One common medication often used to treat depression is desipramine (often known by the brand name Norpramin). On this page, we’ve outlined some important information about this prescription drug.

What is desipramine (Norpramin)?

What is desipramine? How does it work?

Desipramine is an antidepressant approved to treat conditions such as major depressive disorder. It may sometimes be used off-label to treat irritable bowel syndrome, bulimia nervosa, neuropathic pain, ADHD, overactive bladder, and post herpetic neuralgia.

Desipramine belongs to a class of medications called tricyclic antidepressants. This class of medications help treat depression by regulating the levels of certain chemicals in the brain called neurotransmitters. Desipramine specifically inhibits the breakdown of the neurotransmitters serotonin and norepinephrine in the brain–thereby increasing their levels. Serotonin and norepinephrine levels are linked to mood regulation, and having increased levels levels may help improve mood.

How is desipramine typically used?

A typical target dosage for desipramine is 100mg to 200mg orally, one to three times daily, but it is typically started at much lower doses. Some older patients and those with certain medical conditions may do better at lower doses. As with any antidepressant, dosage may be increased by the treating provider depending on the severity of symptoms and the patient’s tolerability of the medication and side effects. 

Do not stop taking desipramine or alter your dose without first informing your Doctor. Stopping desipramine too abruptly may cause an uncomfortable withdrawal syndrome. If you need to stop the medication, your doctor would gradually lower your dosage over a period. This is referred to as tapering down your dose.

What are some possible side effects?

Some common side effects of desipramine include:

• Dry mouth
• Nausea
• Tiredness / weakness
• Drowsiness
• Increased sensitivity to light 
• Excessive sweating

Some serious (but uncommon side effects) include:

• Muscle spasms in the jaw, neck, and back. 
• Seizures
• Uncontrollable shaking or movement of the body. 
• Fever
• Difficulty swallowing or breathing
• Severe rash

Call 911 or seek emergency care if you notice any severe side effects. You can find a more comprehensive list of side effects here. 

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. Desipramine helps with depression by increasing the levels of the neurotransmitter norepinephrine in the brain. While this helps improve mood, norepinephrine is also involved in controlling some other activities of the brain e.g. breathing, heartbeats, blood pressure etc.   

Many non-serious side effects of mental health medications like desipramine go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. 

How do your genes relate to desipramine? 

Genetics can affect your body’s response to medication. Some people with a certain variation of CYP2D6 might be slow metabolizers for desipramine. Being a slow metabolizer means your body will break down the medication more slowly than others, which means the drug sticks around in your body for longer than average and may lead to increased side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking desipramine is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• In teenagers and young adults, the medication can increase suicidal thoughts. Inform your doctor if you are having any of these thoughts when taking desipramine. 
• Inform your doctor if you have any family history of bipolar disorder or any other medical conditions before you start taking desipramine. 
• Desipramine may lead to severe conditions when taken alongside some other medications. Notify your doctor of any other medication you are on before taking desipramine. 
• Notify your doctor if you have any history of diabetes as the medicine may increase or lower blood sugar. 
• Also, inform your doctor if you experience any changes in your vision when you take desipramine to prevent serious eye problems. 

If you show signs of an allergic reaction to desipramine (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how desipramine works. Make sure to tell your doctor about all other medications you are taking before starting desipramine to avoid negative interactions. For full details, see the FDA’s full list of precautions. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.