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(dess-IPP-ruh-meen HIGH-droe-KLOR-ide)
Norpramin, Alti-Desipramine, Apo-Desipramine, Dom-Desipramine, Novo-Desipramine, Nu-Desipramine, PMS-Desipramine
Class: Tricyclic antidepressant

 Action Inhibits reuptake of norepinephrine and serotonin in CNS.

 Indications Relief of symptoms of depression. Unlabeled use(s): Facilitation of cocaine withdrawal; treatment of panic and eating disorders (eg, bulimia nervosa).

 Contraindications Hypersensitivity to any tricyclic antidepressant. Not to be given in combination with or within 14 days of treatment with an MAO (monoamine oxidase) inhibitor; cross-sensitivity may occur across the dibenzazepines. Do not give during acute recovery phases of MI.

 Route/Dosage

ADULTS: PO 100 to 300 mg/day. May be given in divided doses or once daily at bedtime. ELDERLY AND ADOLESCENT PATIENTS: PO 25 to 150 mg/day.

 Interactions

Barbiturates, carbamazepine, charcoal: May decrease desipramine effects. Cimetidine, fluoxetine, haloperidol, quinidine, oral contraceptives, phenothiazine antipsychotics: May increase desipramine effects. Clonidine: May result in hypertensive crisis. CNS depressants: CNS and respiratory effects may be increased. MAO inhibitors: Hyperpyretic crises, severe convulsions and death may occur if administered together or within 14 days of each other.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Orthostatic hypotension; hypertension; tachycardia; palpitations; arrhythmias; ECG changes; hypertensive episodes during surgery; stroke; heartblock; CHF. CNS: Confusion; disturbed concentration; hallucinations; delusions; nervousness; numbness; tremors; extrapyramidal symptoms (pseudoparkinsonism; movement disorders; akathisia); restlessness; agitation; panic; insomnia; nightmares; mania; exacerbation of psychosis; drowsiness; dizziness; weakness; fatigue; emotional lability; seizures. DERM: Rash; pruritus; photosensitivity reaction; dry skin; acne; itching; sweating. EENT: Conjunctivitis; blurred vision; increased intraocular pressure; mydriasis; tinnitus; nasal congestion; peculiar taste in mouth. GI: Nausea; vomiting; anorexia; GI distress; diarrhea; flatulence; dry mouth; constipation. GU: Impotence; sexual dysfunction; nocturia; urinary frequency; urinary tract infection; vaginitis; cystitis; urinary retention or hesitancy. HEPA Hepatitis; jaundice. HEMA: Bone marrow depression including agranulocytosis; eosinophilia; purpura; thrombocytopenia; leukopenia. META: Elevation or depression of blood sugar levels. RESP: Pharyngitis, rhinitis; sinusitis; bronchospasm; cough. OTHER: Breast enlargement.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Not recommended in children < 12 yr. Special risk patients: Use drug with caution in patients with history of seizures, urinary retention, urethral or ureteral spasm, angle-closure glaucoma, increased intraocular pressure, or cardiovascular disorders; in patients receiving thyroid medication and in patients who have hepatic or renal impairment, schizophrenia or paranoia.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer in equal doses or one dose at bedtime.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Document serum bilirubin, alkaline phosphatase and blood glucose levels throughout therapy.
  • Assess and document baseline behaviors and psychological status.
  • Notify physician and discontinue medication immediately if patient has increased agitation and/or paranoid delusions.
  • Document body weight monthly.
  • Notify physician and withhold medication if there is a BP drop of 20 mmHg or if heart arrhythmia or increase in heart rate develops.
  • Inform physician if patient has urinary elimination problems.
OVERDOSAGE: SIGNS & SYMPTOMS
  Confusion, agitation, hallucinations, seizures, status epilepticus, clonus, choreoathetosis, hyperactive reflexes, positive Babinski’s signs, coma, cardiac arrhythmias, renal failure, flushing, dry mouth, dilated pupils, hyperpyrexia

 Patient/Family Education

  • Warn patient of risk of seizure.
  • Instruct patient to keep weekly record of weight.
  • Teach patient how to take BP and heart rate.
  • Explain missed medication procedure: < 2 hrs, take medication; more than 2 hrs, wait until next scheduled dose. Do not double doses.
  • Teach proper techniques for oral hygiene to help prevent/treat dry mucous membranes.
  • Tell patient to increase fluid intake.
  • Inform male patient of possible sexual dysfunction.
  • Tell patient of possible difficult urination.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Advise patient to complete full course of therapy; may take 4 to 6 wks to see full benefits.

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