desipramine

Adjunctive therapy • Brands: Norpramin

Last reviewed: 2025-12-30

General information

Class: Adjunctive therapy
Common US brands: Norpramin
Typical dose range: Label dosing is individualized. Adult outpatient titration commonly starts low (often 25–50 mg/day) and increases gradually toward 100–200 mg/day as tolerated; the labeled maximum is 300 mg/day (label).
Therapeutic drug monitoring recommended; reference range 100–300 ng/mL.
Last reviewed: 2025-12-30

Dosing & forms

Forms/strengths: Oral tablets (label): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.
Frequency: Some regimens use bedtime dosing to reduce daytime adverse effects, while others split dosing to improve tolerability; this is individualized to sedation and blood-pressure effects (clinical).
Typical range: Label dosing is individualized. Adult outpatient titration commonly starts low (often 25–50 mg/day) and increases gradually toward 100–200 mg/day as tolerated; the labeled maximum is 300 mg/day (label).
Therapeutic range: 100–300 ng/mL

Mechanism (brief)

Secondary-amine tricyclic antidepressant (TCA); predominantly norepinephrine reuptake inhibition with less antihistamine/anticholinergic effect than tertiary-amine TCAs.

Metabolism & Half‑life

Metabolism: CYP2D6
Half‑life: Single-dose range 15–18 h

Therapeutic Drug Monitoring (TDM)

Recommended: Yes

Reference range: 100–300 ng/mL

View labelExact

Monitoring highlights

Baseline and follow-up ECG planning in patients with cardiac history, older age, electrolyte disturbance risk, or multiple QT-active drugs (clinical).
TDM after steady state or after major interaction changes when response is partial or toxicity is suspected (Hiemke 2018/clinical).
Anticholinergic burden (bowel and bladder symptoms, cognition), falls risk, and orthostatic vitals during titration (clinical).
Suicidality and mood switching surveillance early in treatment and after dose changes, especially in young adults and bipolar-spectrum illness (label/clinical).

Sources

NORPRAMIN (desipramine) prescribing information — DailyMed (2025)
Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017 — Pharmacopsychiatry (2018)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)

General information

Class: Adjunctive therapy

Common US brands: Norpramin

Typical dose range: Label dosing is individualized. Adult outpatient titration commonly starts low (often 25–50 mg/day) and increases gradually toward 100–200 mg/day as tolerated; the labeled maximum is 300 mg/day (label).

Therapeutic drug monitoring recommended; reference range 100–300 ng/mL.

Last reviewed: 2025-12-30

Dosing & forms

Forms/strengths: Oral tablets (label): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.

Frequency: Some regimens use bedtime dosing to reduce daytime adverse effects, while others split dosing to improve tolerability; this is individualized to sedation and blood-pressure effects (clinical).

Typical range: Label dosing is individualized. Adult outpatient titration commonly starts low (often 25–50 mg/day) and increases gradually toward 100–200 mg/day as tolerated; the labeled maximum is 300 mg/day (label).

Therapeutic range: 100–300 ng/mL

Monitoring highlights

Baseline and follow-up ECG planning in patients with cardiac history, older age, electrolyte disturbance risk, or multiple QT-active drugs (clinical).

TDM after steady state or after major interaction changes when response is partial or toxicity is suspected (Hiemke 2018/clinical).

Anticholinergic burden (bowel and bladder symptoms, cognition), falls risk, and orthostatic vitals during titration (clinical).

Suicidality and mood switching surveillance early in treatment and after dose changes, especially in young adults and bipolar-spectrum illness (label/clinical).