Drug reference

Clomipramine

TCA · Antidepressant

Also known as Clomipramine hydrochloride

TCAAntidepressant

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Manufacturer advises avoid.

FDA category + note

Top interactionssee all 12 →

PhenelzineContraindicatedDatabaseDDInter
EpinephrineSevereTextbook-citedKDT 7e · p950
AdrenalineSevereTextbookKDT 7e · p365
ArtemisininsSevereTextbookKDT 7e · p816-835

Mechanism

Clomipramine hydrochloride, a tricyclic antidepressant, blocks the re-uptake of both serotonin and noradrenaline. It is more selective for serotonergic transmission.

Indications

Obsessive-compulsive disorder (second-line)Panic disorder (second-line, unlicensed)depressionpsychotic depression (with first-generation antipsychotics)pain conditionsCataplexy (associated with narcolepsy)

Dosing

Adult: doses that are sufﬁciently high for effective treatment but not so high as to cause toxic effects. Low doses should be used for initial treatment in the elderly. In most patients the long half-life of tricyclic antidepressant drugs allows oncedaily administration, usually at night; the use of modiﬁedrelease preparations is therefore unnecessary.…

Pharmacokinetics

Half-life

32 hours (parent), 70 hours (active metabolite)

Metabolism

hepatic (CYP2D6, CYP2C19, CYP3A3/4, CYP1A2)

Side effects

Common

SedationAntimuscarinic side-effectscognitive dullingblurred visiondry mouthtachycardiaconstipationdifficulty urinatingorthostatic hypotensionweight gain

Serious

Cardiotoxicity in overdosage
quinidine-like effects on cardiac conduction (life threatening in overdose)
lowered seizure threshold
serotonin syndrome (with MAOIs)

Pregnancy & lactation

Pregnancy

Manufacturer advises avoid.

Drug interactions

Phenelzine

Contraindicated

Database

Increased risk of serotonin syndrome and potentiated sympathomimetic effects.

Should not be used concurrently with MAOIs or within 14 days of stopping MAOIs.

Source: DDInter

Epinephrine

Severe

Textbook-cited

Exaggerated hypertensive response

Use local anaesthetic without adrenaline in patients on TCAs

Source: KDT 7e · p950

Adrenaline

Severe

Textbook

Potentiation of adrenaline's effects.

Vasoconstrictor (adrenaline) containing LA should be avoided in patients receiving tricyclic antidepressants.

Source: KDT 7e · p365

Artemisinins

Severe

Textbook

Increased risk of cardiac conduction defects.

Source: KDT 7e · p816-835

Meglumine Antimoniate

Severe

Textbook

Increased cardiotoxicity (e.g., QT prolongation).

Source: Harrison 22e · p1740

Amiodarone

Severe

Database

Increased risk of TCA side effects, including cardiac arrhythmias (especially QT prolongation and Torsades de Pointes), and serotonin syndrome.

Avoid concomitant use. If unavoidable, use with extreme caution, starting with a lower dose of clomipramine and monitoring ECG closely for QT prolongation. Consider therapeutic drug monitoring (TDM) for clomipramine.

Source: DDInter

Amisulpride

Severe

Database

Drug interaction classified as: synergy.

Source: DDInter

Anagrelide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Arbutamine