Tricyclic antidepressant (TCA)
Selective inhibition of norepinephrine reuptake with minimal serotonergic, anticholinergic, and sedative effects compared to other TCAs.
Major depressive disorder (MDD).
Attention-deficit/hyperactivity disorder (ADHD), neuropathic pain, enuresis, agitation and aggression in traumatic brain injury (TBI), augmentation in treatment-resistant depression, depression in Parkinson’s disease (PD)
Oral tablets
25–50 mg p.o. daily, titrated based on clinical response and tolerability.
75–200 mg/day, with lower doses often sufficient for pain management.
Metabolized primarily by CYP2D6; half-life approximately 15–30 hours.
Dry mouth, constipation, insomnia, weight loss, tremor, orthostatic hypotension.
Cardiac conduction abnormalities including QT prolongation; overdose risk with toxicity similar to other TCAs.
Baseline ECG recommended for patients over 40 or with cardiac risk factors; monitor blood pressure, heart rate, and signs of orthostatic hypotension.
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Desipramine may be effective in the treatment of ADHD, especially in children and adolescents with co-occurring tic disorders. May be better tolerated in elderly or those with mild cognitive impairment (MCI) due to lower anticholinergic and sedative burden; however, still carries risk of falls and cardiac conduction changes. Use with caution and monitor closely in these populations.