of possibility of cardiovascular toxicity, including arrhythmias Caution in patients with a history of seizure disorder, because this drug has been shown to lower seizure threshold; seizures precede cardiac dysrhythmias and death in some patients The pupillary dilation that occurs following use of many antidepressant drugs may trigger an angle-closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy The patient should be cautioned that this drug may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery Coadministration with MAO inhibitors 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 Clinical worsening and suicide risk Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide; there has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (selective serotonin reuptake inhibitors [SSRIs] and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18 to 24) with major depressive disorder (MDD) and other psychiatric disorders Short-term studies did not show an increase in risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms Prescriptions should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce risk of overdose Bipolar disorder A major depressive episode may be the initial presentation of bipolar disorder; it is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder Whether any of the depressive symptoms represent a conversion is unknown; however, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression; the drug is not approved for use in treating bipolar depression Serotonin syndrome The development of a potentially life-threatening serotonin syndrome has been reported with serotonin-norepinephrine reuptake inhibitors (SNRIs) and SSRIs alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue) Serotonin syndrome symptoms may include mental status changes (eg, agitation, hallucinations, delirium, and coma), autonomic instability (eg, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular changes (eg, tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (eg, nausea, vomiting, diarrhea); patients should be monitored for the emergence of serotonin syndrome Drug interaction overview This drug is capable of blocking antihypertensive effect of guanethidine and similarly acting compounds In patients who may use alcohol excessively, the potentiation may increase the danger inherent in any suicide attempt or overdosage Pregnancy There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at http://womensmentalhealth.org/clinical-and-research­programs/pregnancyregistry/antidepressants Safe use during pregnancy has not been established; therefore, if it is to be given to pregnant patients or women of childbearing potential, the possible benefits must be weighed against possible hazards to mother and child Animal reproductive studies have been inconclusive Lactation Safe use during lactation has not been established; therefore, if it is to be given to pregnant patients, nursing mothers, or women of childbearing potential, the possible benefits must be weighed against possible hazards to mother and childPregnancy 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. 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 BRAND FORM. UNIT PRICE PILL IMAGE desipramine oral- 10 mg tabletdesipramine oral- 10 mg tabletdesipramine oral- 10 mg tabletdesipramine oral- 150 mg tabletdesipramine oral- 75 mg tabletdesipramine oral- 50 mg tabletdesipramine oral- 25 mg tabletdesipramine oral- 75 mg tabletdesipramine oral- 150 mg tabletdesipramine oral- 150 mg tabletdesipramine oral- 100 mg tabletdesipramine oral- 50 mg tabletdesipramine oral- 25 mg tabletdesipramine oral- 10 mg tabletdesipramine oral- 25 mg tabletdesipramine oral- 10 mg tabletdesipramine oral- 100 mg tabletdesipramine oral- 75 mg tabletdesipramine oral- 50 mg tabletdesipramine oral- 25 mg tabletdesipramine oral- 150 mg tabletdesipramine oral- 100 mg tabletdesipramine oral- 75 mg tabletdesipramine oral- 50 mg tabletdesipramine oral- 25 mg tabletdesipramine oral- 100 mg tabletdesipramine oral- 150 mg tabletdesipramine oral- 100 mg tabletdesipramine oral- 75 mg tabletdesipramine oral- 50 mg tabletNorpramin oral- 25 mg tabletNorpramin oral- 10 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationdesipramine oral DESIPRAMINE - ORAL (des-IP-ra-meen) COMMON BRAND NAME(S): Norpramin WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: Desipramine is used to treat depression. This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. This medication belongs to a class of medications called tricyclic antidepressants. It works by restoring the balance of a certain natural substance (norepinephrine) in the brain.This drug is not recommended for use in children younger than 18 years due to risk of serious side effects. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking desipramine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 1 to 3 times daily. The dosage is based on your medical condition and response to treatment. Your doctor may start you at a low dose and gradually increase your dose. This medication may make you sleepy or wakeful. Depending on how this medication affects you, your doctor may direct you to take the entire dose once daily either in the morning or at bedtime.Follow your doctor's instructions carefully. Do not take more or less medication or take it more often than prescribed. Your condition will not improve any faster and your risk of side effects will increase. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day.Keep taking this medication even if you feel well. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Your dose may need to be gradually decreased.This medication does not work right away. It may take 2 to 3 weeks before you experience the full benefits when this medication is used for depression.Inform your doctor if your condition lasts or gets worse. SIDE EFFECTS: See also Warning section.Headache, nausea, dizziness, drowsiness, nervousness, trouble sleeping, blurred vision, increased appetite, weight gain, constipation and dry mouth may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting