Desipramine (Norpramin): doses, uses, and side effects

Healthcare providers often prescribe medications to help alleviate depression symptoms. Some of the most commonly used drugs are SSRIs (selective serotonin reuptake inhibitors) like Zoloft (sertraline) and Lexapro (escitalopram). Desipramine, a type of medication called a TCA (tricyclic antidepressant), isn’t usually the first choice for treating depression. Let’s discuss what desipramine does and why it isn’t a standard treatment. 

Ro

Improve and support your health from the comfort of home

Learn more

Desipramine (brand name Norpramin) is a type of drug called a TCA (tricyclic antidepressant) TCAs work by regulating brain chemicals (neurotransmitters) like serotonin and norepinephrine, which affect mood. When these levels get too low, you may experience depression symptoms. TCAs raise the level of these chemicals to relieve symptoms (FDA, 2018; Maan, 2021).

Desipramine is approved by the FDA (US Food and Drug Administration) for the treatment of depression. However, it has many severe side effects, so it’s usually not the first choice for depression treatment (Maan, 2021).

Desipramine is sometimes prescribed off-label to treat other conditions when deemed appropriate by a healthcare provider, including (Maan, 2021):

• Bulimia (bulimia nervosa): People with bulimia usually experience binge-eating followed by purging behaviors like self-induced vomiting or laxative use. Desipramine can significantly reduce binging and purging, though it may not be the first choice of treatment due to side effects. Desipramine may be prescribed for people with bulimia who haven’t improved after trying other treatments (Jain, 2021). 

• Sleep disorders (REM sleep behavior disorder): In particular, desipramine is used to treat REM sleep behavior disorder. With this type of sleep disorder, people physically act out their dreams while sleeping. For example, they may kick or punch. A few studies suggest that some people with this condition improve when they take desipramine (Aurora, 2010; Schenck, 1986).

• ADHD (attention deficit hyperactivity disorder): Desipramine can decrease ADHD symptoms, though it isn’t the first choice of medication (Wilens, 1996).

• Irritable bowel syndrome (IBS): IBS is a condition that causes recurring abdominal pain, gas, diarrhea, and constipation. People who take TCAs (including desipramine) may significantly reduce their IBS symptoms (Rahimi, 2009). 

• Pain: Since desipramine raises the level of brain chemicals like serotonin, it may reduce the sensation of pain, especially nerve-related (neuropathic) pain. For example, it may relieve pain in the hands and feet from diabetes (diabetic neuropathy) or long-term pain from shingles (Max, 1992; Maan, 2021). 

• Overactive bladder: Desipramine may be helpful in people with an overactive bladder, since it may reduce symptoms like frequent urination and bladder pain (Hillelsohn, 2014). 

Desipramine is a prescription-only medication and isn’t available over-the-counter. Oral tablets come in dosages of 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg. 

The typical starting dosage is 25 to 50 mg. A healthcare provider will typically adjust the dosage  based on your symptoms, side effects, and response to the medication to a maximum dosage of 300 mg per day (FDA, 2018).

Desipramine may cause some mild to severe side effects. Common side effects include (Maan, 2021; FDA, 2018):

• Drowsiness

• Dry mouth

• Dizziness

• Blurred vision

• Constipation

• Ringing in the ears (tinnitus)

• Clumsiness or lack of coordination

• Feeling restless or anxious

• Difficulty fully emptying your bladder during urination (urinary retention)

• Weight gain or weight loss

• Skin rash

• Breast enlargement (gynecomastia)

• Sensitive skin in the sunlight (photosensitivity)

• Sexual problems like difficulty getting aroused or reaching orgasm

Because of desipramine’s potential side effects, you shouldn’t drive while taking this medication until you see how it affects you. 

Less frequently, people have more serious adverse reactions while taking desipramine. Severe adverse effects of desipramine include (FDA, 2018): 

• Blood pressure changes: You may develop severe high or low blood pressure. You may also experience sudden drops in blood pressure when you sit or stand up (orthostatic hypotension), which may cause dizziness or fainting.

• Racing heartbeat or abnormal heartbeats: Desipramine may cause abnormally rapid heartbeats or changes in your heartbeats (arrhythmias), linked to heart attack or stroke. Symptoms may include dizziness or feeling like your heart is racing or skipping beats. 

• Serotonin syndrome: TCAs like desipramine raise the level of a brain chemical called serotonin. If combined with another drug that raises serotonin too, like an SSRI, serotonin levels can get too high, resulting in a dangerous and possibly fatal reaction called serotonin syndrome. Symptoms of this condition include high fever, racing heart beats, blood pressure changes, hallucinations, and coma. 

• Mood or behavior changes: This medication can cause confusion, hallucinations, racing thoughts, severe agitation or anxiety, or worsening depression.

• Liver problems: You may develop yellowing of your skin and the whites of your eyes (jaundice) if the medication damages your liver.

• Seizures

• Numbness in your arms or legs

• Blood disorders: Desipramine can make it hard for your body to make new blood cells, causing anemia, clotting problems, or bleeding. 

You should consult a healthcare provider or seek emergency care if you experience severe side effects. 

Desipramine has a black box warning—the most serious type of FDA warning. The warning indicates that there is an increased risk of suicidal thoughts and behaviors in children and young adults (up to age 24) taking these medications (FDA, 2018). 

Other precautions

Before prescribing desipramine, a healthcare provider will review your medical history to ensure it’s the right treatment. Certain conditions and risk factors can put you at higher risk for serious side effects, including (FDA, 2018):

• Heart disease 

• History of heart attacks or stroke

• Glaucoma

• Urinary or bladder problems

• Seizure disorder (epilepsy)

• Alcohol use

• Bipolar disorder, schizophrenia, or other mental health conditions

• Kidney, liver, or thyroid disease

• Past allergic reactions to desipramine or other TCAs (examples include amitriptyline, clomipramine, imipramine, doxepin, and nortriptyline)

Desipramine isn’t recommended for people who are pregnant, breastfeeding, or 65 years and older.

Taking certain drugs or supplements with desipramine can raise your risk of negative side effects. Drugs that interact with desipramine include: 

• Antidepressants: Mixing desipramine with antidepressant medications like SSRIs and MAOIs (monoamine oxidase inhibitors) increases your risk of serotonin syndrome.

• Herbs: Some herbs or supplements, such as St. John’s wort, increase your risk of serotonin syndrome if taken with desipramine. 

• Recreational substances: Recreational substances like cocaine and ecstasy can boost serotonin and increase your risk of serotonin syndrome if you mix them with desipramine.

• Heartburn medications: Acid blockers like cimetidine interfere with your body’s ability to get rid of desipramine by interfering with a chemical called CYP2D6. This can raise your level of desipramine and put you at higher risk for toxic effects. Other medications that interfere with CYP2D6 also raise your level of desipramine, including Prozac (fluoxetine) and some heart medications. 

• Alcohol: Since both desipramine and alcohol can make you sleepy (sedated), confused, and dizzy, the effects are more severe when used simultaneously. 

• Drugs with similar side effects: You have a higher risk of adverse effects if you combine desipramine with medications that have similar side effects, including Benadryl (diphenhydramine) and Xanax (alprazolam, a benzodiazepine). 

These examples don’t include all possible interactions. It’s important to let your healthcare provider know what medications you’re taking before starting desipramine

Desipramine isn’t a standard treatment for depression since it carries a risk of severe side effects, but it can be useful if other medications don’t help your symptoms. A healthcare provider can help determine whether desipramine is a good treatment for you.