desipramine (Rx)

Depression

100-200 mg PO qHS or divided q12hr

Up to 300 mg/day in severely ill

Renal Impairment

Supplemental dose not necessary in peritoneal or hemodialysis

Other Indications & Uses

Off-label: Postherpetic neuralgia, vulvodynia, eating disorder

Dosing considerations

Initial therapy may be administered in divided doses or a single daily dose

Dosage should be initiated at a lower level and increased according to tolerance and clinical response

Maintenance therapy may be given on a once-daily schedule for patient convenience and compliance

Treatment of patients requiring as much as 300 mg should generally be initiated in hospitals, where regular visits by the physician, skilled nursing care, and frequent electrocardiograms (ECGs) are available

The best available evidence of impending toxicity from very high doses is prolongation of the QRS or QT intervals on the ECG

Clinical symptoms of intolerance, especially drowsiness, dizziness, and postural hypotension, should also alert the physician to the need for reduction in dosage

Adolescents

<12 years: Safety and efficacy not established

Initial: 25-50 mg PO qDay; may gradually increase if needed to 100 mg/day PO qDay or divided q8-12hr

Not to exceed 150 mg/day

Dosing considerations

Initial therapy may be administered in divided doses or a single daily dose

Dosage should be initiated at a lower level and increased according to tolerance and clinical response

Maintenance therapy may be given on a once-daily schedule for patient convenience and compliance

The best available evidence of impending toxicity from very high doses is prolongation of the QRS or QT intervals on the ECG

Clinical symptoms of intolerance, especially drowsiness, dizziness, and postural hypotension, should also alert the physician to the need for reduction in dosage

Depression

25-100 mg PO qHS or divided q12hr

Up to 150 mg/day in severely ill

Contraindicated (18)

• disopyramide

  desipramine and disopyramide both increase QTc interval. Contraindicated.

• eliglustat

  desipramine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

• ibutilide

  desipramine and ibutilide both increase QTc interval. Contraindicated.

• indapamide

  desipramine and indapamide both increase QTc interval. Contraindicated.

• iobenguane I 123

  desipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• isocarboxazid

  isocarboxazid and desipramine both increase serotonin levels. Contraindicated.

• lomitapide

  desipramine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• pentamidine

  desipramine and pentamidine both increase QTc interval. Contraindicated.

• phenelzine

  phenelzine and desipramine both increase serotonin levels. Contraindicated.

• pimozide

  desipramine and pimozide both increase QTc interval. Contraindicated.

• procainamide

  desipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and desipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• quinidine

  quinidine and desipramine both increase QTc interval. Contraindicated.

• safinamide

  desipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• selegiline

  selegiline and desipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• sotalol

  desipramine and sotalol both increase QTc interval. Contraindicated.

• thioridazine

  thioridazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• tranylcypromine

  tranylcypromine and desipramine both increase serotonin levels. Contraindicated.

Serious - Use Alternative (145)

• adagrasib

  adagrasib, desipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  desipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amiodarone

  desipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amitriptyline

  amitriptyline and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• arformoterol

  desipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• arsenic trioxide

  desipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  desipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• axitinib

  desipramine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and desipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  desipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• bosutinib

  desipramine increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• buprenorphine

  buprenorphine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine subdermal implant and desipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  buprenorphine transdermal and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buspirone

  desipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• calcium/magnesium/potassium/sodium oxybates

  desipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• chlorpromazine

  chlorpromazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  desipramine and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  desipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  desipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• cyclobenzaprine

  desipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• desvenlafaxine

  desipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dexfenfluramine

  desipramine, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmethylphenidate

  desipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine

  desipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextromethorphan

  desipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• diethylpropion

  desipramine, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dobutamine

  desipramine, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  desipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of desipramine by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  dolasetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• dopamine

  desipramine, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  desipramine, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dosulepin

  desipramine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  desipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

• dronedarone

  desipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  desipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• eliglustat

  desipramine increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

• encorafenib

  encorafenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  desipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  epinephrine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine racemic

  epinephrine racemic and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• erythromycin base

  desipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  desipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  desipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  desipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fenfluramine

  desipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fexinidazole

  fexinidazole and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fluconazole

  desipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  fluoxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  desipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  fosamprenavir increases levels of desipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• givosiran

  givosiran will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• granisetron

  granisetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  granisetron and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• guanfacine

  desipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  haloperidol will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  desipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• imipramine

  desipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• iobenguane I 131

  desipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• isoproterenol

  desipramine, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ivosidenib

  ivosidenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoconazole

  desipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• lefamulin

  lefamulin and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• levalbuterol

  desipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levoketoconazole

  desipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  desipramine, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lofepramine

  desipramine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lorcaserin

  desipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lumefantrine

  lumefantrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  desipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  desipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• meperidine

  desipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• metaproterenol

  desipramine, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methamphetamine

  desipramine, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylene blue

  methylene blue and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  desipramine, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metoclopramide intranasal

  desipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midodrine

  desipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• milnacipran

  milnacipran and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  desipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nefazodone

  nefazodone and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• netupitant/palonosetron

  netupitant/palonosetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  desipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  desipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  desipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  desipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  desipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• olopatadine intranasal

  desipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  desipramine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of desipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palonosetron

  palonosetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panobinostat

  desipramine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• paroxetine

  paroxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  paroxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  desipramine, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phentermine

  desipramine, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  desipramine, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  desipramine, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pirbuterol

  desipramine, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pitolisant

  desipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• promazine

  promazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• propylhexedrine

  desipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  desipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  desipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• quinidine

  quinidine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• ribociclib

  ribociclib increases toxicity of desipramine by QTc interval. Avoid or Use Alternate Drug.

• salmeterol

  desipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• selegiline transdermal

  selegiline transdermal and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, desipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• serdexmethylphenidate/dexmethylphenidate

  desipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• sertraline

  sertraline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  desipramine and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  desipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• St John's Wort

  desipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• tedizolid

  tedizolid, desipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• terbutaline

  desipramine, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• thioridazine

  thioridazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• toremifene

  desipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• trazodone

  desipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  desipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• umeclidinium bromide/vilanterol inhaled

  desipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  desipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• vandetanib

  desipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  venlafaxine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  desipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  desipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  desipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vortioxetine

  desipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• xylometazoline

  desipramine, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  yohimbe, desipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  desipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziprasidone

  desipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (354)

• 5-HTP

  desipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  abiraterone increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  abobotulinumtoxinA increases effects of desipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• aclidinium

  aclidinium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  acrivastine and desipramine both increase sedation. Use Caution/Monitor.

