Carrie Yuan PharmD is a board-certified ambulatory care pharmacist. She is a clinical pharmacist in the Family Medicine Clinic at Harborview Medical Center in Seattle and a clinical associate professor at the University of Washington School of Pharmacy.

Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy and is an active leader in professional pharmacy associations.

Norpramin (desipramine) carries a boxed warning for an increased risk of suicidal thinking and behavior in children, adolescents, and young adults treated with antidepressants. The decision to use this drug in a young person should carefully be considered, weighing potential risks with the clinical need. Speak to your healthcare provider right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, and very rapid speech).

Norpramin (desipramine) is a tricyclic antidepressant (TCA) used to treat depression in adults.

TCAs are thought to restore levels of neurotransmitters serotonin and norepinephrine in the brain by preventing reabsorption, thereby increasing levels in the brain. Neurotransmitters are chemical messengers that allow nerve cells (neurons) to communicate. The changing levels of these neurotransmitters in the brain are suggested to play an important role in the symptoms of depression. For example, serotonin's primary function is to stabilize mood, and norepinephrine helps the body respond to stress.

Norpramin is available as a tablet to take by mouth.

Brand Name(s): Norpramin

Controlled Substance: N/A

Active Ingredient: Desipramine hydrochloride

The Food and Drug Administration (FDA) approved Norpramin to treat depression in adults. It is not approved for use in children.

Depression is a common mood disorder, and its symptoms can interfere with a person's ability to function in their day-to-day life. Symptoms of clinical depression can include, but are not limited to:

Take Norpramin at any time of day, with or without food. Take it at bedtime if it makes you tired.

Store desipramine tablets at room temperature (68 F to 77 F) and protect them from light and moisture. Do not keep them in the bathroom, as exposure to moisture can affect how well they work. Keep this medication out of reach of children and pets.

Healthcare providers may prescribe desipramine for off-label uses, meaning for conditions not specifically indicated by the FDA.

Some off-label uses of desipramine include:

Antidepressants can take two to four weeks to see the full effects, but some people may take them for up eight weeks before noticing symptom improvement. Also, note that the starting dose may not be effective and require an increase over several weeks.

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common side effects of Norpramin can include:

Norpramin (desipramine) carries a boxed warning for an increased risk of suicidal thinking and behavior in children, adolescents, and young adults treated with antidepressants. This medication is not approved for use in children or adolescents; however, young adults who take Norpramin should be aware of the potential adverse effects. Watch for worsening depression, suicidal thoughts, or unusual behavioral changes, especially when starting therapy.

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and symptoms can include:

Norpramin may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Safe use of Norpramin in pregnancy has not been established. If you are pregnant, you and your healthcare provider will decide on its use based on the benefits versus potential risks for you and the fetus.

Desipramine is present in human breast milk at low levels; however, the drug has not been detected in the bloodstream of breastfed infants. Limited data and case reports indicate no adverse effects on infant growth and development.

Adults over age 65 may be at a higher risk for side effects like falls and confusion; therefore, lower doses are recommended.  

If you miss a dose, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and take the next dose at the regularly scheduled time. Do not take an extra dose to make up for the missed dose.

Overdosing on desipramine may result in death, so immediate hospitalization and monitoring are required. Treatment with activated charcoal may be helpful if administered early (e.g., within two hours) in the overdose.

Symptoms of overdose may include:

If you think you or someone else may have overdosed on Norpramin, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Norpramin, call 911 immediately.

It is very important that your doctor check your progress at regular visits to allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

For some teenagers and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or are getting worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not take desipramine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking desipramine during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping desipramine before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.

Desipramine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use desipramine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue, tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before taking any other medicines with desipramine.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.

This medicine may raise or lower your blood sugar. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

Before having any kind of surgery, tell the medical doctor in charge that you are using this medicine. Taking desipramine together with medicines used during surgery may increase the risk of side effects.

Check with your doctor immediately if you have vision changes, such as blurred vision, difficulty reading, or eye pain, during or after treatment. This could be a sign of a serious eye problem.

This medicine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are drowsy or not alert.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Tell your healthcare provider about all your medications, including prescription and over-the-counter (OTC) drugs, vitamins, and herbal supplements. Norpramin has several drug interactions.

MAOIs that treat psychiatric disorders should not be used with Norpramin, as the combination may precipitate life-threatening serotonin syndrome. Serotonin syndrome is a rare but potentially severe and life-threatening condition that occurs due to increased serotonin stimulation in the central nervous system.

Other serotonergic drugs (drugs that stimulate serotonin receptors) may increase the risk of serotonin syndrome, so this combination should be closely monitored during initiation and dose increases.

Cytochrome P450 2D6 (CYP2D6) Inhibitors

Drugs that inhibit the liver enzyme cytochrome P450 2D6 can increase the concentration of Norpramin. You may need lower doses of Norpramin or the interacting drug. Monitoring plasma concentrations of Norpramin can aid in dosing decisions.

The sedative effects of other psychotropic medications, such as sedatives or tranquilizers, can be enhanced when combined with Norpramin. People sensitive to excessive sedation or falls should be especially cautious.

Norpramin belongs to a family of drugs known as tricyclic antidepressants (TCAs). Other medications in this family include:

You should only take one TCA at a time. Combining a TCA like Norpramin with another class of psychotropic medications can be done with careful monitoring and dose adjustments of either medication if needed.

The most common side effects of Norpramin are dry mouth, constipation, dizziness, and drowsiness.

Desipramine and other TCAs work by decreasing the reabsorption of serotonin and norepinephrine reuptake, thereby increasing the concentrations of those neurotransmitters in the brain. In depression, it is common to have a chemical imbalance of insufficient neurotransmitters. TCAs improve depression symptoms by increasing the concentrations of these neurotransmitters.

Norpramin is usually started at a low dose to minimize side effects and then gradually increased over the course of several weeks to a therapeutically effective dose. Once at that dose, it may take two to four weeks to see the full effects. However, it can take up to eight weeks to notice symptom improvement in some cases. Therefore, patience is important.

Stay in close contact with your healthcare provider while taking Norpramin. The dose may need to be changed to find what works best for you. It can take several weeks to find the correct dose and then another several weeks before seeing the full effect of Norpramin.

Let your healthcare provider know if you or others notice a clinical worsening of symptoms, suicidality, or unusual changes in behavior. Some medications affect how Norpramin works. Make sure your healthcare provider knows all your prescriptions, especially those used to treat depression. Also, let them know of any OTC products and herbal supplements.

Avoid excessive use of alcohol while taking this medication; alcohol can exacerbate severe side effects of Norpramin. In addition, Norpramin can cause dizziness or drowsiness, so don't drive or do activities requiring concentration before knowing how this medication will affect you. To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

DailyMed. Label: Norpramin- desipramine hydrochloride tablet, sugar coated.

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By Carrie Yuan, PharmD Carrie Yuan PharmD is a clinical pharmacist with expertise in chronic disease medication management for conditions encountered in primary care. 

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