Norpramin Tapering Guide
desipramine
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial antidepressant treatment.
Overview
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
Mechanism of Action
Selective norepinephrine reuptake inhibitor among TCAs. Minimal serotonin reuptake activity. Less histamine and muscarinic blockade than amitriptyline or imipramine.
Taper Notes
Slow hyperbolic taper. Less anticholinergic rebound than imipramine or amitriptyline.
Hyperbolic Tapering Guidance
Therapeutic drug monitoring is appropriate — desipramine has a defined therapeutic plasma window. Slower in CYP2D6 poor metabolizers.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Withdrawal Timeline
1-3 days after dose reduction
5-10 days
2-4 weeks
Sleep disturbance can persist 4-8 weeks
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated
- CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion, quinidine) — substantially increase levels
- QT-prolonging drugs — additive arrhythmia risk
Contraindications
- Recent MAOI use
- Acute MI recovery
- Known QT prolongation
Toxicity
Toxic in overdose — cardiac arrhythmia, seizures, especially in CYP2D6 poor metabolizers.
Pharmacokinetics
ADME Profile
Hepatic via CYP2D6 (major) and CYP1A2.
~90%
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Other Drug Profiles
Sources & References
Norpramin (desipramine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.