Desipramine

Aka: Desipramine, Norpramin, Pertofrane

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II. Indications

  1. Major Depression
  2. Nocturnal Enuresis

III. Mechanism

  1. See Tricyclic Antidepressant
  2. Desipramine is derived from demethylated Imipramine

IV. Dosing: Major Depression

  1. Adults
    1. Start: 50 mg orally daily for 3 days
    2. Next: 50 mg orally twice daily for 3 days
    3. Next: 100 mg orally at bedtime for 3 days
    4. Therapeutic dose: 150 mg orally at bedtime
    5. Maximum: 250 mg mg/day
  2. Teens and Elderly
    1. Start 25 mg orally at bedtime
    2. Advance to 50 to 100 mg orally daily or divided twice daily as tolerated and to effect
    3. Maximum: 150 mg/day

V. Dosing: Nocturnal Enuresis in Children

  1. Same dosing as with Imipramine
  2. Consider other measures for Nocturnal Enuresis first
  3. Consider baseline EKG before starting medication
  4. Initial dose
    1. Avoid in age <6 years
    2. Start at 10 mg orally nightly given one hour before bedtime
  5. Maximum dosing: up to 0.9 to 1.5 mg/kg
    1. Age 6-8 years
      1. May increase dose by 10 mg every 1-2 weeks as needed up to 25 mg per night one hour before bed
    2. Age 8-12 years
      1. May increase dose by 10 mg every 1-2 weeks as needed up to 50 mg per night one hour before bed
    3. Age over 12 years
      1. May increase dose by 10 mg every 1-2 weeks as needed up to 75 mg per night one hour before bed
  6. Discontinue after 3-6 months (some guidelines suggest maximum of 3 months)
    1. Taper to one half dose nightly for 2 weeks
    2. Taper to one half dose every other night for 2 weeks

VI. Pharmacokinetics

  1. Serum Half Life: 21 hours
  2. Therapeutic plasma level: 125 to 300

VII. Safety

  1. Unknown safety in pregnancy
  2. Safe in Lactation

VIII. Adverse effects

  1. See Tricyclic Antidepressants
  2. Much less adverse effects than tertiary amines
  3. Moderate adverse effects
    1. Orthostatic Hypotension
    2. Cardiac Arrhythmia

IX. Precautions

  1. See Tricyclic Antidepressants
  2. Serious cardiotoxicity in overdosage
    1. See Tricyclic Antidepressant Overdose

X. Advantages

  1. Activating
  2. Inexpensive
  3. Attention Deficit Hyperactivity Disorder effect

XI. Resources

  1. Desipramine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee14dd2c-c54b-4cd1-a3a0-f7ad5a5a0ed0

XII. References

  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 36-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

desipramine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DESIPRAMINE 10 MG TABLET Generic $0.10 each
DESIPRAMINE 100 MG TABLET Generic $0.56 each
DESIPRAMINE 150 MG TABLET Generic $0.74 each
DESIPRAMINE 25 MG TABLET Generic $0.18 each
DESIPRAMINE 50 MG TABLET Generic $0.46 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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