Desipramine (Norpramin)
Tricyclic antidepressant (norepinephrine reuptake inhibitor)
- Major Depression
- Treatment resistant depression
- Low sedation
- ADHD
Features
Dosing
75-300 mg/d, start 25-50 mg/d.
Serum level is options (target 150-300)
Management
Strongest norepinephrine effects. Lowest anticholinergic burden. Low risk of sedation.
TOLERABILITY: ANTICHOLINERGIC: Constipation (treat docusate 100 mg BID + sennosides 8.6 mg; bethanechol 10-25 mg tid if severe), urinary retention (treat bethanechol 25mg tid), dry mouth (treat spry gum tid, biotene; or pilocarpine swish), blurry vision, confusion.
RISKS: HEART: Orthostatic hypotension (treat elastic abdominal binders or support stockings; if severe, fludrocortisone 0.1-0.2 mg qd or midrodine 0.5 mg tid), falls, cardiac arrhythmias; HEPATOTOXICITY: Extremely rare (4 per 100,000 patient-years).
EMR Text
Depression
Desipramine use based on FDA approval in major depressive disorder.
Desipramine side effects, including cardiac, hypotension, and hepatotoxicity, reviewed with patient.