desipramine

Adjunctive therapy

Brands: Norpramin

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is desipramine?
Desipramine (brand Norpramin; generics) is a secondary-amine tricyclic antidepressant (TCA) indicated for depression. It is often described as more noradrenergic and less sedating than tertiary-amine TCAs such as amitriptyline or imipramine, but it still carries meaningful anticholinergic and cardiac safety considerations (label/clinical).
What is Norpramin?
Norpramin is a brand name for desipramine.
What is Norpramin (desipramine) used for?
Label indications include: Depression.
What drug class is Norpramin (desipramine)?
Secondary-amine tricyclic antidepressant (TCA); predominantly norepinephrine reuptake inhibition with less antihistamine/anticholinergic effect than tertiary-amine TCAs.
What strengths does Norpramin (desipramine) come in?
Oral tablets (label): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Norpramin
Therapeutic drug monitoring recommended; reference range 100–300 ng/mL.
Last reviewed: 2025-12-30

Label indications

Depression.

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Clinical Highlights

Desipramine (brand Norpramin; generics) is a secondary-amine tricyclic antidepressant (TCA) indicated for depression. It is often described as more noradrenergic and less sedating than tertiary-amine TCAs such as amitriptyline or imipramine, but it still carries meaningful anticholinergic and cardiac safety considerations (label/clinical). TCAs have a narrow therapeutic index and are dangerous in overdose. Treatment planning commonly includes safe-storage counseling and prescribing quantities that match risk (clinical).

Therapeutic drug monitoring (TDM) is commonly used with TCAs to reduce avoidable toxicity while supporting adequate exposure in partial response. The AGNP guideline therapeutic reference range for desipramine is 100–300 ng/mL (Hiemke 2018).
Compared with more sedating TCAs, desipramine may be considered when daytime sedation is a limiting factor, while still weighing orthostasis, constipation/urinary retention, and arrhythmia risk (clinical).
The compare view, desipramine evidence feed, and desipramine print page support side-by-side review when selecting among TCAs or planning a taper.

Dosing & Formulations

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

Older adults and medically frail patients often start at lower doses with slower titration and earlier follow-up due to falls, confusion, and conduction risk (clinical).
For TCAs, clinicians often obtain an ECG in higher-risk patients (older age, cardiac history, multiple QT-active drugs) and consider TDM after steady state or after major interaction changes (clinical).

Monitoring & Risks

Boxed warning: antidepressants increase the risk of suicidal thoughts/behaviors in children, adolescents, and young adults; close monitoring early in treatment is typical (label). Anticholinergic side effects: dry mouth, constipation, urinary retention, blurred vision, and cognitive slowing can limit adherence, especially in older adults (label/clinical).

Orthostatic hypotension and sedation can increase falls risk, particularly during titration or when combined with other sedatives (label/clinical).
Cardiac conduction effects (QRS/QT changes) and arrhythmias are key safety concerns for the TCA class; baseline and follow-up ECGs are commonly used when risk is elevated (clinical).
Mood switching can occur in bipolar-spectrum illness. Screening history and coordination with mood-stabilizer coverage are commonly considered when treating depressive episodes (clinical).

Drug Interactions

MAOIs are contraindicated; washout periods are used to reduce risk of Serotonin syndrome and hypertensive reactions (label). Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, bupropion, quinidine) can raise TCA exposure; dose adjustments and/or TDM are commonly used (clinical).

Other anticholinergic medications (some antipsychotics, antihistamines) can compound constipation, urinary retention, and delirium risk (clinical).
QT-prolonging medications and other agents that affect cardiac conduction add risk; regimen review commonly includes OTC cold/sleep products (clinical).

Practice Notes

Desipramine is typically positioned after SSRI/SNRI trials in major depressive disorder guidelines because TCAs require more safety monitoring and carry higher overdose risk (APA/CANMAT/clinical). When depressive symptoms occur in bipolar disorder, antidepressants are commonly paired with a mood stabilizer and monitored for Mania/Hypomania; see the bipolar disorder hub for longitudinal care pathways.

If anticholinergic burden or cardiac risk limits use, clinicians often reassess alternatives (e.g., SNRIs, nortriptyline with TDM, or non-TCA options) rather than escalating dose into toxicity (clinical).
When discontinuing after longer courses, gradual tapering is commonly used to reduce cholinergic rebound (GI upset, insomnia, anxiety) and to distinguish withdrawal from relapse (clinical).

References

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)Guidelinedepressionclinical
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)