Generic Name: desipramine (Oral route)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. Risk in children, adolescents, and young adults must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Desipramine hydrochloride is not approved for use in pediatric patients .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antidepressant
Pharmacologic Class: Antidepressant, Tricyclic
Uses For Norpramin
Desipramine is used to treat depression. It works by increasing the activity of a chemical called norepinephrine in the brain. This medicine is a tricyclic antidepressant.
This medicine is available only with your doctor's prescription.
Before Using Norpramin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of desipramine in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of desipramine in the elderly. However, elderly patients are more likely to have confusion, falling episodes, and age-related kidney problems, which may require an adjustment in the dose for patients receiving desipramine.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Methylene Blue
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Arsenic Trioxide
- Chloral Hydrate
- Doxorubicin Hydrochloride Liposome
- Iobenguane I 123
- Morphine Sulfate Liposome
- Peginterferon Alfa-2b
- Perflutren Lipid Microsphere
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Behavior and mood changes or
- Diabetes or
- Glaucoma, angle-closure or history of or
- Heart rhythm problems (eg, arrhythmia) or
- Schizophrenia (mental illness) or
- Seizures, history of or
- Urinary retention (trouble urinating), history of—Use with caution. May make these conditions worse.
- Bipolar disorder (mood disorder with mania and depression), or risk of or
- Heart attack, recent—Should not be used in patients with these conditions.
- Heart or blood vessel disease or
- Thyroid disease—Use with caution. May cause side effects to become worse.
- Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of Norpramin
Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
This medicine should come with a Medication Guide. Read and follow the instructions carefully. Ask your doctor or pharmacist if you have any questions.
Tell your doctor if you are also using other medicine to treat depression, such as amitriptyline, citalopram, fluoxetine, nortriptyline, paroxetine, or sertraline. You must wait at least 5 weeks after you stop using fluoxetine before you can start using desipramine.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (tablets):
- For depression:
- Adults—100 to 200 milligrams (mg) once a day or in divided doses during the day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 300 mg per day.
- Older adults and teenagers—25 to 100 mg once a day or in divided doses during the day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 150 mg per day.
- Children—Use and dose must be determined by your doctor.
- For depression:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using Norpramin
It is very important that your doctor check your progress at regular visits to allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.
For some teenagers and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or are getting worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
Do not take desipramine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking desipramine during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping desipramine before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.
Desipramine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use desipramine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue, tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before taking any other medicines with desipramine.
Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness.
This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.
This medicine may raise or lower your blood sugar. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.
Before having any kind of surgery, tell the medical doctor in charge that you are using this medicine. Taking desipramine together with medicines used during surgery may increase the risk of side effects.
Check with your doctor immediately if you have vision changes, such as blurred vision, difficulty reading, or eye pain, during or after treatment. This could be a sign of a serious eye problem.
This medicine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are drowsy or not alert.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
Norpramin Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:Incidence not known
- Abdominal or stomach pain
- black, tarry stools
- blurred or double vision
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- chest pain or discomfort
- confusion about identity, place, and time
- cough or hoarseness
- dark urine
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- dry mouth
- fast, irregular, pounding, or racing heartbeat or pulse
- inability to move the arms, legs, or facial muscles
- inability to speak
- light-colored stools
- loss of appetite
- loss of bladder control
- muscle spasms or jerking of all extremities
- pain or discomfort in the arms, jaw, back, or neck
- painful or difficult urination
- pinpoint red or purple spots on the skin
- pounding in the ears
- seeing, hearing, or feeling things that are not there
- shakiness and unsteady walk
- slow speech
- sore throat and fever
- sores, ulcers, or white spots on the lips or in the mouth
- stiffness of the limbs
- sudden loss of consciousness
- swollen glands
- talking, feeling, and acting with excitement
- trouble sleeping
- twisting body movements
- unsteadiness, trembling, or problems with muscle control or coordination
- unusual bleeding or bruising
- unusual tiredness or weakness
- yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Incidence not known
- Abdominal or stomach cramps
- bigger, dilated, or enlarged pupils (black part of the eye)
- decrease in the frequency of urination
- decrease in urine volume
- decreased interest in sexual intercourse
- difficulty in passing urine (dribbling)
- hair loss or thinning of the hair
- inability to have or keep an erection
- increased in sexual ability, desire, drive, or performance
- increased interest in sexual intercourse
- increased sensitivity of the eyes to light
- loss in sexual ability, desire, drive, or performance
- painful urination
- swelling of the breasts or breast soreness in both females and males
- swelling or inflammation of the mouth
- unexpected or excess milk flow from breasts in females
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
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