Desipramine
From Pharmacopedia
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TCA, Antidepressant
Desipramine
Norpramin
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Interactions
Pharmacogenomic + mechanism interactions
Pharmacogenomic guideline recommendationsCPIC and Dutch Pharmacogenetics Working Group clinical guidelines
CPIC rec 8093968 [Strong]: Initiate therapy with recommended starting dose CPIC pair-level B (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040]
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CPIC rec 8093961 [Optional]: Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level B (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040] FDA labeling (Precautions)
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CPIC rec 8093977 [Optional]: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider a 50% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level B (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040] FDA labeling (Precautions)
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CPIC rec 8093973 [Optional]: Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments. CPIC pair-level B (CYP2D6, CYP2C19 and Tricyclic Antidepressants) [PMID 23486447, 27997040]
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Pharmacokinetic mechanismSubstrate / metabolism relationships from primary literature
FDA Drug Interactions Table: sensitive index substrate of CYP2D6.
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Inferred from pharmacokinetic dataMaterialised by the inference engine; provenance shown per row
Quinidine inhibits CYP2D6 (inhibitor_strong, intensity 95); Desipramine is a substrate_major of CYP2D6 (intensity 80). Derived: Desipramine exposure raised.
⏱ reversible competitive, effect resolves over ~5 inhibitor half-livesInferred via Enzyme:CYP2D6 (exposure raised)
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Fluoxetine inhibits CYP2D6 (inhibitor_strong, intensity 90); Desipramine is a substrate_major of CYP2D6 (intensity 80). Derived: Desipramine exposure raised.
⏱ mechanism-based, interaction persists ~4-6 weeks after stopping the inhibitorInferred via Enzyme:CYP2D6 (exposure raised)
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Paroxetine inhibits CYP2D6 (inhibitor_strong, intensity 90); Desipramine is a substrate_major of CYP2D6 (intensity 80). Derived: Desipramine exposure raised.
⏱ mechanism-based, interaction persists ~4-6 weeks after stopping the inhibitorInferred via Enzyme:CYP2D6 (exposure raised)
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Confidence in this inference: is the inferred magnitude sound?overstatedsound
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Bupropion inhibits CYP2D6 (inhibitor_strong, intensity 85); Desipramine is a substrate_major of CYP2D6 (intensity 80). Derived: Desipramine exposure raised.
⏱ reversible competitive, effect resolves over ~5 inhibitor half-livesInferred via Enzyme:CYP2D6 (exposure raised)
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Mirabegron inhibits CYP2D6 (inhibitor_moderate, intensity 55); Desipramine is a substrate_major of CYP2D6 (intensity 80). Derived: Desipramine exposure raised.
Inferred via Enzyme:CYP2D6 (exposure raised)
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Summary
Classes
TCA, Antidepressant
Common uses
Pharmacy
Pharmacology
Purported mechanism
Selective norepinephrine reuptake inhibitor