Desipramine

Brand names

• Alti-Desipramine
• Apo-Desipramine
• Deprexan
• Norpramin
• Novo-Desipramine
• Nu-Desipramine
• Pertofrane
• PMS-Desipramine

Usage

To relieve symptoms of major depression.

How it works

Desipramine affects levels of norepinephrine and serotonin, brain chemicals that are thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Confusion, heartbeat irregularities, hallucinations, seizures, extreme fatigue or drowsiness, blurred or altered vision, breathing difficulty, constipation, impaired concentration, difficult urination, fever, extreme and persistent restlessness, loss of coordination and balance, difficulty swallowing or speaking, dilated pupils, eye pain, fainting. Also trembling, shaking, weakness, and stiffness in the extremities; shuffling gait.

Common

Drowsiness or dizziness, headache, dry mouth or unpleasant taste, fatigue, heightened sensitivity to light, weight gain, nausea, increased appetite.

Less common

Heartburn, difficulty sleeping, diarrhea, sweating, vomiting.

Possible interactions

Other medicaments:

Desipramine may increase the effects of:

• all medicaments with atropinelike effects.
• all medicaments with sedative effects; watch for excessive sedation.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx), leading to possible toxicity.

Desipramine may decrease the effects of:

• clonidine (Catapres).
• guanethidine (Ismelin, Esimil).
• guanfacine (Tenex).
• levodopa, by decreasing absorption of the levodopa.
• venlafaxine (Effexor).

Desipramine taken concurrently with:

• albuterol (Ventolin) may increase the effect of albuterol on the blood vessels.
• anticonvulsants-carbamazepine (Tegretol) or phenytoin (Dilantin) are examples-requires careful monitoring for changes in seizure patterns (need to adjust anticonvulsant dose).
• cisapride (Propulsid) increases risk of heart rhythm problems.
• dofetilide (Tikosyn) increases risk of heart rhythm problems. The combination should be avoided.
• ethchlorvynol (Placidyl) may cause delirium; avoid concurrent use.
• gatifloxacin (Tequin) or grepafloxacin (Raxar) may increase risk of heart rhythm problems. Combination is not recommended.
• monoamine oxidase (MAO) type A inhibitor medicaments may cause high fever, seizures and high blood pressure; avoid combining. Wait 14 days between either.
• propafenone (Rythmol) may lead to toxic desipramine levels.
• quinestrol (Estrovis) may increase or decrease desipramine levels.
• quinidine may cause desipramine toxicity.
• sparfloxacin (Zagam) may increase risk of heart rhythm problems.
• stimulant medicaments (amphetamine, cocaine, epinephrine, phenylpropanolamine, etc.) may cause severe high blood pressure and/or high fever.
• thyroid preparations may increase the risk of heart rhythm disorders.
• tramadol (Ultram) may increase seizure risk.
• large doses (greater than 2 g/day) of vitamin C may lead to increased removal of desipramine and need to adjust dose.
• warfarin (Coumadin) may cause an increased risk of bleeding. Increased testing of INR is indicated.
• zolpidem (Ambien) may lead to hallucinations.

The following medicaments may increase the effects of desipramine:

• cimetidine (Tagamet).
• fluoxetine (Prozac).
• fluvoxamine (Luvox).
• methylphenidate (Ritalin).
• nefazodone (Serzone).
• phenothiazines.
• ritonavir (Norvir) and other protease inhibitors.

The following medicaments may decrease the effects of desipramine:

• barbiturates.
• chloral hydrate (Noctec, Somnos, etc.).
• clonazepam (Klonopin).
• estrogen.
• lithium (Lithobid, Lithotab, etc.).
• oral contraceptives (birth control pills).
• reserpine (Serpasil, Ser-Ap-Es, etc.).

Herbal medicines or minerals:

Since desipramine and St. John's wort may act to increase serotonin, the combination is not advised. St. John's wort also increases sun sensitivity. Since part of the way ginseng works may be as a MAO inhibitor, do not combine with desipramine. Indian snakeroot, kava kava and yohimbe are also best avoided while taking this medicine.
High doses of vitamin C may blunt the therapeutic effects of desipramine.

Alcohol:

Avoid completely. This medicament can markedly increase the intoxicating effects of alcohol; the combination can depress brain function.

Tobacco smoking:

May accelerate the elimination of this medicament and require increased doses.

Marijuana smoking:

Occasional - (once or twice weekly): transient increase in drowsiness and mouth dryness as well as possible unacceptable increases in heart rate.
Daily - persistent drowsiness and mouth dryness; possible reduced effectiveness of this medicament.

Exposure to sun:

This medicament may cause photosensitivity and changes in iris and skin pigment color with sun exposure.

Exposure to heat:

This medicament can inhibit sweating and impair adaptation to hot environments, increasing the risk of heatstroke. Avoid saunas.

Exposure to cold:

The elderly should use caution and avoid conditions conducive to hypothermia.

Exposure to environmental chemicals:

This medicament may mask the symptoms of poisoning due to handling certain insecticides (organophosphorous types). Read labels carefully.

Discontinuation:

Best to stop this medicament gradually. Abrupt withdrawal after prolonged use may cause headache, malaise and nausea. If this medicament is stopped, doses of other medicaments may need adjustment.

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