Norpramin (Desipramine Hydrochloride)

(des ip' ra meen)

A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as desipramine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take desipramine, but in some cases, a doctor may decide that desipramine is the best medication to treat a child's condition. You should know that your mental health may change in unexpected ways when you take desipramine or other antidepressants even if you are an adult over age 24. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Your healthcare provider will want to see you often while you are taking desipramine, especially at the beginning of your treatment. Be sure to keep all appointments for office visits with your doctor. No matter your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal. This risk is higher if you or anyone in your family has or has ever had bipolar disorder (mood that changes from depressed to abnormally excited) or mania (frenzied, abnormally excited mood) or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you.

Desipramine is used to treat depression. Desipramine is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed for mental balance.

Desipramine comes as a tablet to take by mouth. It is usually taken one or more times a day and may be taken with or without food. Take desipramine at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take desipramine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of desipramine and gradually increase your dose. It may take 2 to 3 weeks for you to feel the full benefit of desipramine. Continue to take desipramine even if you feel well. Do not stop taking desipramine without talking to your doctor. If you suddenly stop taking desipramine, you may experience withdrawal symptoms such as nausea, headache, and weakness. Your doctor will probably want to decrease your dose gradually.

Before taking desipramine,
• tell your doctor and pharmacist if you are allergic to desipramine, clomipramine (Anafranil), imipramine (Tofranil), trimipramine (Surmontil), any other medications, or any of the ingredients in desipramine tablets. Ask your doctor or pharmacist for a list of the ingredients.
• tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take desipramine. If you stop taking desipramine, you should wait at least 14 days before you start to take an MAO inhibitor.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, herbal products and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin); antihistamines; cimetidine (Tagamet); estrogens; flecainide (Tambocor); fluoxetine (Prozac); guanethidine (Ismelin); levodopa (Sinemet, Larodopa); lithium (Eskalith, Lithobid); medication for high blood pressure, seizures, Parkinson's disease, diabetes, mental illness, nausea, asthma, colds, or allergies; methylphenidate (Ritalin); muscle relaxants; oral contraceptives; phenobarbital; propafenone (Rythmol); quinidine; sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); sleeping pills; thyroid medications; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Your doctor may tell you not to take desipramine if you have stopped taking fluoxetine during the past 5 weeks.
• tell your doctor if you have recently had a heart attack. Your doctor may tell you that you should not take desipramine.
• tell your doctor if anyone in your family has or has ever had an irregular heartbeat or has died suddenly. Also tell your doctor if you have or have ever had heart or blood vessel disease such as high blood pressure, atherosclerosis (hardening of the arteries), angina (chest pain), irregular heartbeat, or a heart attack; an enlarged prostate (a male reproductive gland) difficulty urinating; diabetes; seizures; an overactive thyroid gland; schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions); or liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking desipramine, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking desipramine.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• ask your doctor about the safe use of alcohol while you are taking this medication.
• tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
• you should know that desipramine may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Desipramine may cause side effects. Call your doctor if any of these symptoms become severe or do not go away:

• nausea
• drowsiness
• weakness or tiredness
• nightmares
• dry mouth
• skin more sensitive to sunlight than usual
• changes in appetite or weight
• constipation
• difficulty urinating
• frequent urination
• changes in sex drive or ability
• excessive sweating

Some side effects can be serious. If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

• jaw, neck, and back muscle spasms
• slow or difficult speech
• shuffling walk
• uncontrollable shaking or movement of a part of the body
• fever
• difficulty breathing or swallowing
• severe rash
• yellowing of the skin or eyes
• irregular heartbeat
• seizures
• sore throat, fever, and other signs of infection

Keep this medication in the container it came in, tightly closed, and out of the reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor. Do not allow anyone else to take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.