IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

01 December 2021
Medically reviewed by
Sumayya Salam
Pharm D
Desipramine vs Imipramine
Table of Contents

With the development of selective serotonin reuptake inhibitors, the usage of tricyclic antidepressants (TCAs) for the treatment of depression has diminished (SSRIs). SSRIs have a less severe side effect profile and a lower potential for toxicity. TCAs, however, continue to be a useful therapeutic option for some depressive conditions, including severe depression with negative symptoms and post-stroke depression. Additionally, the TCAs are effective in Fibromyalgia, neuropathic pain, and migraine.

The tricyclic antidepressant imipramine and its metabolite desipramine work in treating endogenous depression requiring 1 to 3 weeks of treatment to achieve therapeutic effectiveness. Desipramine is administered when a drug with significant stimulatory side effects is necessary for treating endogenous depression. These medications also treat severe obsessive-compulsive neurosis, Anxiety, panic disorder,  and childhood enuresis (involuntary urination).

The possibility that some antidepressants may be more effective than others is of theoretical and practical utility. So, which of the drug is more effective- Desipramine or Imipramine? Let us find out.

What Is Desipramine? 

Desipramine is a medication that belongs to the drug class named tricyclic antidepressant under the brand name Norpramin. The FDA has approved the secondary amine tricyclic antidepressant desipramine for the treatment of depression. Desipramine has shown therapeutic antinociceptive advantages, perhaps due to its influence on norepinephrine.

What Is Imipramine? 

Imipramine is a tricyclic antidepressant drug that belongs to the brand name Tofranil. It is an antidepressant with a tertiary amine nucleus. This medication treats mental disorders, namely depression, Anxiety, panic attacks, and bedwetting.  

How Does Imipramine And Desipramine Work?

Imipramine and Desipramine selectively block the norepinephrine reuptake from the neuronal synapse and thereby increase the naturally occurring chemical in the brain that uplifts the mood. 

Imipramine- Imipramine is a tertiary amine. It blocks the reuptake of norepinephrine and serotonin. Imipramine treats enuresis more effectively due to its affinity for serotonin and increased anticholinergic effects.

Imipramine also inhibits D-2 receptors. It inhibits antimuscarinic receptors, causing adverse effects on the cholinergic system. Moreover, it inhibits H1 and alpha 1 and 2 adrenergic receptors.

Desipramine- Desipramine blocks norepinephrine and serotonin reuptake. It is said to have a better ability to inhibit norepinephrine than tertiary amine tricyclic antidepressants, which are more effective at blocking serotonin receptors. Reuptake blockage raises the level of neurotransmitters that are readily accessible at the synapses. 

Desipramine appears to alter norepinephrine to have antinociceptive effects. Desipramine also downregulates beta-adrenergic and serotonin receptors in addition to these pathways. Additionally, it also has alpha-1 blocking, antihistamine, and anticholinergic properties.

Desipramine vs Imipramine: Which Is Better Option For You?

Desipramine is a medication under the brand name Tofranil. Whereas, Imipramine is the drug under the brand name Norpramin. 

Desipramine treats depression and neuropathy diabetes, while Imipramine treats depression, Anxiety, bedwetting, panic disorder, PTSD, and even neuropathic pain. 

Desipramine is not considered the first choice drug as it can lead to heart-related issues. On the other hand, Imipramine is the first choice medication used to treat mental disorders. 

Desipramine is not recommended for patients with heart-related issues, epilepsy, or glaucoma, whereas Imipramine is not recommended for people with diabetes as it can increase blood sugar levels. 

Desipramine is a drug that can be consumed by pediatrics under the physician's supervision, whereas, Imipramine is not recommended for pediatrics. 

Desipramine can cause drowsiness; however, it depends from person to person. Whereas, Imipramine can lead to lowering one's sex drive and can even cause weight gain. 

Desipramine is a metabolite of imipramine.
Tricyclic antidepressant imipramine and its metabolite desipramine are used to treat endogenous depression and take one to three weeks of treatment before showing any therapeutic benefit.
Substantial and specific side effects, such as dry mouth, sweating, and elevated heart rate, accompany long-term maintenance of Imipramine medication for patients with panic disorder and agoraphobia.

Study: Which is Effective Desipramine vs. Imipramine

Objective: Comparison between Imipramine plus mianserin and Desipramine plus mianserin within the subjects with post-stroke depression. 

Aim: the aim is to have a minimum baseline score of 5 on the 17-item Hamilton Depression Scale (HAMD) and The Melancholia Scale (MES)

Method: The Melancholia Scale (ME) used for measuring the depressive state detected the somatic symptoms, which had a minute influence on the evaluation of depression. About 20 patients fulfilled the criteria. Out of 120 stroke patients, the doses given of the drugs were flexible, using side effects as a guide during treatment.

Results: Both intentions to treat analysis and efficacy data excluding patients who had dropped out during the first 2 weeks of treatment due to the side effects showed that imipramine (mean dose 75 mg daily) plus mianserin with the dosage dose 25 mg per day was superior to desipramine (mean dose 66 mg daily) plus mianserin (27 mg daily). The only difference detected during the test was that the patients on Imipramine had most of the complaints within the 14 days, which faded quickly. 

Desipramine vs Imipramine: Which Is More Effective? 

Both medications are antidepressants. Their work is similar but not the same. Both Desipramine and Imipramine are considered adequate but depend upon person to person and according to the medical expert's prescription. However, do not consume the medications without strict medical guidance since it can lead to adverse symptoms. 