• albuterol

  desipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and desipramine both increase QTc interval. Use Caution/Monitor.

• alfentanil

  alfentanil and desipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  desipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and desipramine both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  alprazolam and desipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  desipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  amiodarone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• amisulpride

  desipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
  
  amisulpride and desipramine both increase sedation. Use Caution/Monitor.

• amitriptyline

  amitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and desipramine both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and desipramine both increase sedation. Use Caution/Monitor.

• amoxapine

  amoxapine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and desipramine both increase sedation. Use Caution/Monitor.

• anagrelide

  anagrelide and desipramine both increase QTc interval. Use Caution/Monitor.

• apomorphine

  desipramine and apomorphine both increase sedation. Use Caution/Monitor.
  
  apomorphine and desipramine both increase QTc interval. Use Caution/Monitor.

• arformoterol

  desipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and desipramine both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and desipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and desipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  desipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  asenapine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and desipramine both increase QTc interval. Use Caution/Monitor.
  
  asenapine and desipramine both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and desipramine both increase QTc interval. Use Caution/Monitor.
  
  asenapine transdermal and desipramine both increase sedation. Use Caution/Monitor.

• atazanavir

  atazanavir increases levels of desipramine by unspecified interaction mechanism. Use Caution/Monitor.

• atomoxetine

  atomoxetine and desipramine both increase QTc interval. Use Caution/Monitor.

• atropine IV/IM

  atropine IV/IM and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• avapritinib

  avapritinib and desipramine both increase sedation. Use Caution/Monitor.

• azelastine

  azelastine and desipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  desipramine and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  baclofen and desipramine both increase sedation. Use Caution/Monitor.

• bedaquiline

  desipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna and opium

  belladonna and opium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and desipramine both increase sedation. Use Caution/Monitor.

• benperidol

  benperidol and desipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• benzphetamine

  desipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexpiprazole

  desipramine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
  
  brexpiprazole and desipramine both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and desipramine both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and desipramine both increase sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and desipramine both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and desipramine both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and desipramine both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  desipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  desipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  bupropion will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.

• butabarbital

  butabarbital and desipramine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and desipramine both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and desipramine both increase sedation. Use Caution/Monitor.

• caffeine

  desipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and desipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and desipramine both increase sedation. Use Caution/Monitor.

• celecoxib

  celecoxib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cenobamate

  cenobamate, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  ceritinib and desipramine both increase QTc interval. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and desipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and desipramine both increase sedation. Use Caution/Monitor.

• chloroquine

  chloroquine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  chloroquine increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and desipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and desipramine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and desipramine both increase sedation. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cinnarizine

  cinnarizine and desipramine both increase sedation. Use Caution/Monitor.

• cisapride

  desipramine and cisapride both increase QTc interval. Use Caution/Monitor.

• clemastine

  clemastine and desipramine both increase sedation. Use Caution/Monitor.

• clobazam

  clobazam will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  desipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  clomipramine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and desipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and desipramine both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and desipramine both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and desipramine both increase sedation. Use Caution/Monitor.
  
  clozapine and desipramine both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of desipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

• cocaine topical

  desipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  codeine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• crizotinib

  crizotinib and desipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  cyclizine and desipramine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and desipramine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and desipramine both increase sedation. Use Caution/Monitor.

• dantrolene

  dantrolene and desipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  desipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• dasatinib

  desipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  desipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  degarelix and desipramine both increase QTc interval. Use Caution/Monitor.

• desflurane

  desflurane and desipramine both increase sedation. Use Caution/Monitor.
  
  desflurane and desipramine both increase QTc interval. Use Caution/Monitor.

• desvenlafaxine

  desvenlafaxine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• deutetrabenazine

  desipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and desipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  desipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmedetomidine

  dexmedetomidine and desipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  desipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  desipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.

• dextroamphetamine transdermal

  desipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromoramide

  dextromoramide and desipramine both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and desipramine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and desipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, desipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• diethylpropion

  desipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and desipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and desipramine both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  desipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  desipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  dimenhydrinate and desipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  diphenhydramine and desipramine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and desipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and desipramine both increase sedation. Use Caution/Monitor.

• dobutamine

  desipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dolasetron

  desipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  donepezil and desipramine both increase QTc interval. Use Caution/Monitor.

• dopamine

  desipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  desipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  desipramine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  desipramine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and desipramine both increase sedation. Use Caution/Monitor.

• dronedarone

  dronedarone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• droperidol

  droperidol and desipramine both increase sedation. Use Caution/Monitor.

• duloxetine

  duloxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• efavirenz

  efavirenz and desipramine both increase QTc interval. Use Caution/Monitor.

• eletriptan

  eletriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  eliglustat increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and desipramine both increase QTc interval. Use Caution/Monitor.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• entrectinib

  entrectinib and desipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  desipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

• epinephrine

  desipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

• epinephrine inhaled

  desipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  desipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.

• ergotamine

  desipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  eribulin and desipramine both increase QTc interval. Use Caution/Monitor.

• escitalopram

  escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, desipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  estazolam and desipramine both increase sedation. Use Caution/Monitor.

• ethanol

  desipramine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and desipramine both increase sedation. Use Caution/Monitor.

• ezogabine

  ezogabine, desipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  desipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fingolimod

  fingolimod and desipramine both increase QTc interval. Use Caution/Monitor.

• flecainide

  desipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluoxetine

  desipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  fluphenazine and desipramine both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and desipramine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  fluvoxamine and desipramine both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  desipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• foscarnet

  desipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fostemsavir

  desipramine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  frovatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  desipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and desipramine both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  gilteritinib and desipramine both increase QTc interval. Use Caution/Monitor.

• glycopyrrolate

  desipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  desipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.

