Reactions 411 - 25 Jul 1992

Desipramine

Neurological manifestations and elevated serumlevels after switching from fluoxetine: 2 casereports

Two women with depression developed toxicity after theinitiation of desipramine therapy which was administered aftertheir depressive symptoms had failed to respond to fluoxetine.

The patients, aged 27 and 54 years, respectively, had beentreated with fluoxetine 60-80 mg/day for 3-4 months.Fluoxetine was withdrawn and, after 4-7 days, desipraminewas initiated (dosage slowly increased to 100-150 mg/day).After 2-4 weeks of desipramine, the patients both experiencedlight headedness and other symptoms including visualhallucinations and syncopal episodes.

In the first woman, the serum desipramine level fell from604 to 277 ng/ml 2 weeks after her desipramine dose had beendecreased to 75 mg/day; her adverse symptoms also resolved.In the second woman, the adverse effects resolved only afterdesipramine was discontinued and her serum desipraminelevels fell from 480 to 96 ng/ml.

Subsequently, over 12-15 weeks, the desipramine dose wasincreased to 300 mg/day in the first woman and desipraminewas restarted (dosage reaching 150 mg/day) in the secondwoman. No further adverse effects were experienced by eitherpatient and depression resolved in both.

Author comment: An antidepressant-free period as long as 5weeks may be required when switching from fluoxetine to atricyclic antidepressant, or else smaller doses of the tricyclicshould be prescribed during the initial 5-week periodVan Ameringen M, et al. Adverse effects of switching from fluoxetine todesipramine. Canadian Journal of Psychiatry 37: 278, May 1992 -Canada 800144853

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Reactions 25 Jul 1992 No. 4110114-9954/10/0411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved