Desipramine

CPT: 80335
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Test Details

Synonyms

  • Norpramin®

Use

Desipramine, a metabolite of imipramine, has actions and uses similar to those of the parent compound and is as effective as imipramine in the treatment of mood disorders. Untoward effects are similar to those produced by imipramine, but anticholinergic and sedative actions are less pronounced. Thus, desipramine may be especially useful in patients who are particularly sensitive to these effects (eg, the elderly).

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Reference Interval

When administered alone: therapeutic: 150−250 ng/mL

Critical Value

Potentially toxic: >500 ng/mL

Additional Information

All the tricyclic antidepressants have significant drug interactions. Being potent inducers of hepatic drug-metabolizing enzymes, particularly CYP3A4, CYP1A2, and CYP2C9, the antiepileptic drugs, carbamazepine, phenytoin, phenobarbital, and primidone, stimulate the oxidative transformation of concurrently prescribed antidepressants.1 This results in decreased drug levels of the antidepressant. With desipramine, it has been noted that up to a 36-fold difference in plasma levels can be observed in patients receiving the same dose.2 One study compared desipramine monotherapy with carbamazepine co-administered.3 The monotherapy group exhibited a 4.6-fold increase in plasma levels and a 62% longer half-life as compared to the co-medicated group. To a lesser extent, co-administration of oxcarbazepine, topiramate, and felbamate can also result in decreased antidepressant levels. Other tricyclic antidepressant drug interactions: hydrocortisone, methylphenidate, and phenothiazines increase tricyclic levels; tricyclics impair the antihypertensive effectiveness of clonidine and guanethidine; tricyclics and alcohol produce additive sedative effects, tricyclics and antiparkinsonism agents have potent anticholinergic side effects, and tricyclics and MAO inhibitors should not be co-administered because of the potential for antihypertensive and CNS crises.

Tricyclics should be avoided in pregnant and lactating women because these drugs have not been established as safe. Geriatric patients are especially prone to postural hypotension, urinary retention, and sedation.4 In general, it has been reported that, “Therapeutic drug monitoring of antidepressants allows us to take into account the influence of factors such as co-medications, diet, smoking habit, impaired organ function, and compliance. Therapeutic drug monitoring and genotyping are thus complementary, and their combined use contributes to improve pharmacotherapy with antidepressants and other drugs.”5

Specimen Requirements

Specimen

Serum or plasma

Volume

1 mL

Minimum Volume

0.3 mL

Container

Red-top tube, lavender-top (EDTA) tube, or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant.

Collection

Transfer separated serum or plasma to a plastic transport tube. For therapeutic monitoring, collect specimen immediately prior to next dose.

Storage Instructions

Room temperature

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Gel-barrier tube; red-top tubes are recommended because gel-barrier tubes may cause significant losses (>40%) of the tricyclic antidepressant from serum.

Clinical Information

Footnotes

1. Spina E, Perucca E. Clinical significance of pharmacokinetic interactions between antiepileptic and psychotropic drugs. Epilepsia. 2002; 43(Suppl 2):37-44. 11903482
2. Nissen D, Poertner C, Dashley K, et al, eds. 2003 Mosby's Drug Consult. St Louis, Mo: Mosby Inc;2003:III-836.
3. Spina E, Avenoso A, Campo GM, Caputi AP, Perucca E. The effect of carbamazepine on the 2-hydroxylation of desipramine. Psychopharm. 1995 Feb; 117(4):413-416. 7604141
4. Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. N Engl J Med. 1989 Aug 3; 321(5):303-309. 2664519
5. Eap CB, Sirot EJ, Baumann P. Therapeutic monitoring of antidepressants in the era of pharmacogenetics studies. Ther Drug Monit. 2004 Apr; 26(2):152-155. 15228156

References

American Medical Association, Division of Drugs and Toxicology. Drug Evaluations Subscription. Chicago, Ill: AMA, Spring 1992.
Rodríguez de la Torre B, Dreher J, Malevany I, et al. Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients. Ther Drug Monit. 2001 Aug; 23(4):435-440. 11477329

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
007765 Desipramine, Serum 3531-1 007765 Desipramine, Serum ng/mL 3531-1

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