• glycopyrronium tosylate topical

  glycopyrronium tosylate topical, desipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• goserelin

  desipramine and goserelin both increase QTc interval. Use Caution/Monitor.

• haloperidol

  haloperidol and desipramine both increase sedation. Use Caution/Monitor.

• henbane

  henbane and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  homatropine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  huperzine A increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  hydrocodone, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  hydromorphone and desipramine both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and desipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and desipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  hyoscyamine spray and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibrutinib

  desipramine increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• iloperidone

  desipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and desipramine both increase sedation. Use Caution/Monitor.

• imatinib

  imatinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine will increase the level or effect of imatinib by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  desipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and imipramine both increase sedation. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, desipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• ipratropium

  ipratropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isoflurane

  isoflurane and desipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  desipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  desipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• itraconazole

  itraconazole and desipramine both increase QTc interval. Use Caution/Monitor.

• ketamine

  ketamine and desipramine both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  desipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  desipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  desipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  lasmiditan, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  desipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lemborexant

  lemborexant, desipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• levalbuterol

  desipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  desipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levorphanol

  levorphanol and desipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  levothyroxine increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liothyronine

  liothyronine increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liotrix

  liotrix increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• lisdexamfetamine

  desipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  desipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and desipramine both increase QTc interval. Use Caution/Monitor.

• lofepramine

  desipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  desipramine and lofexidine both increase sedation. Use Caution/Monitor.
  
  desipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.

• loprazolam

  loprazolam and desipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and desipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lormetazepam

  lormetazepam and desipramine both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and desipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and desipramine both increase sedation. Use Caution/Monitor.

• lsd

  desipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lurasidone

  lurasidone increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• maprotiline

  desipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and maprotiline both increase sedation. Use Caution/Monitor.

• maraviroc

  maraviroc will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• marijuana

  marijuana will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  meclizine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• melatonin

  desipramine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and desipramine both increase sedation. Use Caution/Monitor.

• meprobamate

  desipramine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  desipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and desipramine both increase sedation. Use Caution/Monitor.

• methadone

  desipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and desipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  desipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and desipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylenedioxymethamphetamine

  desipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylphenidate

  desipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate transdermal

  methylphenidate transdermal will increase the level or effect of desipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• midazolam

  midazolam and desipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  desipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  mifepristone, desipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• mirabegron

  mirabegron will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  desipramine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  desipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• modafinil

  desipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• motherwort

  desipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  desipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  desipramine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and desipramine both increase sedation. Use Caution/Monitor.

• naldemedine

  desipramine increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

• naratriptan

  naratriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nefopam

  nefopam, desipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  nelfinavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nilotinib

  nilotinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• norepinephrine

  desipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  desipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.

• nortriptyline

  desipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and nortriptyline both increase sedation. Use Caution/Monitor.

• ofloxacin

  desipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  olanzapine and desipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and desipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  desipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

• olodaterol inhaled

  desipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• opium tincture

  opium tincture and desipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  desipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and desipramine both increase sedation. Use Caution/Monitor.

• osilodrostat

  osilodrostat and desipramine both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and desipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  oxazepam and desipramine both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  oxybutynin topical and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  oxybutynin transdermal and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  oxycodone and desipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  desipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.

• oxymorphone

  oxymorphone and desipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod and desipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  desipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and desipramine both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• panobinostat

  panobinostat will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.

• papaveretum

  papaveretum and desipramine both increase sedation. Use Caution/Monitor.

• papaverine

  desipramine and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib

  parecoxib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• paroxetine

  desipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  desipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  desipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  peginterferon alfa 2b, desipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentazocine

  pentazocine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital and desipramine both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  perphenazine and desipramine both increase sedation. Use Caution/Monitor.

• phendimetrazine

  desipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  phenobarbital and desipramine both increase sedation. Use Caution/Monitor.

• phentermine

  desipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  desipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine ophthalmic

  desipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  desipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  desipramine and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  pimozide and desipramine both increase sedation. Use Caution/Monitor.

• pirbuterol

  desipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  desipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  pralidoxime and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  pregabalin, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  primidone and desipramine both increase sedation. Use Caution/Monitor.

• prochlorperazine

  prochlorperazine and desipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and desipramine both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and desipramine both increase QTc interval. Use Caution/Monitor.
  
  promethazine and desipramine both increase sedation. Use Caution/Monitor.

• propafenone

  propafenone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propantheline

  propantheline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  propofol and desipramine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  desipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  desipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and desipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine and desipramine both increase sedation. Use Caution/Monitor.
  
  quetiapine, desipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinacrine

  quinacrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quinine

  desipramine and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  desipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  ranolazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  rapacuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• remimazolam

  remimazolam, desipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rifabutin

  rifabutin decreases levels of desipramine by increasing metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of desipramine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• risperidone

  desipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and desipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  ritonavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• rizatriptan

  rizatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  rocuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  rolapitant will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  desipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• salmeterol

  desipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• SAMe

  desipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• scopolamine

  scopolamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  desipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and desipramine both increase sedation. Use Caution/Monitor.

• selpercatinib

  selpercatinib increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• sevoflurane

  sevoflurane and desipramine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and desipramine both increase QTc interval. Use Caution/Monitor.

• shepherd's purse

  desipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of desipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of desipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  desipramine, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• solifenacin

  solifenacin and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  solifenacin and desipramine both increase QTc interval. Use Caution/Monitor.

• sorafenib

  sorafenib and desipramine both increase QTc interval. Use Caution/Monitor.

• stiripentol

  stiripentol, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  sufentanil and desipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  sufentanil SL, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  desipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

• sumatriptan

  sumatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  suvorexant and desipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  desipramine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• tamsulosin

  desipramine increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
  
  desipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  tapentadol and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• telavancin

  desipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and desipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  desipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tetrabenazine

  tetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  thioridazine and desipramine both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and thiothixene both increase QTc interval. Use Caution/Monitor.

• thyroid desiccated

  thyroid desiccated increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  tiotropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tofacitinib

  desipramine increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolterodine

  tolterodine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  desipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• trazodone

  desipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and desipramine both increase sedation. Use Caution/Monitor.

