| CLOMIPRAMINE HYDROCHLORIDE
Classifications: psychotherapeutic; tricyclic antidepressant; Therapeutic: antipsychotic; tricyclic antidepressant
Pregnancy Category: C
25 mg, 50 mg, 75 mg capsules
Inhibits the reuptake of norepinephrine and serotonin at the presynaptic neuron. Of the tricyclic antidepressants (TCAs),
it is the most selective and potent inhibitor of serotonin (5-HT) reuptake.
The basis of its antidepressant effects is thought to be due to the elevated serum levels of norepinephrine and serotonin.
Obsessive-compulsive disorder (OCD).
Panic disorder, anxiety, agoraphobia.
Hypersensitivity to other tricyclic compounds; acute recovery period after MI, QT elongation, cardiac arrhythmias (AV block,
bundle-branch block); suicidal ideation; children <10 y, pregnancy (category C).
History of convulsive disorders, prostatic hypertrophy, urinary retention, cardiovascular, hepatic, GI, or blood disorders;
history of seizure disorder; respiratory depression; older adults; diabetes mellitus; GERD; Parkinson's disease; closed
angle glaucoma; asthma; bipolar disorder; history of suicidal ideation; lactation.
Route & Dosage
Adult: PO 75300 mg/d in divided doses
Child (1018 y): PO 100200 mg/d in divided doses, start at 50 mg/d
Adult: PO 50150 mg/d in single or divided doses
- Give in divided doses with meals to reduce GI adverse effects.
- Following titration to the full dose, drug may be given as a single dose at bedtime to reduce daytime sedation.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%) Body as a Whole:
Hypotension, tachycardia. GI: Constipation
, dry mouth. Endocrine:
Galactorrhea, hyperprolactinemia, amenorrhea, weight gain. Hematologic:
thrombocytopenia, anemia. CNS:
dizziness, hyperthermia, neuroleptic malignant syndrome,
seizures (especially with abrupt withdrawal). Urogenital:
Delayed ejaculation, anorgasmia.
Diagnostic Test Interference
Clomipramine appears to elevate serum prolactin levels. Serum AST and ALT are elevated. Serum levels of triiodothyronine (T3) and free triiodothyronine (FT3) have been significantly reduced from baseline. Thyroxine-binding globulin (TBG) levels were increased from baseline, whereas thyroxine (T4), free thyroxine (FT4), and reverse T3 were unchanged.
InteractionsDrug: mao inhibitors
may precipitate hyperpyrexic crisis, tachycardia, or seizures; antihypertensive agents
potentiate orthostatic hypotension; cns depressants
add to CNS depression; norepinephrine
and other sympathomimetics
may increase cardiac toxicity; cimetidine
decreases hepatic metabolism, thus increasing imipramine levels; methylphenidate
inhibits metabolism of imipramine
and thus may increase its toxicity. Herbal: Ginkgo
may decrease seizure threshold; St. John's wort
may cause serotonin syndrome
Rapidly absorbed from GI tract; 2078% reaches systemic circulation. Onset:
Depression: approx 2 wk; OCD: approx 410 wk. Peak:
26 h. Distribution:
Widely distributed including the CSF; crosses placenta. Metabolism:
Extensive first-pass metabolism in the liver; active metabolite is desmethylclomipramine. Elimination:
5060% in urine, 2432% in feces. Half-Life:
Assessment & Drug Effects
- Monitor for seizures, especially in those with predisposing factors such as alcoholism, brain injury, or concurrent therapy
with other drugs that lower seizure threshold.
- Lab tests: Periodic CBC with differential, platelet count, and Hct and Hgb. Monitor liver functions, especially with long-term
- Monitor for and report signs of neuroleptic malignant syndrome (see Appendix F).
- Monitor for sedation and vertigo, especially at the beginning of therapy and following dosage increases. Supervision of ambulation
may be indicated.
- Notify physician of fever and complaints of sore throat since these may indicated need to rule out adverse hematologic changes.
Patient & Family Education
- Do not take nonprescribed drugs or discontinue therapy without consent of physician. Abrupt discontinuation may cause nausea,
headache, malaise, or seizures.
- Men should understand that the drug may cause impotence or ejaculation failure. Advise them to report this problem to physician.
- Report promptly a sore throat accompanied by fever.
- Use caution with ambulation until response to drug is known.
- Moderate alcohol intake since it may potentiate adverse drug effects.