How does this medication work? What will it do for me?

Desipramine belongs to the class of medications known as tricyclic antidepressantsDesipramine helps to elevate mood and eliminate or reduce other symptoms associated with depression. Tricyclic antidepressants such as desipramine work by increasing the amount of norepinephrine and serotonin neurotransmitters (chemical substances in the brain) available in certain parts of the brain.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Apo-Desipramine is no longer being manufactured for sale in Canada. For brands that may still be available, search under desipramine HCl. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

For the treatment of depression in adults, the recommended starting dose of desipramine is 25 mg to 50 mg taken by mouth, with or without food. This dose is usually increased gradually until the most effective dose is found. The usual adult dose is 100 mg to 200 mg daily. Doses above 300 mg daily are not recommended. Seniors should not take more than 150 mg daily. It may take several weeks before the medication has its full effect so you should be patient with the results.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to desipramine or any ingredients of this medication
  • have acute congestive heart failure or heart block
  • have recently had a heart attack
  • have taken a MAO inhibitor (e.g., phenelzine, tranylcypromine) in the last 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medicat

ion. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal cramps
  • constipation
  • decreased interest in sexual activity
  • diarrhea
  • difficulty urinating
  • dizziness when getting up from a sitting or lying position
  • drowsiness
  • dryness of mouth or eyes
  • hair loss or thinning
  • headache
  • loss of appetite
  • nausea
  • nightmares
  • sexual dysfunction
  • sweating
  • tiredness or weakness
  • trouble sleeping
  • unpleasant taste
  • vomiting
  • weight changes (gain or loss)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blood sugar changes (increase or decrease)
  • breast enlargement (for both males and females)
  • mood changes (anxiety, confusion, excitement, irritable mood, racing thoughts)
  • clumsiness or lack of coordination
  • difficulty concentrating
  • fast, pounding, or irregular heartbeat
  • increased blood pressure
  • new or worsened emotional problems
  • numbness or tingling of the hands or feet
  • ringing in the ears
  • signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
  • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
  • symptoms of high blood pressure (e.g., headache
  • symptoms of low blood pressure (e.g., dizziness, fainting, blurred vision, nausea, vomiting)
  • testicle swelling
  • uncontrollable twitching or jerking

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
  • signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
  • symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
  • symptoms of a severe allergic reaction such as swelling of the mouth or throat, chest tightness, or shortness of breath

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Diabetes: Both elevation and lowering of blood sugar levels have been reported with desipramine use. People with diabetes or hypoglycemia (low blood sugar) should monitor their blood glucose levels closely while taking this medication.

Drowsiness/reduced alertness: Desipramine may reduce the mental or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a motor vehicle. Use appropriate caution until you determine how this medication affects you.

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Heart rhythm: Desipramine can cause abnormal heart rhythms, particularly when taken in high doses. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you start to experience symptoms of an irregular heartbeat, such as dizziness, fainting, chest pain or shortness of breath, contact your doctor.

Kidney function:  Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Mental health: Desipramine may cause activation of mania or hypomania. It may also cause episodes of psychosis in people with schizophrenia. If you experience symptoms such as hallucinations, mania (feeling unusually over-excited or uninhibited), unexplained confusion or delusional thinking, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.

People with a history of bipolar disorder should be closely monitored by their doctor while using this medication.

Seizures: Desipramine can increase the risk of seizures. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when naratriptan is combined with other medications that act on serotonin, such as serotonin reuptake inhibitors, medications used to treat depression. These combinations must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, or changes in mental state, including delirium and agitation. Coma and death are possible.

Thyroid disease: People taking medication to treat thyroid problems may be more at risk of heart problems, such as irregular heart rhythms. If you have a history of thyroid disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary problems: This medication can affect urinary tract function. It may cause difficulty starting urine flow, completely emptying the bladder, or contribute to incontinence (urine leakage). If you have a history of urinary  problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Suicidal thoughts: Desipramine may increase the risk of suicidal thoughts, especially when starting therapy or adjusting the dosage.  If you experience thoughts of suicide or self harm, or notice them in a family member who is taking this medication, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Desipramine passes into breast milk. If you are a breast-feeding mother and are taking desipramine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Seniors may be more at risk of experiencing side effects from taking desipramine. Lower doses may be required.

What other drugs could interact with this medication?

There may be an interaction between desipramine and any of the following:

  • abiraterone
  • aclidinium
  • alcohol
  • alpha agonists (e.g., clonidine, methyldopa)
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
  • anti-emetics (e.g., granisetron, ondansetron)
  • antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, ketotifen, loratadine, rupatadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • apraclonidine
  • atropine
  • azelastine
  • barbiturates (e.g., phenobarbital)
  • benzodiazepines (e.g., diazepam, lorazepam)
  • benztropine
  • beta2-agonists (e.g., formoterol, olodaterol, salbutamol, salmeterol)
  • botulinum toxin-containing products
  • brimonidine
  • buprenorphine
  • buspirone
  • butorphanol
  • cannabis
  • chloral hydrate
  • cimetidine
  • clarithromycin
  • clidinium
  • cobicistat
  • darifenacin
  • desmopressin
  • dextromethorphan
  • dexmethylphenidate
  • disopyramide
  • domperidone
  • donepezil
  • dronedarone
  • eletriptan
  • eluxadoline
  • entacapone
  • epinephrine
  • ergot alkaloids (e.g., dihydroergotamine, ergonovine,  ergotamine, methylergonovine)
  • erythromycin
  • esketamine
  • galantamine
  • glucagon
  • glycopyrrolate
  • ipratropium
  • kava kava
  • lemborexant
  • levodopa
  • linezolid
  • lithium
  • methadone
  • methylphenidate
  • metoclopramide
  • mirabegron
  • mirtazepine
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, tranylcypromine)
  • muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, trazodone)
  • nitroglycerine
  • norepinephrine
  • oxybutynin
  • ozanimod
  • phenylephrine
  • pomalidomide
  • potassium chloride
  • pramipexole
  • procainamide
  • quinidine
  • quinine
  • rasagiline
  • rifabutin
  • rifampin
  • rivastigmine
  • ropinirole
  • rotigotine
  • St. John's Wort
  • scopolamine
  • seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, rufinamide, topiramate, valproic acid, zonisamide)
  • selegiline
  • selective serotonin reuptake inhibitors (SSRI antidepressants; e.g., fluoxetine, fluvoxamine, paroxetine)
  • serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
  • solifenacin
  • sotalol
  • sulfonylureas (e.g., gliclazide, glyburide, tolbutamide)
  • terbinafine
  • thalidomide
  • thiazide diuretics (e.g., hydrochlorthiazide, indapamide, metolazone)
  • thyroid replacements (e.g., dessicated thyroid, levothyroxine)
  • tiotropium
  • tolterodine
  • trazodone
  • other tricyclic antidepressants (e.g., amitriptyline, clomipramine, trimipramine)
  • tryptophan
  • umeclidinium
  • vandetanib
  • zolpidem
  • zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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