• triclofos

  triclofos and desipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and desipramine both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  trihexyphenidyl and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  desipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  desipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and desipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  desipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  trospium chloride and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• valbenazine

  valbenazine and desipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  valerian and desipramine both increase sedation. Use Caution/Monitor.

• vecuronium

  vecuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• venlafaxine

  venlafaxine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• voclosporin

  voclosporin, desipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  desipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• xylometazoline

  desipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  desipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  desipramine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  ziprasidone and desipramine both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (98)

• acarbose

  desipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• amobarbital

  amobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• anticholinergic/sedative combos

  anticholinergic/sedative combos and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• atracurium

  atracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• atropine

  atropine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.
  
  desipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  desipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• belladonna alkaloids

  belladonna alkaloids and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• benztropine

  benztropine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• bethanechol

  bethanechol increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• brimonidine

  desipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• butabarbital

  butabarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  butalbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• carbachol

  carbachol increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• carbamazepine

  carbamazepine decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown.

• cevimeline

  cevimeline increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• chlorpromazine

  desipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  desipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• cisatracurium

  cisatracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• cyclizine

  cyclizine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• cyclobenzaprine

  cyclobenzaprine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• darifenacin

  darifenacin and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• desflurane

  desflurane, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• dexmethylphenidate

  dexmethylphenidate increases effects of desipramine by decreasing metabolism. Minor/Significance Unknown.

• dicyclomine

  dicyclomine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• diphenhydramine

  diphenhydramine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.
  
  desipramine and diphenhydramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• donepezil

  donepezil increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• echothiophate iodide

  echothiophate iodide increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• estradiol

  estradiol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  estrogens conjugated synthetic, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  estrogens esterified, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  estropipate, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethanol

  ethanol decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• ethinylestradiol

  ethinylestradiol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

• etomidate

  etomidate, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  desipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fesoterodine

  fesoterodine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• flavoxate

  flavoxate and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• fluphenazine

  desipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• galantamine

  galantamine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• glimepiride

  desipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  desipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  desipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate

  glycopyrrolate and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• glycopyrrolate inhaled

  glycopyrrolate inhaled and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• hydroxyprogesterone caproate (DSC)

  hydroxyprogesterone caproate (DSC), desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• insulin aspart

  desipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  desipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  desipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  desipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  desipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  desipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  desipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• isoproterenol

  isoproterenol, desipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• ketamine

  ketamine, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• lithium

  lithium, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• mestranol

  mestranol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metformin

  desipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• miglitol

  desipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• nateglinide

  desipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• neostigmine

  neostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• onabotulinumtoxinA

  onabotulinumtoxinA and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• panax ginseng

  panax ginseng increases effects of desipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  desipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phenobarbital

  phenobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• physostigmine

  physostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• pilocarpine

  pilocarpine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• pioglitazone

  desipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of desipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• primidone

  primidone, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• prochlorperazine

  desipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  progesterone micronized, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  desipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  desipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propofol

  propofol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• pyridostigmine

  pyridostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• repaglinide

  desipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• rivastigmine

  rivastigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• rosiglitazone

  desipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• sage

  desipramine and sage both increase sedation. Minor/Significance Unknown.

• saxagliptin

  desipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• secobarbital

  secobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of desipramine by decreasing metabolism. Minor/Significance Unknown.

• sevoflurane

  sevoflurane, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• sitagliptin

  desipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• succinylcholine

  succinylcholine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole decreases levels of desipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• thioridazine

  desipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• tolazamide

  desipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  desipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• trifluoperazine

  desipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• vasopressin

  desipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• verapamil

  verapamil increases levels of desipramine by decreasing metabolism. Minor/Significance Unknown.

• vildagliptin

  desipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• zolpidem

  zolpidem, desipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• 5-HTP

  Monitor Closely (1)desipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  Monitor Closely (1)abobotulinumtoxinA increases effects of desipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• acarbose

  Minor (1)desipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• aclidinium

  Monitor Closely (1)aclidinium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  Monitor Closely (1)acrivastine and desipramine both increase sedation. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib, desipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (2)desipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and desipramine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• alfentanil

  Monitor Closely (1)alfentanil and desipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (2)desipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and desipramine both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  Monitor Closely (1)alprazolam and desipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  Monitor Closely (1)desipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Monitor Closely (1)amiodarone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Monitor Closely (2)desipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.
  
  amisulpride and desipramine both increase sedation. Use Caution/Monitor.

• amitriptyline

  Monitor Closely (2)amitriptyline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• amoxapine

  Monitor Closely (2)amoxapine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amoxapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• anagrelide

  Monitor Closely (1)anagrelide and desipramine both increase QTc interval. Use Caution/Monitor.

• anticholinergic/sedative combos

  Minor (1)anticholinergic/sedative combos and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• apomorphine

  Monitor Closely (2)desipramine and apomorphine both increase sedation. Use Caution/Monitor.
  
  apomorphine and desipramine both increase QTc interval. Use Caution/Monitor.

• arformoterol

  Monitor Closely (2)desipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and desipramine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• aripiprazole

  Monitor Closely (2)aripiprazole and desipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and desipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  Monitor Closely (1)desipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arsenic trioxide

  Serious - Use Alternative (1)desipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  Serious - Use Alternative (1)artemether and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (2)desipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  
  artemether/lumefantrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• asenapine

  Monitor Closely (3)asenapine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and desipramine both increase sedation. Use Caution/Monitor.
  
  asenapine and desipramine both increase QTc interval. Use Caution/Monitor.

• asenapine transdermal

  Monitor Closely (2)asenapine transdermal and desipramine both increase QTc interval. Use Caution/Monitor.
  
  asenapine transdermal and desipramine both increase sedation. Use Caution/Monitor.

• atazanavir

  Monitor Closely (1)atazanavir increases levels of desipramine by unspecified interaction mechanism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (1)atomoxetine and desipramine both increase QTc interval. Use Caution/Monitor.

• atracurium

  Minor (1)atracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• atropine

  Minor (2)atropine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.
  
  desipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  Monitor Closely (1)atropine IV/IM and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)desipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• avapritinib

  Monitor Closely (1)avapritinib and desipramine both increase sedation. Use Caution/Monitor.

