Desipramine

Type of Drug: Tricyclic antidepressant.

Prescribed for: Depression, cocaine withdrawal, panic disorder, and bulimia nervosa.

General Information

Desipramine is one of the tricyclic antidepressant drugs, which block the movement of certain stimulant chemicals in and out of nerve endings, have a sedative effect, and counteract the effects of a hormone called acetylcholine (which makes them anticholinergic drugs). They prevent the reuptake of important neurohormones (norepinephrine or serotonin) at the nerve ending. Theory says that people with depression have a chemical imbalance in their brains and that drugs such as Desipramine work to reestablish a proper balance. Although Desipramine and similar antidepressants immediately block neurohormones, it takes 2 to 4 weeks for their clinical antidepressant effect to come into play. Call your doctor if you’re not better after 6 to 8 weeks.

Tricyclic antidepressants can also elevate mood, increase physical activity and mental alertness, and improve appetite and sleep patterns in a depressed patient. They are mild sedatives and are useful in treating mild forms of depression associated with anxiety. These drugs are broken down in the liver.

Cautions and Warnings

Do not take Desipramine if you are allergic or sensitive to it or other tricyclic antidepressants. None of these drugs should be used if you are recovering from a heart attack.

If you have a history of epilepsy or other convulsive disorders, difficulty in urination, glaucoma, heart disease, liver disease, or hyperthyroidism, Desipramine should be taken with caution. People who are schizophrenic or paranoid may get worse if given a tricyclic antidepressant, and manic-depressive people may switch phase. This can also happen if they are changing or stopping antidepressants.

Desipramine and other antidepressants can be lethal if taken in large quantities. Severely depressed people should be allowed to keep only small numbers of pills on hand.

Possible Side Effects

Desipramine is generally safer than other tricyclic antidepressants.

• Most common: sedation and anticholinergic effects (blurred vision, disorientation, confusion, hallucinations, muscle spasms or tremors, seizures and/or convulsions, dry mouth, constipation [especially in older adults], difficult urination, worsening glaucoma, sensitivity to bright light or sunlight).
• Less common: blood-pressure changes, abnormal heart rates, heart attack, anxiety, restlessness, excitement, numbness and tingling in the extremities, poor coordination, rash, itching, retention of fluids, fever, allergy, changes in composition of blood, nausea, vomiting, loss of appetite, stomach upset, diarrhea, enlargement of the breasts (both sexes), changes in sex drive, and blood-sugar changes.
• Rare: agitation, inability to sleep, nightmares, feeling of panic, a peculiar taste in the mouth, stomach cramps, black discoloration of the tongue, yellowing of the eyes and/or skin, changes in liver function, increased or decreased weight, excessive perspiration, flushing, frequent urination, drowsiness, dizziness, weakness, headache, loss of hair, nausea, and not feeling well.

Drug Interactions

• Taking Desipramine with monoamine oxidase (MAO) inhibitors can cause high fevers, convulsions, and occasionally death. Don’t take MAO inhibitors until at least 2 weeks after Desipramine has been discontinued. Patients who must take both Desipramine and an MAO inhibitor require close medical observation.
• Desipramine interacts with Guanethidine and Clonidine. Be sure to tell your doctor if you are taking any high-blood-pressure medicine.
• Desipramine increases the effects of barbiturates, tranquilizers, other sedative drugs, and alcohol. Also, barbiturates may decrease the effectiveness of Desipramine.
• Taking Desipramine and thyroid medicine together will enhance the effects of both medicines, possibly causing abnormal heart rhythms. The combination Of Desipramine and Reserpine may cause overstimulation.
• Oral contraceptives can reduce the effect of Desipramine, as can smoking. Charcoal tablets can prevent Desipramine’s absorption into the bloodstream. Estrogens can increase or decrease the effect of Desipramine.
• Drugs such as Bicarbonate of Soda, Acetazolamide, Quinidine, or Procainamide will increase the effect of Desipramine. Cimetidine, Methylphenidate, and Phenothiazine drugs (like Thorazine and Compazine) block the liver metabolism of Desipramine, causing it to stay in the body longer, which can cause severe drug side effects.

Food Interactions

Take Desipramine with food if it upsets your stomach.

Usual Dose

Adult: 75 to 300 mg per day. Your dosage must be tailored to your needs. People taking high doses of this drug should have regular heart examinations to check for side effects.
Adolescent and Senior: lower doses are recommended, usually 25 to 150 mg per day.
Child (under age 12): do not use.

Overdosage

Symptoms of overdosage are confusion, inability to concentrate, hallucinations, drowsiness, lowered body temperature, abnormal heart rate, heart failure, enlarged pupils of the eyes, convulsions, severely lowered blood pressure. Stupor, and coma. Agitation, stiffening of body muscles, vomiting, and high fever may also occur. The overdose victim should be taken to a hospital emergency room immediately. ALWAYS bring the medicine bottle.

Special Information

Avoid alcohol and other depressants while taking this drug. Do not stop taking this medicine unless your doctor specifically tells you to do so. Abruptly stopping this medicine may cause nausea, headache, and a sickly feeling.

This medicine can cause drowsiness, dizziness, and blurred vision. Be careful when driving or operating hazardous machinery. Avoid prolonged exposure to the sun or sun lamps.

Call your doctor at once if you develop seizures, difficult or rapid breathing, fever and sweating, blood-pressure changes, muscle stiffness, loss of bladder control, or unusual tiredness or weakness. Dry mouth may lead to an increase in dental cavities, gum bleeding and disease. People taking Desipramine should pay special attention to dental hygiene.

If you forget a dose of Desipramine, skip it and go back to your regular schedule. Do not take a double dose.

Special Populations

Pregnancy/Breast-feeding
Desipramine crosses into your developing baby’s circulation. Birth defects have been reported when this drug was taken during the first 3 months of pregnancy. There have been reports of newborn infants suffering from heart, breathing, and urinary problems after their mothers had taken a tricyclyc antidepressant immediately before delivery. Avoid this medication while pregnant.

Small amounts of tricyclic antidepressants pass into breast milk and sedate the baby. Nursing mothers taking Desipramine should consider bottle-feeding.

Seniors
Older adults are more sensitive to the effects of this drug, especially abnormal rhythms and other heart side effects, and often require a lower dose to achieve the same effects. Follow your doctor’s directions and report any side effects at once.