Antidepressant Medications Anti-depressant Drugs Antidepressant: desipramine, Norpramin, Pertofrane

Antidepressant: desipramine, Norpramin, Pertofran(e)

Generic Name: desipramine
Brand Name(s): Norpramin, Pertofran(e)
Common Use: Antidepressant

Desipramine displays an antidepressant property similar to that of other tricyclic antidepressants.

The anticholinergic actions of desipramine are responsible for many of the commonly observed side effects of the drug. Desipramine is known to lower the convulsive threshold.

Desipramine increases the percentage of Stage 4 sleep (deep sleep) and decreases the percentage of REM sleep. A partial recovery of REM sleep is seen after 3 to 5 weeks of drug administration. However, in spite of this recovery, a REM rebound occurs following rapid drug withdrawal, which is experienced as an increase in dreaming. The significance of these effects on the sleep cycle remains to be clarified.

An increase in psychomotor activity is observed as an early manifestation of the effects of desipramine; however, a significant antidepressant effect should not be expected before the end of the second week.

Treatment of endogenous depressive illness, including the depressed phase of manic depressive illness, involutional melancholia and psychotic depression. It may also be indicated in the management of depression of a nonpsychotic degree such as in selected cases of depressive neurosis. Patients with transient mood disturbances or normal grief reaction are not expected to benefit from tricyclic antidepressants.

Desipramine should not be given in conjunction with, or within 2 weeks of, treatment with a MAO inhibitor; hyperpyretic crises, severe convulsions and death have occurred in patients receiving MAO inhibitors and tricyclic antidepressants. When desipramine is substituted for an MAO inhibitor, at least 2 weeks should elapse between the treatments; administration of desipramine should then be started cautiously and should be increased gradually.

Desipramine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery; therefore, the patient should be cautioned accordingly.

Adverse Side Effects

The more common adverse reactions involve anticholinergic effects such as dry mouth, disturbances of visual accommodation, constipation and mild urinary retention. Also commonly seen are light headedness, drowsiness, increased perspiration and mild tremors as well as insomnia. Adverse reactions of the cardiovascular system may be much more serious, however, these occur less frequently.

Note:
Included in the listing that follows are a few adverse reactions that have not been reported with desipramine. However, the pharmacological similarities among the tricyclic antidepressant drugs require that each of the reactions be considered when desipramine is administered.

Hypotension, hypertension, There have been reports of sudden death in children.

Confusional states (especially in the elderly) with hallucinations, disorientation, delusions; anxiety, restlessness, agitation; insomnia and nightmares; hypomania; exacerbation of psychosis.

Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures; alteration in EEG patterns; tinnitus.

Dry mouth, and rarely associated sublingual adenitis; blurred vision, disturbance of accommodation, mydriasis; constipation, paralytic ileus; urinary retention, delayed micturition, dilatation of urinary tract.

Skin rash, petechiae, urticaria, itching, photosensitization (excessive exposure to sunlight should be avoided), edema (of face and tongue or general), drug fever, cross sensitivity with other tricyclic drugs.

Bone marrow depressions including agranulocytosis, eosinophilia, purpura, thrombocytopenia.

Anorexia, nausea and vomiting, epigastric distress, peculiar taste, abdominal cramps, diarrhea, stomatitis, black tongue, hepatitis, jaundice (simulating obstructive), altered liver function, elevated liver function tests, increased pancreatic enzymes.

Gynecomastia in the male, breast enlargement and galactorrhea in the female; increased or decreased libido, impotence, painful ejaculation, testicular swelling; elevation or depression of blood sugar levels; syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Jaundice (simulating obstructive), altered liver function; weight gain or loss; perspiration, flushing, urinary frequency, nocturia; parotid swelling; drowsiness, dizziness, weakness and fatigue, headache; alopecia; elevated alkaline phosphatase.

Though not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, malaise and abdominal cramping.

Overdose

Symptoms:
In patients presenting with signs of peripheral atropine effects, agitation and cardiac arrhythmias, the possibility of tricyclic antidepressant overdosage should be entertained. The following signs and symptoms of overdosage may occur; reflecting CNS intoxication, the patient may exhibit pressure of speech, agitation, hallucinations, hyperacusia, choreoathetoid movements and myoclonus which may be mistaken for seizures, increased tendon reflexes, Babinski reflex, grand mal seizures and hyperactive coma progressing to flaccid coma; the cardiovascular complications are the most life threatening and may involve arrhythmias including tachycardia, nodal tachycardia, atrioventricular block, intraventricular conduction delays and asystole as well as myocardial damage, congestive heart failure and shock; in general, other signs of intoxication would also resemble those of atropine poisoning and would include flushed skin, dry mouth, dilated pupils, pyrexia, urinary retention with distended bladder and rarely, adynamic ileus.

General management measures as in other cases of coma and shock would be applicable including bladder catheterization, cardiac monitoring, etc. Early appropriate evacuation of the ingested material and/or the use of activated charcoal is indicated.

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