• axitinib

  Serious - Use Alternative (1)desipramine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• azelastine

  Monitor Closely (1)azelastine and desipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)desipramine and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and desipramine both increase sedation. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  Minor (1)bazedoxifene/conjugated estrogens, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bedaquiline

  Monitor Closely (1)desipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Minor (1)belladonna alkaloids and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• belladonna and opium

  Monitor Closely (2)belladonna and opium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and desipramine both increase sedation. Use Caution/Monitor.

• benperidol

  Monitor Closely (1)benperidol and desipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.Serious - Use Alternative (1)benzhydrocodone/acetaminophen and desipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  Monitor Closely (1)desipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• benztropine

  Minor (1)benztropine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• bethanechol

  Minor (1)bethanechol increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• bosutinib

  Serious - Use Alternative (1)desipramine increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• brexpiprazole

  Monitor Closely (2)desipramine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
  
  brexpiprazole and desipramine both increase sedation. Use Caution/Monitor.

• brimonidine

  Monitor Closely (1)brimonidine and desipramine both increase sedation. Use Caution/Monitor.Minor (1)desipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• brivaracetam

  Monitor Closely (1)brivaracetam and desipramine both increase sedation. Use Caution/Monitor.

• brompheniramine

  Monitor Closely (1)brompheniramine and desipramine both increase sedation. Use Caution/Monitor.

• buprenorphine

  Monitor Closely (1)buprenorphine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)desipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (2)buprenorphine subdermal implant and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine subdermal implant and desipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Monitor Closely (1)desipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• bupropion

  Monitor Closely (2)bupropion will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.

• buspirone

  Serious - Use Alternative (1)desipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  Monitor Closely (1)butalbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)butalbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butorphanol

  Monitor Closely (1)butorphanol and desipramine both increase sedation. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)desipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)desipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• carbachol

  Minor (1)carbachol increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• carbamazepine

  Minor (1)carbamazepine decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and desipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and desipramine both increase sedation. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)celecoxib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cenobamate

  Monitor Closely (1)cenobamate, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  Monitor Closely (1)ceritinib and desipramine both increase QTc interval. Use Caution/Monitor.

• cevimeline

  Minor (1)cevimeline increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and desipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and desipramine both increase sedation. Use Caution/Monitor.

• chloroquine

  Monitor Closely (2)chloroquine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  chloroquine increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and desipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  Minor (1)desipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and desipramine both increase sedation. Use Caution/Monitor.

• cimetidine

  Monitor Closely (1)cimetidine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and desipramine both increase sedation. Use Caution/Monitor.

• cisapride

  Monitor Closely (1)desipramine and cisapride both increase QTc interval. Use Caution/Monitor.

• cisatracurium

  Minor (1)cisatracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• citalopram

  Serious - Use Alternative (2)citalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  desipramine and citalopram both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (1)desipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and desipramine both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (2)clobazam will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  desipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Monitor Closely (2)clomipramine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonazepam

  Monitor Closely (1)clonazepam and desipramine both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)desipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clorazepate

  Monitor Closely (1)clorazepate and desipramine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine and desipramine both increase sedation. Use Caution/Monitor.
  
  clozapine and desipramine both increase QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (2)cobicistat will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of desipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

• cocaine topical

  Monitor Closely (1)desipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (2)codeine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• conjugated estrogens

  Minor (1)conjugated estrogens, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• crizotinib

  Monitor Closely (1)crizotinib and desipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  Monitor Closely (1)cyclizine and desipramine both increase sedation. Use Caution/Monitor.Minor (1)cyclizine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.Minor (1)cyclobenzaprine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and desipramine both increase sedation. Use Caution/Monitor.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and desipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)desipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (1)darifenacin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Minor (1)darifenacin and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• dasatinib

  Monitor Closely (1)desipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  Monitor Closely (1)desipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• degarelix

  Monitor Closely (1)degarelix and desipramine both increase QTc interval. Use Caution/Monitor.

• desflurane

  Monitor Closely (2)desflurane and desipramine both increase sedation. Use Caution/Monitor.
  
  desflurane and desipramine both increase QTc interval. Use Caution/Monitor.Minor (1)desflurane, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• desvenlafaxine

  Monitor Closely (1)desvenlafaxine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)desipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (2)desipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and desipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)desipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dexfenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and desipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)desipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)dexmethylphenidate increases effects of desipramine by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine

  Monitor Closely (3)desipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
  
  desipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dextroamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dextroamphetamine transdermal

  Monitor Closely (1)desipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromethorphan

  Serious - Use Alternative (1)desipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromoramide

  Monitor Closely (1)dextromoramide and desipramine both increase sedation. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine and desipramine both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and desipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, desipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dicyclomine

  Minor (1)dicyclomine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• diethylpropion

  Monitor Closely (1)desipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, diethylpropion. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• difelikefalin

  Monitor Closely (1)difelikefalin and desipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and desipramine both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Monitor Closely (1)desipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)desipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and desipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (2)diphenhydramine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  diphenhydramine and desipramine both increase sedation. Use Caution/Monitor.Minor (2)diphenhydramine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.
  
  desipramine and diphenhydramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and desipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and desipramine both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)desipramine and disopyramide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)desipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dobutamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dofetilide

  Serious - Use Alternative (2)desipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of desipramine by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)desipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dolasetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  Monitor Closely (1)donepezil and desipramine both increase QTc interval. Use Caution/Monitor.Minor (1)donepezil increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• dopamine

  Monitor Closely (1)desipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dopamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dopexamine

  Monitor Closely (1)desipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, dopexamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• dosulepin

  Monitor Closely (2)desipramine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and dosulepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  Monitor Closely (2)desipramine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and desipramine both increase sedation. Use Caution/Monitor.

• dronedarone

  Monitor Closely (1)dronedarone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  Monitor Closely (1)droperidol and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Monitor Closely (1)duloxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)duloxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• echothiophate iodide

  Minor (1)echothiophate iodide increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• efavirenz

  Monitor Closely (1)efavirenz and desipramine both increase QTc interval. Use Caution/Monitor.

