| Field Name |
Data Description |
| Test Name |
Desipramine Level |
| Code |
Desipramine Level. |
|
CPT Code |
80335 |
| Last Modified |
|
| Test Name |
Desipramin. |
| Synonyms |
Norpramin |
| Patient Preparation |
|
| Spec. Requirements |
Blood |
| Tube |
Red, Lavender(EDTA), Green(Heparin-no gel) |
| Collection Volume |
4.0 mL Red, 2.0 mL Lavender, 4.0 mL Green |
| Storage |
Ambient, Refrigerate or Freeze 14 days |
| Routine TAT |
|
| STAT TAT |
N/A |
| Days Test Performed |
|
| Performed by BHS |
None |
| See Availability |
|
| Reference Lab |
LabCorp of America |
| Reference Lab Code |
007765 Desipramine |
| Clinical Use |
Desipramine, a metabolite of imipramine, has actions and uses similar to those of the parent compound and is as effective as imipramine in the treatment of mood disorders. Untoward effects are similar to those produced by imipramine, but anticholinergic and sedative actions are less pronounced. Thus, desipramine may be especially useful in patients who are particularly sensitive to these effects (eg, the elderly). All the tricyclic antidepressants have significant DRUG INTERACTIONS. Being potent inducers of hepatic drug- metabolizing enzymes, particularly CYP3A4, CYP1A2, and CYP2C9, the antiepileptic drugs, carbamazepine, phenytoin, phenobarbital, and primidone, stimulate the oxidative transformation of concurrently prescribed anti- depressants. This results in decreased drug levels of the antidepressant. With desipramine, it has been noted that up to a 36-fold difference in plasma levels can be observed in patients receiving the same dose. One study compared desipramine monotherapy with carbamazepine co- administered. The monotherapy group exhibited a 4.6-fold increase in plasma levels and a 62% longer half-life as compared to the co-medicated group. To a lesser extent, co- administration of oxcarbazepine, topiramate, and felbamate can also result in decreased antidepressant levels. OTHER TRICYCLIC ANTIDEPRESSANT DRUG INTERACTIONS: hydrocortisone, methylphenidate, and phenothiazines increase tricyclic levels; tricyclics impair the antihypertensive effectivenessof clonidine and guanethidine; tricyclics and alcohol produce additive sedative effects, tricyclics and antipark- insonism agents have potent anticholinergic side effects, and tricyclics and MAO inhibitors should not be co- administered because of the potential for antihypertensive and CNS crises. Tricyclics should be avoided in pregnant and lactating women because these drugs have not been established as safe. Geriatric patients are especially prone to postural hypotension, urinary retention, and sedation. In general, it has been reported that, "Therapeutic drug monitoring of antidepressants allows us to take into account the influence of factors such as co-medications, diet, smoking habit, impaired organ function, and compliance. Therapeutic drug monitoring and genotyping are thus complementary, and their combined use contributes to improve pharmacotherapy with antidepressants and other drugs." |
| Reference Range |
|
| Critical Value |
|
|
|
| Testing Sample Type |
Serum or Plasma |
| Min Lab Testing Volume |
0.5 mL |
| Special Handling |
|
| Lab Notes |
|
| Methodology |
LC/MS-MS - Liquid Chromatography/Tandem Mass Spectrometry |
| Limitations |
DO NOT USE A GEL-BARRIER TUBE. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant.
Causes for Rejection:Gel-barrier tube; red-top tubes are recommended because gel-barrier tubes may cause significant losses (>40%) of the tricyclic antidepressant from serum |
|
