Indications:

Depression: Approved for the treatment of depression.
Neuropathic Pain: Although used, it is not officially licensed for this indication.

Contraindications:

Hypersensitivity to desipramine or any formulation components.
Recent use of MAO inhibitors or certain other medications such as linezolid and intravenous methylene blue.
Patients in the acute recovery phase of a myocardial infarction.

Suicidality: Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults. This risk must be weighed against the clinical need. The risk does not show in studies with adults over 24 and decreases in those over 65.

Use with care in patients with cardiovascular disease, chronic constipation, diabetes, epilepsy, glaucoma, a history of bipolar disorder or psychosis, and those at risk of suicide.
The medication should be discontinued if there is a shift to mania.
Patients should be monitored closely at the beginning of therapy and when adjusting the dose.

Common: Anxiety, confusion, dizziness, drowsiness, dry mouth, headache, nausea, palpitations, and tremors.
Serious: Arrhythmias, bone marrow depression, seizures, and orthostatic hypotension.

Anticholinergic Effects: Can cause issues like constipation and blurred vision.
CNS Depression: May impair mental or physical abilities; caution advised when driving or operating machinery.
Serotonin Syndrome: Can occur especially when combined with other serotonergic drugs.
Hematologic Effects: Rarely, can cause blood disorders such as agranulocytosis.

Pregnancy: Should only be used if the potential benefit justifies the potential risk to the fetus.
Breastfeeding: Considered safe as the amount secreted into breast milk is too small to be harmful.
Elderly: Higher risk of falls and confusion; doses should be lower and increased more cautiously.
Hepatic/Renal Impairment: Use with caution, adjusting the dose as necessary.

Should be tapered slowly to avoid withdrawal symptoms, which might include nausea, headache, and malaise.

Animal Studies: Inconclusive. Potential neonatal risks include irritability, jitteriness, and rare convulsions.
ACOG Recommendations: Depression treatment during pregnancy should be personalized, involving mental health clinicians, obstetricians, and pediatricians. Risks of medication should be balanced against untreated depression risks. For those at high risk for postpartum depression, medications may be resumed post-delivery.
Enrollment Recommendation: Pregnant women on antidepressants are encouraged to enroll in the National Pregnancy Registry for Antidepressants to help monitor outcomes.

Cardiovascular Issues: Include cardiac arrhythmia, cerebrovascular accidents, edema, heart block, hypertension, myocardial infarction, and more.
Central Nervous System Effects: Can cause agitation, anxiety, confusion, dizziness, drowsiness, hallucinations, and other neurological effects.
Dermatological Reactions: Possible alopecia, diaphoresis, pruritus, photosensitivity, and skin rash.
Gastrointestinal Effects: May cause abdominal cramps, constipation, diarrhea, nausea, and more.
Hematologic Concerns: Rare instances of bone marrow suppression such as agranulocytosis and thrombocytopenia.
Metabolic Effects: Potential for weight gain or loss, changes in serum glucose levels, and SIADH.
Other Effects: Include potential for bone fractures, ocular effects like blurred vision, orthostatic hypotension, and risk of serotonin syndrome when combined with other serotonergic drugs.

Adults (Depression): Start with 25 to 50 mg daily, adjust as needed up to 100-200 mg daily; maximum 300 mg per day.
Diabetic Neuropathy and Other Off-label Uses: Specific initial doses and adjustments are detailed for conditions like irritable bowel syndrome and postherpetic neuralgia.
Discontinuation: Gradual tapering is recommended to minimize withdrawal symptoms.

Patients should be closely monitored for any worsening of depression or emergence of suicidal thoughts, especially early in treatment or when changing dosages.
Prescribers should be cautious about potential interactions with MAO inhibitors and the array of side effects that might necessitate discontinuation of therapy.

- Discontinued product [DSC].
- Contains brilliant blue fcf (fd&c blue #1), corn starch, sodium benzoate, soybean oil.

- Discontinued product [DSC].
- Contains corn starch, fd&c yellow #10 (quinoline yellow), sodium benzoate, soybean oil.