TaperCommunitydesipramine
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial antidepressant treatment.
Desipramine is a secondary-amine tricyclic antidepressant — the active metabolite of imipramine. More noradrenergic and less anticholinergic than older TCAs, often chosen when sedation or anticholinergic burden is a concern.
10mg, 25mg, 50mg, 75mg, 100mg, 150mg tablets
Tablets: 10mg, 25mg, 50mg, 75mg, 100mg, 150mg
Category C
Selective norepinephrine reuptake inhibitor among TCAs. Minimal serotonin reuptake activity. Less histamine and muscarinic blockade than amitriptyline or imipramine.
Slow hyperbolic taper. Less anticholinergic rebound than imipramine or amitriptyline.
Therapeutic drug monitoring is appropriate — desipramine has a defined therapeutic plasma window. Slower in CYP2D6 poor metabolizers.
1-3 days after dose reduction
5-10 days
2-4 weeks
Sleep disturbance can persist 4-8 weeks
Toxicity
Toxic in overdose — cardiac arrhythmia, seizures, especially in CYP2D6 poor metabolizers.
Pharmacokinetics
Hepatic via CYP2D6 (major) and CYP1A2.
~90%
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