Norpramin Side Effects

Generic Name: desipramine

Please note - some side effects for Norpramin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Side Effects of Norpramin - for the Consumer

Norpramin

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Norpramin:

Constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; loss of appetite; nausea; tiredness; trouble sleeping; weakness.

Seek medical attention right away if any of these SEVERE side effects occur when using Norpramin:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; changes in sexual desire or ability; chest pain; confusion; dark urine; difficulty speaking or swallowing; excessive sweating; fainting; fast or irregular heartbeat; fever, chills, or sore throat; mood or mental changes (eg, new or worsening agitation, anxiety, delusions, hallucinations, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, suicidal thoughts or actions); numbness or tingling in an arm or leg; one-sided weakness; restlessness or inability to sit still; seizures; severe or persistent dizziness or headache; severe or persistent trouble sleeping; slurred speech; stiff muscles; tremor; trouble urinating; uncontrolled muscle movements (eg, of face, tongue, arms, legs); unusual bleeding or bruising; vision problems; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

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Norpramin Side Effects - for the Professional

Norpramin

Included in the following listing are a few adverse reactions that have not been reported with this specific drug. However, the pharmacologic similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when Norpramin is given.

Cardiovascular: Hypotension, hypertension, palpitations, heart block, myocardial infarction, stroke, arrhythmias, premature ventricular contractions, tachycardia, ventricular tachycardia, ventricular fibrillation, sudden death

There has been a report of an "acute collapse" and "sudden death" in an 8-year-old (18 kg) male, treated for 2 years for hyperactivity.

There have been additional reports of sudden death in children.

Psychiatric: Confusional states (especially in the elderly) with hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia and nightmares; hypomania; exacerbation of psychosis

Neurologic: Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures; alterations in EEG patterns; tinnitus

Symptoms attributed to Neuroleptic Malignant Syndrome have been reported during desipramine use with and without concomitant neuroleptic therapy.

Anticholinergic: Dry mouth, and rarely associated sublingual adenitis; blurred vision, disturbance of accommodation, mydriasis, increased intraocular pressure; constipation, paralytic ileus; urinary retention, delayed micturition, dilation of urinary tract

Allergic: Skin rash, petechiae, urticaria, itching, photosensitization (avoid excessive exposure to sunlight), edema (of face and tongue or general), drug fever, cross-sensitivity with other tricyclic drugs

Hematologic: Bone marrow depressions including agranulocytosis, eosinophilia, purpura, thrombocytopenia

Gastrointestinal: Anorexia, nausea and vomiting, epigastric distress, peculiar taste, abdominal cramps, diarrhea, stomatitis, black tongue, hepatitis, jaundice (simulating obstructive), altered liver function, elevated liver function tests, increased pancreatic enzymes

Endocrine: Gynecomastia in the male, breast enlargement and galactorrhea in the female; increased or decreased libido, impotence, painful ejaculation, testicular swelling; elevation or depression of blood sugar levels; syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Other: Weight gain or loss; perspiration, flushing; urinary frequency, nocturia; parotid swelling; drowsiness, dizziness, proneness to falling, weakness and fatigue, headache; fever; alopecia; elevated alkaline phosphatase

Withdrawal Symptoms: Though not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise.

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Side Effects by Body System - for Healthcare Professionals

Other

Anticholinergic effects have been reported frequently and include dry mouth, blurry vision, constipation and urinary retention.

Nervous system

Nervous system side effects are common. General stimulation (manifested by insomnia and subjective and objective evidence of increased activity) have been reported frequently. Drowsiness, lightheadedness, dizziness, sleep abnormalities, myoclonus, jitteriness, tremor, delirium, cognitive impairment (especially in the elderly), and seizures have also been reported.

Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent. These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency (ROL)), both in healthy subjects and depressed patients. The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound. Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.

Cardiovascular

Orthostatic hypotension, tachycardia, PR interval prolongation, QRS widening, other conduction abnormalities and ventricular arrhythmias have been reported. One study has found a the relative risk of myocardial infarction to be 2.2 times greater in patients receiving tricyclic antidepressants including desipramine.

Both antiarrhythmic and proarrhythmic effects have been reported in association with tricyclic therapy. One case report of a patient who experienced cardiac ischemia while taking desipramine has suggested that genetic differences in drug metabolizing activity may predispose some patients to desipramine- induced cardiotoxicity. Caution should be exercised if desipramine must be used in patients with cardiovascular disease.

General

Weight gain, and less frequently, hair loss have been reported.

Endocrine

Hyponatremia in association with the syndrome of inappropriate secretion of antidiuretic hormone has been reported.

Gastrointestinal

Dry mouth and constipation have been reported most frequently although nausea, vomiting and diarrhea have also occurred.

Other

Although tricyclic antidepressants are not addicting, withdrawal symptoms (such as nervousness, anxiety, restlessness, akathisia, nausea, malaise, sweating and salivation) after abrupt discontinuation of tricyclics may occur. However, withdrawal from desipramine has been reported less frequently than with other tricyclics.

Hematologic

A case of reversible eosinophilia with neutropenia has been reported.

Hypersensitivity

Hypersensitivity reactions, particularly drug eruptions, have been reported. Bronchospasm has also occurred.

Hepatic

Drug-induced hepatitis and liver function test abnormalities have been rarely reported.

Genitourinary

Urinary retention and male and female sexual dysfunction have been reported.

Dermatologic

A single case of desipramine- induced photosensitive blue- gray pigmentation has been reported.

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