Clomipramine Hydrochloride

Indications

Clomipramine Hydrochloride is used for: Depression, Panic disorder, Obsessive compulsive disorder, Cataplexy, Narcolepsy, Phobias, Premature ejaculation, Enuresis, Trichotillomania

Adult Dose

Oral Adjunct for cataplexy associated with narcolepsy Adult: Initially, 10 mg daily gradually increased to 10-75 mg daily. Elderly: Dose reduction may be needed. Obsessive compulsive disorder; Panic disorder; Phobias Adult: Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily. Elderly: Initially, 10 mg daily. Depression Adult: Initially, 10 mg daily; may increase gradually to 30-150 mg daily if needed. Up to 250 mg daily or more may be required in more severe cases. Elderly: Initially, 10 mg daily; may increase gradually over 10 days to 30-75 mg daily. Max Dosage: 100-150 mg daily.

Child Dose

Obsessive-Compulsive Disorder <10 years: Safety and efficacy not established >10 years: 25 mg PO qDay initially Gradually increase to maximum 3 mg/kg/day or 100 mg/day, whichever is less May further increase to maximum 3 mg/kg/day or 200 mg/day, whichever is less; may give as single dose qHS once tolerated

Renal Dose

Administration

Should be taken with food.

Contra Indications

Hypersensitivity. Concomitant use of MAOIs; recovery phase following MI, heartblock or other arrhythmias; mania; childn.

Precautions

Cardiovascular insufficiency; narrow-angle glaucoma; urinary retention; history of epilepsy; renal or hepatic dysfunction; electroconvulsive therapy; hypotension; hyperthyroidism or concomitant treatment with thyroid preparations; suicidal tendencies; surgery; pregnancy and lactation; tasks requiring mental alertness; elderly; avoid abrupt withdrawal. Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

Pregnancy-Lactation

Pregnancy Category: C Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

Interactions

Barbiturates increase metabolism of tricyclic antidepressants; conversely cimetidine, guanethidine, haloperidol and phenothiazines block the tricyclic metabolism. CNS effects of alcohol enhanced. Potentially Fatal: If clomipramine is to be substituted for MAOIs, at least 3 wk should elapse after discontinuing MAOIs. Risk of hypertension and arrhythmias if co-administered with adrenaline and noradrenaline.

Adverse Effects

Side effects of Clomipramine Hydrochloride : >10% Xerostomia (84%), Headache (50-55%), Constipation (47%), Ejaculation failure (42%), Fatigue (35-40%), Nausea (30-35%), Impotence (20-25%), Weight gain (18%) 1-10% Weight loss (5%), Hepatotoxicity (1-3%) Frequency Not Defined Common, Dizziness, mainia, somnolence, tremor, Dyspepsia, Blurred vision, Urinary retention, Orgasm incapacity, libido change Potentially Fatal: Death, rare (except in patients with preexisting significant heart block and patients on MAOI therapy). Induction of mania in individuals with underlying manic-depressive illness or worsening of psychoses in already psychotic individuals.

Mechanism of Action

Clomipramine is a potent inhibitor of serotonin re-uptake in the brain. Significant antagonism at cholinergic and ?1-receptors. Weak antagonism at dopamine receptors. It has also antidepressant, sedative and anticholinergic effects.