Names and pronunciation
(dess-ip′ra-meen)
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Drug reference
(dess-ip′ra-meen)
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Func. class.: Antidepressant, tricyclic
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Chem. class.: Dibenzazepine, second- ary amine
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Do not confuse: desipramine/disopyramide
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ACTION: Blocks reuptake of norepi- nephrine, serotonin into nerve endings, thereby increasing action of norepineph- rine, serotonin in nerve cells
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USES: Depression
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CONTRAINDICATIONS: Hyper- sensitivity to tricyclics, carBAMazepine, closed-angle glaucoma, acute MI, MAOIs Precautions: Pregnancy, breastfeeding, geriatric patients, severe depression, increased intraocular pressure, seizure disorder, CV disease, urinary retention, cardiac dysrhythmias, cardiac conduc- tion disturbances, family history of sud- den death, prostatic hypertrophy, thyroid disease
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Black Box Warning: Children <18 yr, suicidal patients Black Box Warning: Depression: moni- tor mental status: mood, sensorium, af- fect, suicidal tendencies, increase in psychiatric symptoms (depression, panic); this product is not indicated for children; monitor mental status baseline and during first few months of treatment • Urinary retention, constipation; con- stipation most likely in children • Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weak- ness; not usual unless product discontin- ued abruptly • Beers: avoid in older adults with de- lirium or at high risk for delirium; assess for confusion; highly anticholinergic • Pregnancy/breastfeeding: no well- controlled studies, use only if benefit outweighs fetal risk; avoid breastfeeding, excretion is unknown Black Box Warning: That suicidal thoughts/behaviors may occur; to notify prescriber immediately • To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision • To avoid alcohol, other CNS depressants • Not to discontinue medication abruptly after long-term use because this may cause nausea, headache, malaise • To wear sunscreen or large hat be- cause photosensitivity occurs
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SIDE EFFECTS CNS: Dizziness, drowsiness, confusion, headache, fatigue, anxiety, tremors, stim- ulation, weakness, insomnia, nightmares, EPS (geriatric patients), increased psy- chiatric symptoms, paresthenia, suicidal ideation, impaired memory, seizures, serotonin syndrome CV: Orthostatic hypotension, ECG changes, tachycardia, hypertension, palpitations EENT: Blurred vision, tinnitus, mydria- sis, ophthalmoplegia ENDO: SIADH GI: Diarrhea, dry mouth, nausea, vomit- ing, paralytic ileus, increased appetite, cramps, epigastric distress, jaundice, hepatitis, stomatitis, constipation, weight gain GU: Retention, dereased libido HEMA: Agranulocytosis, thrombocytope- nia, eosinophilia, leukopenia INTEG: Rash, urticaria, sweating, pruri- tus, photosensitivity
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INTERACTIONS Increase: serotonin syndrome, neurolep- tic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists, other tricy- clic antidepressants Increase: CNS depression—alcohol, bar- biturates, opioids, CNS depressants, skel- etal muscle relaxants Increase: desipramine level—cimeti- dine, dilTIAZem, fluvoxaMINE, FLUox- etine, PARoxetine, sertraline, verapamil Increase: life-threatening B/P elevations— cloNIDine; do not use concurrently Increase: hypertension—EPINEPHrine, norepinephrine Increase: hyperpyrexia, seizures, excita- tion; do not use within 14 days of MAOIs Increase: QT interval—tricyclics, SUNItinib, vorinostat, ziprasidone, gatifloxacin, levo- FLOXacin, moxifloxacin, sparfloxacin, class IA/III antidysrhythmics, linezolid, methylene blue Drug/Herb Increase: serotonin syndrome—St. John’s wort, SAM-e, yohimbe; avoid concurrent use Increase: CNS depression—kava, valerian Drug/Lab Test Increase: serum bilirubin, blood glu- cose, alkaline phosphatase, LFTs
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TREATMENT OF OVERDOSE: ECG monitoring; lavage; administer anticonvulsant
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DOSAGE AND ROUTES • Adult: PO 50-75 mg/day in 1-4 divided doses; titrate by 25-50 mg weekly up to 300 mg/day in single or divided doses (inpatient), 200 mg/day (outpatient) • Geriatric: PO 25 mg/day at bedtime, titrate weekly; may increase to 150 mg/ day • Adolescent: PO 25-50 mg/day in di- vided doses; max 150 mg/day • Child 6-12 yr: PO 1-3 mg/kg/day in divided doses; max 5 mg/kg/day
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Available forms: Tablets 10, 25, 50, 75, 100, 150 mg
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Administer: • Increased fluids, bulk in diet for consti- pation, especially in geriatric patients; with food or milk for GI symptoms; crushed if patient is unable to swallow medication whole; without regard for food • Dosage at bedtime if oversedation oc- curs during day; may take entire dose at bedtime; geriatric patients may not toler- ate once-daily dosing D
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Assess: • Pain: characteristics, including loca- tions, intensity, alleviating factors, prior to and periodically • CV: B/P (lying, standing), pulse; if systolic B/P drops 20 mm Hg, hold prod- uct, notify prescriber; take VS, ECG in cardiac patients • Hepatic studies: AST, ALT, bilirubin; thy- roid function studies; monitor blood glu- cose and cholesterol in those who are overweight • Weight weekly, BMI initially and periodi- cally; appetite may increase with product • EPS primarily in geriatric patients: ri- gidity, dystonia, akathisia • Seizure activity in those with a history of seizures; may be prior to cardiac events
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Evaluate: • Therapeutic response: decreased de- pression
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That therapeutic effects may take 2-3 wk
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PHARMACOKINETICS Well absorbed, widely distributed, protein binding 92%, extensively metabolized in the liver (CYP2D6) to active metabo- lite of imipramine; some patients are poor metabolizers; half-life 15-60 hr
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• Adult: PO 50-75 mg/day in 1-4 divided doses; titrate by 25-50 mg weekly up to 300 mg/day in single or divided doses (inpatient), 200 mg/day (outpatient)
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