• eletriptan

  Monitor Closely (1)eletriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  Contraindicated (1)desipramine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.Monitor Closely (2)eliglustat increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and desipramine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)desipramine increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Serious - Use Alternative (1)encorafenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Monitor Closely (1)entrectinib and desipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  Monitor Closely (2)desipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
  
  desipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine

  Monitor Closely (2)desipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  desipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• epinephrine inhaled

  Monitor Closely (1)desipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  Monitor Closely (2)desipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
  
  desipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ergotamine

  Monitor Closely (1)desipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Monitor Closely (1)eribulin and desipramine both increase QTc interval. Use Caution/Monitor.

• erythromycin base

  Serious - Use Alternative (1)desipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)desipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)desipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)desipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Monitor Closely (1)escitalopram increases toxicity of desipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, desipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  Monitor Closely (1)estazolam and desipramine both increase sedation. Use Caution/Monitor.

• estradiol

  Minor (1)estradiol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  Minor (1)estrogens esterified, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  Minor (1)estropipate, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethanol

  Monitor Closely (1)desipramine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• ethinylestradiol

  Minor (1)ethinylestradiol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Oxidative metabolism of TCAs may be decreased by ethinyl estradiol. Increased antidepressant serum concentrations may occur. Potential for increased TCA adverse effects.

• etomidate

  Monitor Closely (1)etomidate and desipramine both increase sedation. Use Caution/Monitor.Minor (1)etomidate, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• eucalyptus

  Minor (1)desipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, desipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  Monitor Closely (3)fenfluramine, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  desipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, fenfluramine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fesoterodine

  Minor (1)fesoterodine and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• fexinidazole

  Serious - Use Alternative (1)fexinidazole and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fingolimod

  Monitor Closely (1)fingolimod and desipramine both increase QTc interval. Use Caution/Monitor.

• flavoxate

  Minor (1)flavoxate and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• flecainide

  Monitor Closely (1)desipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole

  Serious - Use Alternative (1)desipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  Monitor Closely (1)desipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  fluoxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (1)fluphenazine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• flurazepam

  Monitor Closely (1)flurazepam and desipramine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and desipramine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluvoxamine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)desipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine, formoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• fosamprenavir

  Serious - Use Alternative (1)fosamprenavir increases levels of desipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• foscarnet

  Monitor Closely (1)desipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fostemsavir

  Monitor Closely (1)desipramine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  Monitor Closely (1)frovatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  Monitor Closely (1)gabapentin, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  Minor (1)galantamine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• ganaxolone

  Monitor Closely (1)desipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and desipramine both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Monitor Closely (1)gilteritinib and desipramine both increase QTc interval. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glimepiride

  Minor (1)desipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  Minor (1)desipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  Minor (1)desipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate

  Monitor Closely (1)desipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.Minor (1)glycopyrrolate and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• glycopyrrolate inhaled

  Monitor Closely (1)desipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.Minor (1)glycopyrrolate inhaled and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• glycopyrronium tosylate topical

  Monitor Closely (1)glycopyrronium tosylate topical, desipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• goserelin

  Monitor Closely (1)desipramine and goserelin both increase QTc interval. Use Caution/Monitor.

• granisetron

  Serious - Use Alternative (2)granisetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  granisetron and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• guanfacine

  Serious - Use Alternative (1)desipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  Monitor Closely (1)haloperidol and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
  
  haloperidol will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• henbane

  Monitor Closely (1)henbane and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  Monitor Closely (1)homatropine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  Monitor Closely (1)huperzine A increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  Monitor Closely (1)hydrocodone, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Monitor Closely (1)hydromorphone and desipramine both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  Minor (1)hydroxyprogesterone caproate (DSC), desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and desipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and desipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  Monitor Closely (1)hyoscyamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  Monitor Closely (1)hyoscyamine spray and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibrutinib

  Monitor Closely (1)desipramine increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• ibutilide

  Contraindicated (1)desipramine and ibutilide both increase QTc interval. Contraindicated.

• iloperidone

  Monitor Closely (2)desipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and desipramine both increase sedation. Use Caution/Monitor.

• imatinib

  Monitor Closely (2)imatinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine will increase the level or effect of imatinib by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  Monitor Closely (2)desipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, desipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Contraindicated (1)desipramine and indapamide both increase QTc interval. Contraindicated.

• insulin aspart

  Minor (1)desipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  Minor (1)desipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  Minor (1)desipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  Minor (1)desipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  Minor (1)desipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  Minor (1)desipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  Minor (1)desipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• iobenguane I 123

  Contraindicated (1)desipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• iobenguane I 131

  Serious - Use Alternative (1)desipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• ipratropium

  Monitor Closely (1)ipratropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isocarboxazid

  Contraindicated (1)isocarboxazid and desipramine both increase serotonin levels. Contraindicated.

• isoflurane

  Monitor Closely (1)isoflurane and desipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  Monitor Closely (1)desipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  Monitor Closely (1)desipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, isoproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)isoproterenol, desipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• itraconazole

  Monitor Closely (1)itraconazole and desipramine both increase QTc interval. Use Caution/Monitor.

• ivosidenib

  Serious - Use Alternative (1)ivosidenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketamine

  Monitor Closely (1)ketamine and desipramine both increase sedation. Use Caution/Monitor.Minor (1)ketamine, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• ketoconazole

  Serious - Use Alternative (1)desipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic

  Monitor Closely (1)desipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  Monitor Closely (1)desipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  Monitor Closely (1)desipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  Monitor Closely (2)lasmiditan, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  desipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lefamulin

  Serious - Use Alternative (1)lefamulin and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  Monitor Closely (1)lemborexant, desipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• levalbuterol

  Monitor Closely (1)desipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• levofloxacin

  Monitor Closely (1)desipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Serious - Use Alternative (1)desipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)levorphanol and desipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  Monitor Closely (1)levothyroxine increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• linezolid

  Serious - Use Alternative (1)linezolid and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• liothyronine

  Monitor Closely (1)liothyronine increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• liotrix

  Monitor Closely (1)liotrix increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• lisdexamfetamine

  Monitor Closely (2)desipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).
  
  desipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, lisdexamfetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lithium

  Monitor Closely (2)desipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and desipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• lofepramine

  Monitor Closely (2)desipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and lofepramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (2)desipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
  
  desipramine and lofexidine both increase sedation. Use Caution/Monitor.

