Desipramine First report of testicular swelling: 2 * cases

Case 1: A 54-year-old man with major depression received desipramine 50 mg/day titrated to 100 mg/day on admission. The patient had no history of adverse drug reactions or genitourinary tract disorders and was receiving ibuprofen 1600 mg/day for pseudogout. A general physical and neurologic examination and laboratory tests were normal. On increasing desipramine dose to 150 mg/day, the patient developed bilateral testicular swelling and a small right testicular hydrocaele. The symptoms disappeared within 5 days of withdrawing desipramine treatment and the patient received maprotiline 200 mg/day without recurrence of testicular swelling or discomfort.

Case 2: A 33-year-old man received imipramine 75 mg/day, increasing to 200 mg/day, for the treatment of a major depressive disorder with panic attacks. The patient had recurrent pyelonephritis and, on admission, physical and neurologic examinations and laboratory tests were normal. Urinary retention and symptomatic postural hypotension developed at an imipramine dose of 200 mg/day (serum imipramine and desipramine concentrations were both less than 25 ng/ml) and imipramine was replaced by desipramine 75 mg/day. At a desipramine dose of 150 mg/day the patient developed testicular swelling which was relieved with warm baths within 4 days without discontinuing desipramine treatment. No further testicular swelling or urinary retention occurred when desipramine 200 mg/ day was given, or during the 4 months after discharge when the desipramine dose was increased to 300 mg/day.

'Both case reports suggest that desipramine may Induce testicular swelling and discomfort In susceptible Indlllidua/s ... ' but it is unclear whether this is a dose-related or idiosyncratic response. Deicken RF. Carr RE. Journal of Clinical Psychiatry 48: 251·252. Jun 1987

6 REACTIONS~ 11 July 1987 0157-7271/87/0711-0006/0$01.00/0 © ADIS Press