The demethylated metabolite is less anticholinergic, less sedative, and more stimulatory and is a SNERI.31 Consequently, a patient treated with imipramine has two compounds that contribute to activity. Overall, the effect is nonselective 5-HT versus NE reuptake. The activity of desimipramine or norimipramine is terminated by 2-hydroxyla-tion, followed by conjugation and excretion. A second N-demethylation can occur, which in turn is followed by 2-hydroxylation, conjugation, and excretion.
The structure and salient properties of desipramine hydrochloride, 10,11-dihydro-N-methyl-5H-dibenz[b,f]azepine-5-propanamine monohydrochloride, 5-(3-methylamino-propyl)-10,11-dihydro-5H-dibenz[b,fazepine hydrochloride (Norpramin, Pertofrane), are discussed under the heading, Imipramine. Among tricyclics, desipramine would be considered when few anticholinergic effects or a low level of sedation are important. It is a SNERI.31
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