• lomitapide

  Contraindicated (1)desipramine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• loprazolam

  Monitor Closely (1)loprazolam and desipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and desipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lormetazepam

  Monitor Closely (1)lormetazepam and desipramine both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine and desipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled and desipramine both increase sedation. Use Caution/Monitor.

• lsd

  Monitor Closely (1)desipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumefantrine

  Serious - Use Alternative (2)desipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  
  lumefantrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• lurasidone

  Monitor Closely (1)lurasidone increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• macimorelin

  Serious - Use Alternative (1)macimorelin and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (2)desipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• maraviroc

  Monitor Closely (1)maraviroc will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• marijuana

  Monitor Closely (2)marijuana will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  Monitor Closely (1)meclizine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• melatonin

  Monitor Closely (1)desipramine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• meprobamate

  Monitor Closely (1)desipramine and meprobamate both increase sedation. Use Caution/Monitor.

• mestranol

  Minor (1)mestranol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• metaproterenol

  Monitor Closely (1)desipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, metaproterenol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• metaxalone

  Monitor Closely (1)metaxalone and desipramine both increase sedation. Use Caution/Monitor.

• metformin

  Minor (1)desipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methadone

  Monitor Closely (2)desipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and desipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)desipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, methamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methocarbamol

  Monitor Closely (1)methocarbamol and desipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (1)methscopolamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• methylenedioxymethamphetamine

  Monitor Closely (1)desipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, methylenedioxymethamphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate

  Monitor Closely (1)desipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methylphenidate transdermal

  Monitor Closely (1)methylphenidate transdermal will increase the level or effect of desipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

• metoclopramide intranasal

  Serious - Use Alternative (1)desipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midazolam

  Monitor Closely (1)midazolam and desipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)desipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, midodrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• mifepristone

  Monitor Closely (1)mifepristone, desipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  Minor (1)desipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• milnacipran

  Serious - Use Alternative (1)milnacipran and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (2)desipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)desipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (2)desipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  morphine and desipramine both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)desipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)desipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)desipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)desipramine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine and desipramine both increase sedation. Use Caution/Monitor.

• naldemedine

  Monitor Closely (1)desipramine increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

• naratriptan

  Monitor Closely (1)naratriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nateglinide

  Minor (1)desipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nefazodone

  Serious - Use Alternative (1)nefazodone and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• nefopam

  Monitor Closely (1)nefopam, desipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  Monitor Closely (1)nelfinavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• neostigmine

  Minor (1)neostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  Monitor Closely (1)nilotinib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  Monitor Closely (2)desipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
  
  desipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• nortriptyline

  Monitor Closely (2)desipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)desipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)desipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)desipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (2)olanzapine and desipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and desipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  Monitor Closely (2)desipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
  
  desipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

• olodaterol inhaled

  Monitor Closely (1)desipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)desipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• onabotulinumtoxinA

  Minor (1)onabotulinumtoxinA and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

• ondansetron

  Serious - Use Alternative (2)desipramine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• opium tincture

  Monitor Closely (1)opium tincture and desipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (2)desipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and desipramine both increase sedation. Use Caution/Monitor.

• osilodrostat

  Monitor Closely (1)osilodrostat and desipramine both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and desipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxazepam

  Monitor Closely (1)oxazepam and desipramine both increase sedation. Use Caution/Monitor.

• oxybutynin

  Monitor Closely (1)oxybutynin and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  Monitor Closely (1)oxybutynin topical and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  Monitor Closely (1)oxybutynin transdermal and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone and desipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  Monitor Closely (1)desipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.

• oxymorphone

  Monitor Closely (1)oxymorphone and desipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and desipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of desipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (2)desipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and desipramine both increase sedation. Use Caution/Monitor.

• palonosetron

  Serious - Use Alternative (1)palonosetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng

  Minor (1)panax ginseng increases effects of desipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pancuronium

  Monitor Closely (1)pancuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• panobinostat

  Monitor Closely (1)panobinostat will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.Serious - Use Alternative (1)desipramine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• papaveretum

  Monitor Closely (1)papaveretum and desipramine both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)desipramine and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib

  Monitor Closely (1)parecoxib will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)desipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  paroxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)desipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)desipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon alfa 2b, desipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentamidine

  Contraindicated (1)desipramine and pentamidine both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (2)desipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and desipramine both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  Monitor Closely (2)perphenazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  perphenazine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phendimetrazine

  Monitor Closely (1)desipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, phendimetrazine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenelzine

  Contraindicated (1)phenelzine and desipramine both increase serotonin levels. Contraindicated.

• phenobarbital

  Monitor Closely (1)phenobarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• phentermine

  Monitor Closely (1)desipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, phentermine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine

  Monitor Closely (1)desipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, phenylephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine ophthalmic

  Monitor Closely (1)desipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenylephrine PO

  Monitor Closely (1)desipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)desipramine, phenylephrine PO. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pholcodine

  Monitor Closely (1)desipramine and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  Minor (1)physostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• pilocarpine

  Minor (1)pilocarpine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• pimozide

  Contraindicated (1)desipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and desipramine both increase sedation. Use Caution/Monitor.

