Norpramin


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Norpramin

 [nor´prah-min]
trademark for a preparation of desipramine, a tricyclic antidepressant.

desipramine hydrochloride

Apo-Desipramine (CA), Dom-Desipramine (CA), Norpramin, Novo-Desipramine (CA), Nu-Desipramine (CA), PHL-Desipramine (CA), PMS-Desipramine (CA), Ratio-Desipramine (CA)

Pharmacologic class: Tricyclic antidepressant

Therapeutic class: Antidepressant

Pregnancy risk category C

FDA Box 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, history of seizure disorders, mania, hypomania, adults with major depressive disorder

• urinary retention

• adolescents and children.

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.

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.

Norpramin

(nôr′prə-mĭn)
A trademark for the drug desipramine hydrochloride.

Norpramin®

Desipramine, see there.
References in periodicals archive ?
Norpramin has several advantages over Ritalin and other stimulants.
Two students were taking medication, which included Ritalin, Norpramin, and Trilafon.
The most effective medications are the tricyclical antidepressants such as Tofranil (imipramine) and Norpramin (despiramine); dopaminergic antidespressants such as Wellbutrin (bupropion); and stimulant medications such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine).
Medications that may help relieve pain include oral pain-relievers, tricyclic antidepressants such as amitriptyline (Norpramin) and nortriptyline (Aventyl, Pamelor), and the anti-seizure drug gabapentin (Neurontin).
The Most Commonly Prescribed Antidepressants Drug class Examples How they work Tricyclic desipramine Increase antidepressants (Norpramin, Pertofrane); norepinephrine nortriptyline (Pamelor) and serotonin.
* Antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs) including sertraline hydrochloride (Zoloft) and fluoxetine hydrochloride (Prozac), citalopram (Celexa), escitalopram (Lexapro) and paroxetine (Paxil); selective noradrenaline reuptake inhibitors (SNRIs), including venlafaxine (Effexor) and duloxetine (Cymbalta); and tricyclic antidepressants, including amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), and imipramine (Tofranil); and atypical antidepressants such as bupropion (Wellbutrin) and trazodone (Desyrl)
Some of the most frequently prescribed tricyclics are amitriptyline (Elavil, Endep), desipramine (Norpramin), clomipramine (Anafranil), doxepin (Sinequan), imipramine, (Tofranil, Tofranil PM), nortriptyline (Pamelor, Aventyl), amoxapine (Asendin), protriptyline (Vivactil) and trimipramine (Surmontil).
Examples include doxepin (Adapin, Sinequan), amitriptyline (Elavil, Etrafon, Limbitrol, Triavil), desipramine (Norpramin), and nortriptyline (Pamelor).
The most commonly prescribed medications for individuals with bulimia are antidepressants, such as Prozac and Norpramin. These medications help relieve depressive symptoms associated with bulimia nervosa and help individuals achieve a more healthy body image.
Examples of this group are desimpramine (Norpramin), nortryptaline (Pamelor), and imipramine (Tofranil).
The only antidepressant approved by the Food and Drug Administration for treatment of bulimia is the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac), but doctors may also prescribe other antidepressants for the condition, including the SSRIs sertraline (Zoloft) and paroxetine (Paxil), and the tricyclic antidepressants imipramine (Tofranil), amitriptyline (Elavil), bupropion (Zyban) and desipramine (Norpramin).
COMMON MEDICATIONS FOR MOOD DISORDERS CLASS GENERIC NAME (BRAND NAME) Selective serotonin Escitalopram (Lexapro) reuptake inhibitors Fluoxetine (Prozac) (SSRIs) Paroxetine (Paxil) Sertraline (Zoloft) Serotonin-norepinephrine Duloxetine (Cymbaita) reuptake inhibitors Venlafaxine (Effexor (SNRIs) Desvenlafaxine (Pristiq) Norepinephrine-dopamine Bupropion (Wellbutrin) reuptake inhibitor Tricyclic antidepressants Amitriptyline (Elavil) (TCAs) Desipramine (Norpramin) Nortriptyline (Pamelor) Benzodiazepines Alprazolam (Xanax) Clonazepam (Klonopin) Diazepam (Valium) Atypical antipsychotics Aripiprazole (Abilify) Quetiapine (Seroquel) Olanzapine (Zyprexa)