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Side Effects of Desipramine (Norpramin)


Side Effects of Desipramine (Norpramin)

Desipramine, know as the brand name Norpramin, has been approved by the Food and Drug Administartion (FDA) for the treatment of depression. Norpramin is also used to treat neuropathic pain, such as may occur in longstanding diabetes or shingles. Norpramin is a tricyclic antidepressant medication.

Norpramin Black Box Warning

The side effect of Norpramin that prompts a black box warning from the FDA is the increased risk of suicide. This Norpramin side effect can be confusing since antidepressants are intended to improve depression and lower the risk of suicide. It is unclear whether antidepressants are directly to blame, or if people who commonly take antidepressants are more likely to consider, attempt, and complete suicide.


Studies show there is no increased risk of suicide in adults over the age of 24 when taking antidepressants. Furthermore, people over the age of 64 are less likely to attempt or commit suicide if they are on an antipsychotic for depression. Therefore, increased risk of suicide may be one of the Norpramin side effects that are most important in people under the age of 25.

Before Taking Norpramin

People with heart disease, diabetes, liver disease, or kidney disease are often unable to take this drug because of disease-specific side effects. Norpramin also increases the risk of seizure in people prone to having seizures (Desipramine label reported by the FDA).

Serious Side Effects

The Norpramin label listed by the FDA otulines the adverse reactions associated with tricyclic antidepressants in, rather than specific Desipramine adverse effects.


This is because all tricyclic antidepressants have similar side effects. It is difficult to determine which of these effects is more or less likely to occur with Desipramine than with other tricyclic antidepressants.


Norpramin severe adverse effects include:


  • Anxiety
  • Irritability
  • Confusion
  • Blurred vision
  • Slow speech or difficulty speaking
  • Insomnia
  • Hallucinations
  • Mania (talking or acting with intense excitement)
  • Pounding in the ears
  • Mouth or lip sores
  • Chest pain or discomfort
  • Tachycardia (fast heart rate)
  • Orthostatic hypotension (dizziness or lightheadedness when getting up from seated or reclining position)


Other severe side effects are abdominal pain, loss of appetite, nausea/vomiting, black, tarry, especially foul-smelling stools, numbness or tingling, convulsions, muscle weakness, shakiness and unsteady walk, pain or discomfort in the arms, jaw, back, or neck, twisting body movements, dark urine, loss of bladder control/painful or difficult urination, easy bruising, rash (usually small red or purple skin spots), and jaundice (yellow eyes and skin).


Canadian regulators are cautioning prescribers and patients that antidepressants, including Norpramin, may greatly increase the risk of angle-closure glaucoma. Angle-closure glaucoma is an increase in the pressure of the fluid within the eye. If left undetected and untreated, angle-closure glaucoma can lead to vision disturbances and overt blindness. Health Canada identified 23 antidepressant drugs, including Norpramin that may have this effect. (Journal of Clinical Psychopharmacology “Short-term Exposure to antidepressant Drugs and Risk of Acute Angle-Closure Glaucoma” (June 2012). This is why angle-closure glaucoma is listed as one of the major Norpramin side effects.

Common Side Effects

The common Norpramin side effects are mild and usually manageable. They are dizziness, headache, dry mouth, nausea, constipation, and tremor.

About Pharmacogenetic Testing

The pharmacogenetics of Norpramin is similar to other tricyclic antidepressants. Norpramin is extensively metabolized in the liver primarily by CYP2D6. CYP1A2 is also involved, but has a minor role in Norpramin’s metabolism.


The adverse side effects of Norpramin occur if an individual poorly metabolizes Norpramin or he or she may not experience the medicine working, making him or her an extensive metabolizer. This causes the problem in not knowing which medications are safe and not safe for him or her.

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Contributors to this Article:
Michael Sapko, MD, PhD; and Deborah Kallick, PhD, Medicinal Chemistry

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