Dosage 

The dosage strength of this medication depends on adults and pediatrics. These are instructions about the quantity and frequency of your drug administration. Consult your physician in case of any queries.

Drug Desipramine Imipramine
Strength 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg. 10 mg, 25 mg, 50 mg
Adult Initial dose Initial dose: 100mg to 200mg orally.
Maximum dose: 300 mg
Initial dose: 75 mg per day orally. 
Maintenance and Maximum dosage: the dosage strength is further increased, subsequently 200mg to maintenance dose till the maximum dosage is 300mg orally.
Pediatric dose Initial dose: 25mg to 100mg orally. 
The maximum dose is 100mg which can be further increased; however, do not exceed 150mg.
Not recommended

Possible Side effects 

These are undesirable effects that occur after taking the drug. The side effects can range from adverse to common; however, in any case, consult the medical expert if you notice any of the side effects. These are a few common side effects that would fade away in a few days. If not, then consult the doctor.

Common side effects Adverse side effects
Nausea or vomiting Worsening depression
Drowsiness Increase in suicidal tendencies
Dizziness Eye pain or redness in the eye
Loss of appetite Increase in heart palpitation
Sexual issues Epilepsy or seizures
Constipation or diarrhea Serotonin syndrome

Precautions and Warnings 

These are steps to avoid unwanted effects on administering the medications. It helps to maximize the effects of drugs by taking proper cautionary measures.

Let your doctor or pharmacist know if you are allergic to Desipramine or other drugs, foods, or substances. Do not consume this drug if you are diagnosed with any conditions such as heart conditions, disorders such as bipolar disorder, seizure or epilepsy, glaucoma, diabetes, or kidney-related issues. Consult your doctor before beginning any new prescription pharmaceuticals, over-the-counter medications, or herbal therapies.

Before Taking Desipramine 

  • Use this medication as directed to get the most benefit.
  • Use whether or not you are eating. Take it with food if it causes stomach discomfort.
  • Take this medication at bedtime as it may make you sleepy.
  • Do not consume this medication if you have been on MOA inhibitors in the past two weeks. 
  • Do not consume this medication if pregnant or breastfeeding; in any case, consult the physician before taking the drug.
  • Do not abruptly discontinue using this medication without first consulting your doctor. It would be best to stop taking this
  • medication gradually since you may be more susceptible to side effects.
  • Stand up over a few minutes to reduce the risk of feeling lightheaded or passing out when sitting or lying down.  
  • Avoid driving or operating heavy machinery when you are on Desipramine.
  • Avoid alcohol, other drugs, and natural things that slow your actions. 

Before Taking Imipramine

  • Do not take Imipramine tablets; tell your doctor you are allergic (hypersensitive) to Imipramine.
  • Inform your doctor if you have heart disease, glaucoma, seizure, porphyria, or liver disease.
  • Do not take MAO inhibitors before or within 14 days of taking Imipramine.
  • Take the medication as directed.
  • Do not take Imipramine if you are breastfeeding or are pregnant. The infant may be born with breathing issues, lethargy,
  • colic, irritability, changes in blood pressure, tremors, and spasms if imipramine tablets were taken within the previous three months.
  • Do not drive or operate heavy machinery when you take Imipramine, as it may cause drowsiness or blurred vision.
  • Avoid drinking alcohol when you are on Imipramine.
  • If you forget to take a dose, do not double the dose.

Interactions of Desipramine

Concurrent use of Monoamine oxidase inhibitors and serotonergic medications may result in fatal side outcomes. Taking other medicines that elevate serotonin may raise your chance of developing serotonin syndrome or toxicity. Drugs like cough-and-cold remedies may contain substances that make you drowsy or decongestants, which might raise your blood pressure or heart rate.

Numerous medications, including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, sparfloxacin, and macrolide antibiotics, may disrupt the cardiac rhythm (QT prolongation) when used with Desipramine.

Interactions of Imipramine

Avoid taking Imipramine if you have used an MAO inhibitor during the last 14 days. A hazardous drug interaction could occur.
A hazardous drug interaction could occur when Imipramine is taken with drugs that reduce blood pressure.
Concurrent use of SSRIs with Imipramine may have cumulative effects on the serotonergic system.

Imipramine with alcohol and other central nervous system depressants like barbiturates, benzodiazepines, and general anesthetics may intensify the depressing effects. Taking tricyclic antidepressants with antiarrhythmic drugs of quinidine is not recommended.

Tricyclic antidepressants may increase the coumarin drug's anticoagulant effects. So, pay attention to plasma prothrombin levels. Co-medication with neuroleptics can result in seizures, a lower convulsion threshold, and increased tricyclic antidepressant levels in the blood. 

Bottom Line From Practical Anxiety Solutions

Imipramine is a tricyclic antidepressant used to relieve neuropathic pain (NP). The monomethyl counterpart of Imipramine, Desipramine, is a powerful and rapid-acting antidepressant. Tricyclic antidepressants work pharmacologically by obstructing neurotransmitter transporters in the presynaptic membrane, preventing serotonin, norepinephrine, and dopamine reuptake.

All TCAs have a low affinity for the -opioid receptor, while Imipramine and Desipramine have a higher relationship than other receptor subtypes. When treating primary depression of at least moderate intensity, Desipramine is just as effective as Imipramine. But the combined use of these drugs is not advised. In case of any adverse effects, seek immediate medical care.

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