Generic Name: Desipramine Hydrochloride
Brand Names: Pertrofrane, Norpramin
Drug Class: TCA
Similar Class Drugs: Protriptyline, Nortriptyline
Available Dosage forms: Oral tablets
What is Desipramine?
Desipramine is FDA approved for the second-line treatment of depressive symptoms.1 Some researchers constructed an inferential hypothesis that depression occurs due to abnormal neurotransmission of monoamines (norepinephrine, dopamine, serotonin). Desipramine interferes with monoamine neurotransmission and also modulates the activity of histamine, choline, and alpha1. Due to it being a secondary amine, Desipramine vigorously blocks the reuptake of norepinephrine. Upregulation of the monoamine in the neuronal synapses culminates in the suppression of depressive symptoms.
One additional theory has suggested that Despramine downregulates the tumor necrosis factor-alpha (TNF-α), a molecule associated with modification of norepinephrine neurotransmission. It is implicated that the antidepressive effects of Desipramine are related to the modulation of TNF rather than direct manipulation of NE reuptake.2
Off-label uses of Desipramine:
– First-line treatment for postherpetic neuralgia. Nonetheless, clinicians prefer alternatives like gabapentin to prevent potential toxicity with Desipramine.1
– Overactive bladder
– Bulimia nervosa
– ADHD
How to use Desipramine?
– The initial dosage in adults is 100 or 200mg
– Dosage can be divided into multiple doses or single dose
– If your condition is severe, your doctor might start your treatment with a dosage of 300mg per day
– Desipramine can be taken with or without food
What are the side effects of Desipramine?
The medication has a diverse toxicity profile.
– Anticholinergic effects include:
- Dry mouth, blurred vision, constipation, tachycardia
– Serotonergic effects:
- Osteoporotic fracture
- Sexual dysfunction
– Antihistamine effects:
- Sedation
– Noradrenergic effects
- Diaphoresis
Other adverse effects of Desipramine:
– Hepatitis
– Seizures
– Tremors
– Suicidal inclination
Who should not use Desipramine?
– Those with known hypersensitivity to TCAs
– Those taking MAOIs
– Those with a recent episode of myocardial infarction
– Pregnant or lactating mothers
Some important considerations:
– Excessive sedation, postural hypotension, dizziness are signs of intolerance to the medication
– Agitation, irritability, and unexplained sadness or suicidal thoughts are signs of concern
– Caregivers and parents are advised to monitor signs of suicidal behavior in patients taking Desipramine
– Desipramine increases the risk of angle-closure glaucoma. Make sure to get yourself evaluated if you experience blurred vision
– Inform your doctor if you are to undergo a surgery
References
- Maan JS, Rosani A, Saadabadi A. Desipramine. [Updated 2021 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470581/
- Reynolds JL, Ignatowski TA, Sud R, Spengler RN. An antidepressant mechanism of desipramine is to decrease tumor necrosis factor-alpha production culminating in increases in noradrenergic neurotransmission. Neuroscience. 2005;133(2):519-31. doi: 10.1016/j.neuroscience.2005.02.023. PMID: 15878644.
