Desipramine

Mechanism :

Neurotransmitter (NE & serotonin) reuptake inhibitor

Indication :

Depression

Contraindications :

Hypersensitivity to desipramine or any component of the formulation; use of MAO inhibitors intended to treat psychiatric disorders (concurrently or within 14 days of stopping desipramine or a MAO inhibitor); initiation of desipramine in a patient receiving linezolid or intravenous methylene blue; use in a patient during the acute recovery phase of MI.

Dosing :

Oral

6 to 12 years:

1 to 3 mg/kg/day in divided doses. Maximum dose: 5 mg/kg/day.

Adolescents:

25 to 100 mg once daily or in divided doses. Maximum: 150 mg/day.

Adverse Effect :

Cardiac arrhythmia, cerebrovascular accident, edema, flushing, heart block, hypertension, hypotension, myocardial infarction, palpitations, premature ventricular contractions, tachycardia, agitation, anxiety, ataxia, confusion, delusions, disorientation, dizziness, drowsiness, drug fever, EEG pattern changes, extrapyramidal reaction, falling, fatigue, hallucination, headache, hypomania, insomnia, neuroleptic malignant syndrome, nightmares, numbness, peripheral neuropathy, psychosis (exacerbation), decreased libido, decreased serum glucose, galactorrhea, gynecomastia, increased libido, increased serum glucose, SIADH, weight gain, weight loss, abdominal cramps, anorexia, constipation, diarrhea, epigastric distress, agranulocytosis, eosinophilia, petechiae, purpura, thrombocytopenia, abnormal hepatic function tests, cholestatic jaundice, hepatitis, increased liver enzymes, increased serum alkaline phosphatase.

Interaction :

Alpha-/Beta-Agonists (Direct-Acting): Tricyclic Antidepressants may enhance the vasopressor effect of Alpha-/Beta-Agonists.
Antiemetics (5HT3 Antagonists): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Barbiturates: May increase the metabolism of Tricyclic Antidepressants.
CYP2D6 Inhibitors: May decrease the metabolism of CYP2D6 Substrates
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon.
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Sulfonylureas: Cyclic Antidepressants may enhance the hypoglycemic effect of Sulfonylureas.

Hepatic Dose :

Use with caution. Start with a lower dose. Adjust dose as per clinical response.