Desipramine 10mg

Antidepressant, Tricyclic 

“Alert: Black Box Warning

Suicidal Ideations
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Closely observe and appropriately monitor patients of all ages who are started on antidepressant therapy for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the prescribing health care provider.”

CSA NA – FDA Approved – REMS (N) – Can Ship  

Desipramine, Norpramin increases the synaptic concentration of norepinephrine (and to a lesser extent, serotonin) in the central nervous system by inhibition of its reuptake by the presynaptic neuronal membrane. However, additional receptor effects have been found including desensitization of adenyl cyclase, down regulation of beta-adrenergic receptors, and down regulation of serotonin receptors.

Depression 

FDA approved for the treatment of depression in adolescents.

Before starting Desipramine, Norpramin make sure your physician is aware of any allergies or medications you currently take.  Desipramine, Norpramin like any other antidepressant can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder (MDD) and other psychiatric disorders; consider risk prior to prescribing.  Desipramine, Norpramin may cause anticholinergic effects (i.e. constipation, xerostomia, blurred vision, urinary retention), central nervous system depression, fragility fracture, ocular effects, orthostatic hypotension, serotonin syndrome.  Desipramine, Norpramin should be used with caution in patients with pre-existing cardiovascular disease because of the risk of conduction abnormalities, diabetes, hepatic and/or renal impairment, with a history of seizures.

Oral: 25mg to 300mg once daily.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature. Generally taken 1-3 hour prior to bed to minimize daytime drowsiness.

You Need to Avoid: Do not stop this medication without tapering dose down over time to prevent withdrawal symptoms (nausea, diarrhea, sweating, headaches, agitation, insomnia, anxiety, tremor, vertigo, dizziness, tingling in extremities). Tolerance to sedation may develop however caution operating heavy machinery or driving if feeling impaired. May increase the central nervous system depressant effects of alcohol so caution if alcohol is to be consumed.

The frequency of side effects is not well defined but can include the following and are based on reports for other agents in this same pharmacologic class, and may not be specifically reported for Desipramine, Norpramin: 

Cardiac arrhythmia, cerebrovascular accident, edema, flushing, heart block, hypertension, hypotension, myocardial infarction, palpitations, premature ventricular contractions, tachycardia, ventricular fibrillation, ventricular tachycardia, agitation, anxiety, ataxia, confusion, delusions, disorientation, dizziness, drowsiness, drug fever, EEG pattern changes, extrapyramidal reaction, falling, fatigue, hallucination, headache, hypomania, insomnia, neuroleptic malignant syndrome, nightmares, numbness, peripheral neuropathy, psychosis (exacerbation), restlessness, seizure, tingling of extremities, tingling sensation, withdrawal syndrome, alopecia, diaphoresis (excessive), pruritus, skin photosensitivity, skin rash, urticaria, decreased libido, decreased serum glucose, galactorrhea, gynecomastia, increased libido, increased serum glucose, SIADH, weight gain, abdominal cramps, anorexia, constipation, diarrhea, epigastric distress, increased pancreatic enzymes, melanoglossia, nausea, paralytic ileus, parotid gland enlargement, stomatitis, sublingual adenitis, unpleasant taste, vomiting, xerostomia, breast hypertrophy, impotence, nocturia, painful ejaculation, testicular swelling, urinary hesitancy, urinary retention, urinary tract dilation, elevated liver enzymes, petechia, purpura, thrombocytopenia, muscle weakness, blurred vision, tinnitus, polyuria and fever. 

Note this is not a complete list of side effects for Desipramine, Norpramin only common ones.

1. What do I do if side effects are intolerable?
   If you are just starting this medication or just had a dosage increase, then it is common to have more prominent side effects for 2 weeks or so and if any remain at that point they will likely remain.  If the symptoms are causing a lot of distress speak to your physician as soon as possible to discuss how to manage the side effects or to consider therapy modification.
2. What do I do if my mood worsens on this medication and I feel much worse?
   Contact your physician immediately, it is rare however antidepressant medications can cause suicidal ideation, generally in those under the age of 24.
3. What is serotonin syndrome?
   Serotonin syndrome is a rare, but potentially life-threatening condition of serotonin toxicity from too much of it in your system generally from the use of certain medications and supplements.  Usually multiple agents are at play or high doses are involved.  The signs and symptoms include agitation, hallucinations, delirium, coma, tachycardia (rapid heart rate), diaphoresis (excessive sweating), tremor, muscle rigidity, nausea, vomiting, diarrhea, and/or seizures.  If serotonin syndrome is suspected, discontinue any serotonergic medications, and seek immediate medical attention.