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desipramine

N06AA01

Forms & Strengths

Oral tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Adult Dosing

Depression: Initial 100 mg/day orally in divided doses or as a single daily dose; titrate gradually up to 200-300 mg/day maximum as needed and tolerated.
Maintenance: 50-100 mg/day.

Pediatric Dosing

Depression (Adolescents): Initial 25-50 mg/day orally in divided doses; titrate gradually up to 100-150 mg/day maximum.
Not recommended for children under 12 years of age due to lack of established safety and efficacy.

Indications

Treatment of depression (major depressive disorder)

Mechanism of Action

Tricyclic antidepressant (TCA) that inhibits the neuronal reuptake of norepinephrine and, to a lesser extent, serotonin, increasing their concentrations in the central nervous system synapses.

Contraindications

Hypersensitivity to desipramine or other tricyclic antidepressants
Co-administration with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI
Acute recovery phase following myocardial infarction
Severe heart block or other cardiac arrhythmias

Adverse Reactions

Anticholinergic effects: dry mouth, blurred vision, constipation, urinary retention
Cardiovascular: orthostatic hypotension, tachycardia, QT prolongation, arrhythmias, conduction delays
Central nervous system: drowsiness, dizziness, tremor, anxiety, insomnia, headache
Metabolic/Endocrine: weight gain, sexual dysfunction, SIADH

Drug Interactions

MAOIs: risk of severe, potentially fatal serotonin syndrome or hypertensive crisis
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): increased plasma concentrations and toxicity of desipramine
CNS depressants (alcohol, opioids, sedatives): enhanced central nervous system depression
Sympathomimetics (e.g., epinephrine): potentiation of cardiovascular effects leading to arrhythmias or severe hypertension

Curated Content: Needs Vetting Before Put to Clinical Use