Category C—Although the data are limited, desipramine does not appear to be a major human teratogen. When used near term, neonatal abstinence syndrome is possible.
Desipramine is excreted into breast milk. No reports of adverse effects have been located. In one patient, milk:plasma ratios of 0.4-0.9 were measured with milk levels ranging between 17 and 35 mcg/ mL. A 1996 review of antidepressant treatment during breastfeeding found no information that desipramine exposure during nursing resulted in quantifiable amounts in an infant or that the exposure caused adverse effects. In 2001, the American Academy of Pediatrics classified desipramine as a drug whose effect on the nursing infant is unknown but may be of concern.
Desipramine has a less toxic side effect profile, especially with respect to anticholinergic effects, but its efficacy has not been well studied.
Baseline ECG is recommended for patients over age 50.
No dosage adjustment necessary.
All TCAs are hepatically metabolzed, highly protein bound and will accumulate, and associated with ↑ LFTs.