desipramine (Norpramin) — CareFirst (Caremark)
Agitation, anxiety, depression in patients 65 years of age or older
Initial criteria
- Patient age ≥ 65 years
- The request is for ONE of the following:
- • Amitriptyline, amoxapine, desipramine, imipramine hydrochloride, imipramine pamoate, nortriptyline, protriptyline, or trimipramine for depression
- • Chlordiazepoxide/amitriptyline for depression associated with anxiety
- • Doxepin for depression and/or anxiety
- • Perphenazine/amitriptyline for depression with anxiety and/or agitation
Approval duration
12 months