Norpramin

Nor·pra·min (nôrpr-mn)

A trademark for the drug desipramine hydrochloride.

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Norpramin,

trademark for an antidepressant (desipramine hydrochloride).

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desipramine hydrochloride

Norpramin

Pharmacologic class: Tricyclic antidepressant

Therapeutic class: Antidepressant

Pregnancy risk category C

FDA Boxed Warning

• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed.
• Drug isn't approved for use in pediatric patients.

Action

Inhibits norepinephrine or serotonin reuptake at presynaptic neuron

Availability

Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

⊘Indications and dosages

➣ Depression

Adults: Initially, 100 to 200 mg/day P.O. Increase gradually if needed to a maximum dosage of 300 mg/day.

Adolescents and elderly adults: 25 to 100 mg/day P.O. as a single dose or in divided doses. Increase gradually if needed to a maximum dosage of 150 mg/day.

Off-label uses

• Arthritis pain
• Cancer pain
• Diabetic or peripheral neuropathy
• Tic douloureux

Contraindications

• Hypersensitivity to drug
• Recovery phase of myocardial infarction (MI)
• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:
• cardiovascular disorders, glaucoma, thyroid disorders
• urinary retention
• adolescents and children younger than age 12.

Administration

• Before giving drug, measure patient's sitting and supine blood pressure to assess for orthostasis.
• Give full dose at bedtime to avoid daytime drowsiness.
• Discontinue drug 2 days before surgery.
☞ Don't give within 14 days of MAO inhibitor, because potentially fatal reaction may occur.

Route	Onset	Peak	Duration
P.O.	Unknown	4-6 hr	Unknown

Adverse reactions

CNS: sedation, weakness, anxiety, restlessness, insomnia, delusions, confusion, agitation, hallucinations, disorientation, extrapyramidal reactions, EEG changes, neuroleptic malignant syndrome, seizures, suicidal behavior or ideation (especially in child or adolescent)

CV: hypotension, hypertension, tachycardia, palpitations, arrhythmias, MI, heart block

EENT: blurred vision, dry eyes, laryngitis

GI: nausea, vomiting, constipation, abdominal cramps, epigastric distress, difficulty swallowing, parotid gland swelling, mouth inflammation, dry mouth, black tongue

GU: urinary retention, delayed voiding, urinary tract dilation, testicular swelling, erectile or other male sexual dysfunction, gynecomastia, menstrual irregularities, galactorrhea, increased or decreased libido

Hematologic: purpura, eosinophilia, bone marrow depression, agranulocytosis, thrombocytopenia

Metabolic: syndrome of inappropriate antidiuretic hormone secretion

Musculoskeletal: muscle weakness

Skin: dry skin, photosensitivity, rash, pruritus, petechiae, sweating

Other: peculiar taste, weight gain, edema, hypothermia, flushing, withdrawal symptoms with abrupt drug cessation (dizziness, nausea, vomiting, headache, malaise, sleep disturbances, hyperthermia, irritability, worsening of depression), sudden death (in children)

Interactions

Drug-drug. Adrenergics, anticholinergics: additive adrenergic or anticholinergic effects

Cimetidine, phenothiazines, quinidine, selective serotonin reuptake inhibitors: increased desipramine effects, possible toxicity

Clonidine: hypertensive crisis

CNS depressants (antihistamines, opioid analgesics, sedative-hypnotics): additive CNS depression

MAO inhibitors: hyperpyretic crisis, severe seizures, death

Sparfloxacin: increased risk of adverse cardiovascular reactions

Drug-diagnostic tests. Glucose: increased or decreased level

Drug-food. Grapefruit juice: increased drug blood level and effects

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

S-adenosylmethionine (SAM-e), St. John's wort: adverse serotonergic effects, including serotonin syndrome

Drug-behaviors. Alcohol use: increased response to alcohol

Smoking: increased metabolism and decreased efficacy of desipramine

Patient monitoring

☞ Assess for suicidal tendencies before starting therapy.
• Monitor blood glucose level and CBC with white cell differential during therapy.
• Watch for severe CNS, cardiovascular, and hematologic adverse reactions.

Patient teaching

• Tell patient to take full dose at bedtime to avoid daytime drowsiness.
☞ Urge patient to promptly report chest pain or easy bruising or bleeding.
• Inform patient that desired therapeutic effect may take 2 to 3 weeks.
☞ Instruct patient or parent to immediately report increasing depression or suicidal ideation (especially in child or adolescent).
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects alertness, vision, and coordination.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

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Norpramin®

Desipramine, see there