Desipramine Skin rash: incidence study

The prevalence , characteristics and outcome of dermatological reactions with desipramine treatment were assessed in 205 children and adolescents (aged 5-17 years) over 3 years. Treatment was initiated at 10 or 25 mg/day and increased to 5mg/kg/ day over 3 weeks Patients received either a commercial desipramine preparation ('Norpramin') , an active study desipramine preparation or placebo . If required , the placebo­treated patients received a further 6 weeks ' treatment with desipramine (open).

Skin rash developed within 4 weeks in 2, 5, 1 and 5 patients treated with commercial , study, placebo or open label desipramine preparations, respectively (1 .5, 14.7, 2.9 and 18.5%). All symptoms resolved within 2-7 days. Following withdrawal of desipramine treatment in 4 patients , rechallenge (n=3) or alternative treatment with nortriptyline (1) failed to provoke a recurrence of the rash. Desipramine therapy was continued in the remaining 8 patients ; 1 experienced a relapse 2 weeks later.

Of the 12 patients who developed a skin rash, 3 had a history of allergy and 6 patients had a family history of drug allergy. While only 3 patients with a rash were able to be examined , the performance of punch biopsy in 1 patient , the appearance of the skin conditions in the other 2 patients and the descriptions of the remaining patients ' conditions were consistent with a drug-induced eruption .

Although a desipramine reaction was the probable cause, the yellow dyes used may also have been a causative factor. Until the mechanism of desipramine-induced rashes has been determined ' ... rechallenglng patients who clinically respond to the drug with only a mild cutaneous eruption and keeping them under close medical supervision seems a prudent approach'.

BIederman J, Gonzalez E, BronsteIn B, De Monaco H, Wright V Journal of Clinical Psychlalry 49 178·183, May 1988 [33 references 1 14"

8 REACTlONS® 20 Aug 1988 0157-7271 / 88/ 0820-0008/ 0$01 ,00/ 0 © ADIS Press