• pioglitazone

  Minor (1)desipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pirbuterol

  Monitor Closely (1)desipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, pirbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pitolisant

  Serious - Use Alternative (1)desipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• pleurisy root

  Minor (1)pleurisy root decreases effects of desipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  Monitor Closely (1)desipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  Monitor Closely (1)pralidoxime and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  Monitor Closely (1)pregabalin, desipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  Monitor Closely (1)primidone and desipramine both increase sedation. Use Caution/Monitor.Minor (1)primidone, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• procainamide

  Contraindicated (1)desipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Contraindicated (1)procarbazine and desipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine

  Monitor Closely (2)prochlorperazine and desipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and desipramine both increase sedation. Use Caution/Monitor.Minor (2)desipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  Minor (1)progesterone micronized, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  Serious - Use Alternative (1)promazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  Monitor Closely (2)promethazine and desipramine both increase QTc interval. Use Caution/Monitor.
  
  promethazine and desipramine both increase sedation. Use Caution/Monitor.Minor (2)desipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propafenone

  Monitor Closely (1)propafenone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propantheline

  Monitor Closely (1)propantheline and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  Monitor Closely (1)propofol and desipramine both increase sedation. Use Caution/Monitor.Minor (1)propofol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• propylhexedrine

  Monitor Closely (1)desipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, propylhexedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• protriptyline

  Monitor Closely (2)desipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  Serious - Use Alternative (1)desipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pyridostigmine

  Minor (1)pyridostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• quazepam

  Monitor Closely (1)quazepam and desipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (2)quetiapine and desipramine both increase sedation. Use Caution/Monitor.
  
  quetiapine, desipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinacrine

  Monitor Closely (1)quinacrine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quinidine

  Contraindicated (1)quinidine and desipramine both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)desipramine and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  Monitor Closely (1)desipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (2)ranolazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  Monitor Closely (1)rapacuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remimazolam

  Monitor Closely (1)remimazolam, desipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide

  Minor (1)desipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• ribociclib

  Serious - Use Alternative (1)ribociclib increases toxicity of desipramine by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin decreases levels of desipramine by increasing metabolism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of desipramine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• risperidone

  Monitor Closely (2)desipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and desipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  Monitor Closely (1)ritonavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• rivastigmine

  Minor (1)rivastigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• rizatriptan

  Monitor Closely (1)rizatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  Monitor Closely (1)rocuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  Monitor Closely (1)desipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• rosiglitazone

  Minor (1)desipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• safinamide

  Contraindicated (1)desipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sage

  Minor (1)desipramine and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)desipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, salmeterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• SAMe

  Monitor Closely (1)desipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saxagliptin

  Minor (1)desipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• scopolamine

  Monitor Closely (1)scopolamine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)desipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)secobarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• selegiline

  Contraindicated (1)selegiline and desipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  Serious - Use Alternative (1)selinexor, desipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of desipramine by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Serious - Use Alternative (1)desipramine, serdexmethylphenidate/dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of desipramine by decreasing metabolism. Minor/Significance Unknown.

• sertraline

  Monitor Closely (1)sertraline will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  desipramine and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Monitor Closely (2)sevoflurane and desipramine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and desipramine both increase QTc interval. Use Caution/Monitor.Minor (1)sevoflurane, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• shepherd's purse

  Monitor Closely (1)desipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sitagliptin

  Minor (1)desipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sodium oxybate

  Serious - Use Alternative (1)desipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of desipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of desipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)desipramine, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• solifenacin

  Monitor Closely (2)solifenacin and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  solifenacin and desipramine both increase QTc interval. Use Caution/Monitor.

• sorafenib

  Monitor Closely (1)sorafenib and desipramine both increase QTc interval. Use Caution/Monitor.

• sotalol

  Contraindicated (1)desipramine and sotalol both increase QTc interval. Contraindicated.

• St John's Wort

  Serious - Use Alternative (1)desipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (1)stiripentol, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• succinylcholine

  Minor (1)succinylcholine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

• sufentanil

  Monitor Closely (1)sufentanil and desipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, desipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sulfamethoxazole

  Monitor Closely (1)desipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of desipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• sumatriptan

  Monitor Closely (1)sumatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  Monitor Closely (1)suvorexant and desipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  Monitor Closely (1)desipramine and tacrolimus both increase QTc interval. Use Caution/Monitor.

• tamsulosin

  Monitor Closely (2)desipramine increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
  
  desipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  Monitor Closely (2)desipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tapentadol and desipramine both increase sedation. Use Caution/Monitor.

• tedizolid

  Serious - Use Alternative (1)tedizolid, desipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin

  Monitor Closely (1)desipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam and desipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (1)desipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, terbutaline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• tetrabenazine

  Monitor Closely (1)tetrabenazine and desipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  Contraindicated (1)thioridazine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Monitor Closely (1)thioridazine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• thiothixene

  Monitor Closely (2)thiothixene and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine and thiothixene both increase QTc interval. Use Caution/Monitor.

• thyroid desiccated

  Monitor Closely (1)thyroid desiccated increases effects of desipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  Monitor Closely (1)tiotropium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tofacitinib

  Monitor Closely (1)desipramine increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolazamide

  Minor (1)desipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  Minor (1)desipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolterodine

  Monitor Closely (1)tolterodine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)desipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• toremifene

  Serious - Use Alternative (1)desipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• tramadol

  Monitor Closely (2)desipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tramadol and desipramine both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Contraindicated (1)tranylcypromine and desipramine both increase serotonin levels. Contraindicated.

• trazodone

  Monitor Closely (2)desipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and desipramine both increase sedation. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and desipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)desipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  desipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trihexyphenidyl

  Monitor Closely (1)trihexyphenidyl and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  Monitor Closely (1)desipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Monitor Closely (2)desipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  desipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)desipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  desipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triprolidine

  Monitor Closely (1)triprolidine and desipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  Monitor Closely (1)desipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  Monitor Closely (1)trospium chloride and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (2)desipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  desipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• valbenazine

  Monitor Closely (1)valbenazine and desipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  Monitor Closely (1)valerian and desipramine both increase sedation. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)desipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vasopressin

  Minor (1)desipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• vecuronium

  Monitor Closely (1)vecuronium and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and desipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Monitor Closely (2)venlafaxine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  desipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• verapamil

  Minor (1)verapamil increases levels of desipramine by decreasing metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (2)desipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  desipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)desipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vildagliptin

  Minor (1)desipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• voclosporin

  Monitor Closely (1)voclosporin, desipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (1)desipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• vortioxetine

  Serious - Use Alternative (1)desipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• xylometazoline

  Monitor Closely (1)desipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• yohimbe

  Serious - Use Alternative (1)yohimbe, desipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  Monitor Closely (1)desipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)desipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ziconotide

  Monitor Closely (1)desipramine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• zolpidem

  Minor (1)zolpidem, desipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.