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

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

Ontology: Desipramine (C0011685)

Definition (NCI) An active metabolite of imipramine, a tertiary amine and a synthetic tricyclic derivative of the antidepressant. Desipramine enhances monoamine neurotransmission in certain areas of the brain by inhibiting the re-uptake of noradrenaline and serotonin at the noradrenergic and serotoninergic nerve endings, respectively. It also induces sedation through histamine 1 receptor blockage and hypotension through beta-adrenergic blockage.
Definition (MSH) A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholinergic activity, through its affinity to muscarinic receptors.
Definition (CSP) tricyclic dibenzazepine compound that potentiates neurotransmission; desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport; this compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003891
SnomedCT 33378002, 372705002
LNC LP16103-1, MTHU004929
English Desipramine, Demethylimipramine, Desmethylimipramine, 5H-Dibenz(b,f)azepine-5-propanamine, 10,11-dihydro-N-methyl-, desmethylimipramine, Desipramine [Chemical/Ingredient], desipramine, DESIPRAMINE, Desipramine (product), Desipramine (substance)
Swedish Desipramin
Czech desipramin
Finnish Desipramiini
Russian DEZIPRAMIN, DESMETILIMIPRAMIN, DEZIPRAMINGIDROKHLORID, ДЕЗИПРАМИН, ДЕЗИПРАМИНГИДРОХЛОРИД, ДЕСМЕТИЛИМИПРАМИН
Japanese デシプラミン, デスメチルイミプラミン
Italian Desmetilimipramina, Demetilimipramina, Desipramina
Croatian DESIPRAMIN
Polish Dezypramina
Spanish desipramina (producto), desipramina (sustancia), desipramina, Desipramina, Desmetilimipramina
French Désipramine
German Desipramin, Desmethylimipramin
Portuguese Desipramina, Desmetilimipramina

Ontology: Pertofrane (C0031232)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D003891
English Pertofrane, Pertofran, Novartis Brand of Desipramine Hydrochloride, Pertrofran, Rhône Poulenc Rorer Brand of Desipramine Hydrochloride, Rhône-Poulenc Rorer Brand of Desipramine Hydrochloride

Ontology: Norpramin (C0701352)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003891
Croatian NORPRAMIN
English norpramin, Norpramin, Aventis Behring Brand of Desipramine Hydrochloride, Aventis Brand of Desipramine Hydrochloride