Norpramin
Norpramin
[nor´prah-min]desipramine hydrochloride
Pharmacologic class: Tricyclic antidepressant
Therapeutic class: Antidepressant
Pregnancy risk category C
FDA Box Warning
• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed.
• Drug isn't approved for use in pediatric patients.
Action
Inhibits norepinephrine or serotonin reuptake at presynaptic neuron
Availability
Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg
Indications and dosages
➣ Depression
Adults: Initially, 100 to 200 mg/day P.O. Increase gradually if needed to a maximum dosage of 300 mg/day.
Adolescents and elderly adults: 25 to 100 mg/day P.O. as a single dose or in divided doses. Increase gradually if needed to a maximum dosage of 150 mg/day.
Off-label uses
• Arthritis pain
• Cancer pain
• Diabetic or peripheral neuropathy
• Tic douloureux
Contraindications
• Hypersensitivity to drug
• Recovery phase of myocardial infarction (MI)
• MAO inhibitor use within past 14 days
Precautions
Use cautiously in:
• cardiovascular disorders, glaucoma, thyroid disorders, history of seizure disorders, mania, hypomania, adults with major depressive disorder
• urinary retention
• adolescents and children.
Administration
• Before giving drug, measure patient's sitting and supine blood pressure to assess for orthostasis.
• Give full dose at bedtime to avoid daytime drowsiness.
• Discontinue drug 2 days before surgery.
See Don't give within 14 days of MAO inhibitor, because potentially fatal reaction may occur.
Adverse reactions
CNS: sedation, weakness, anxiety, restlessness, insomnia, delusions, confusion, agitation, hallucinations, disorientation, extrapyramidal reactions, EEG changes, neuroleptic malignant syndrome, seizures, suicidal behavior or ideation (especially in child or adolescent)
CV: hypotension, hypertension, tachycardia, palpitations, arrhythmias, MI, heart block
EENT: blurred vision, dry eyes, laryngitis
GI: nausea, vomiting, constipation, abdominal cramps, epigastric distress, difficulty swallowing, parotid gland swelling, mouth inflammation, dry mouth, black tongue
GU: urinary retention, delayed voiding, urinary tract dilation, testicular swelling, erectile or other male sexual dysfunction, gynecomastia, menstrual irregularities, galactorrhea, increased or decreased libido
Hematologic: purpura, eosinophilia, bone marrow depression, agranulocytosis, thrombocytopenia
Metabolic: syndrome of inappropriate antidiuretic hormone secretion
Musculoskeletal: muscle weakness
Skin: dry skin, photosensitivity, rash, pruritus, petechiae, sweating
Other: peculiar taste, weight gain, edema, hypothermia, flushing, withdrawal symptoms with abrupt drug cessation (dizziness, nausea, vomiting, headache, malaise, sleep disturbances, hyperthermia, irritability, worsening of depression), sudden death (in children)
Interactions
Drug-drug. Adrenergics, anticholinergics: additive adrenergic or anticholinergic effects
Cimetidine, phenothiazines, quinidine, selective serotonin reuptake inhibitors: increased desipramine effects, possible toxicity
Clonidine: hypertensive crisis
CNS depressants (antihistamines, opioid analgesics, sedative-hypnotics): additive CNS depression
MAO inhibitors: hyperpyretic crisis, severe seizures, death
Sparfloxacin: increased risk of adverse cardiovascular reactions
Drug-diagnostic tests. Glucose: increased or decreased level
Drug-food. Grapefruit juice: increased drug blood level and effects
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
S-adenosylmethionine (SAM-e), St. John's wort: adverse serotonergic effects, including serotonin syndrome
Drug-behaviors. Alcohol use: increased response to alcohol
Smoking: increased metabolism and decreased efficacy of desipramine
Patient monitoring
See Assess for suicidal tendencies before starting therapy.
• Monitor blood glucose level and CBC with white cell differential during therapy.
• Watch for severe CNS, cardiovascular, and hematologic adverse reactions.
Patient teaching
• Tell patient to take full dose at bedtime to avoid daytime drowsiness.
See Urge patient to promptly report chest pain or easy bruising or bleeding.
• Inform patient that desired therapeutic effect may take 2 to 3 weeks.
See Instruct patient or parent to immediately report increasing depression or suicidal ideation (especially in child or adolescent).
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects alertness, vision, and coordination.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.