Clomipramine

Indications
 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.
Max Dosage:
Oral
Obsessive compulsive disorder
Adult: Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily.
Child: ≥10 yr: Initially, 25 mg daily, increased gradually over 2 wk. Max: 3 mg/kg/day or 100 mg daily, whichever is smaller. Give in divided doses. Once titrated, dose may be given as a single dose at bedtime.
Elderly: Initially, 10 mg daily.
Oral
Panic disorder
Adult: Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily.
Child: ≥10 yr: Initially, 25 mg daily, increased gradually over 2 wk. Max: 3 mg/kg/day or 100 mg daily, whichever is smaller. Give in divided doses. Once titrated, dose may be given as a single dose at bedtime.
Elderly: Initially, 10 mg daily.
Oral
Phobias
Adult: Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily.
Child: ≥10 yr: Initially, 25 mg daily, increased gradually over 2 wk. Max: 3 mg/kg/day or 100 mg daily, whichever is smaller. Give in divided doses. Once titrated, dose may be given as a single dose at bedtime.
Elderly: Initially, 10 mg daily.
Oral
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.
Intramuscular
Depression
Adult: Initially, 25-50 mg daily, may increase dose gradually. Max: 100-150 mg daily. Substitute with oral dosage as soon as possible.
Elderly: Initially, 10 mg daily gradually increased to 30-75 mg if necessary.
Intramuscular
Obsessive compulsive disorder
Adult: Initially, 25-50 mg daily, may increase dose gradually. Max: 100-150 mg daily. Substitute with oral dosage as soon as possible.
Elderly: Initially, 10 mg daily gradually increased to 30-75 mg if necessary.
Intravenous
Depression
Adult: Initially, 50-75 mg diluted in 250-500 ml of 0.9% sodium chloride or 5% glucose infused over 1.5-3 hr. Substitute with oral therapy when a satisfactory response has been achieved. The initial oral dose can be double the max parenteral dose; adjust subsequently according to response.
Intravenous
Obsessive compulsive disorder
Adult: Initially, 50-75 mg diluted in 250-500 ml of 0.9% sodium chloride or 5% glucose infused over 1.5-3 hr. Substitute with oral therapy when a satisfactory response has been achieved. The initial oral dose can be double the max parenteral dose; adjust subsequently according to response.
Contraindications
 Hypersensitivity. Concomitant use of MAOIs; recovery phase following MI, heartblock or other arrhythmias; mania; childn.
Warnings / 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.
Adverse Reactions
 Dryness of mouth; disturbances in micturition; drowsiness, increased sweating; sexual dysfunction; confusion, paraesthesia, ataxia, tremors; extrapyramidal symptoms; tinnitus, dizziness, fatigue, headache; wt gain esp in women; gynaecomastia and galactorrhoea.
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.
Overdose Reactions
 Initial CNS stimulation followed by severe CNS depression. Cardiac dysrhythmias, severe hypotension, convulsions, changes in the electrocardiogram, particularly in QRS axis or width, drowsiness, stupor, ataxia, restlessness, agitation, delirium, severe sweating, hyperactive reflexes, muscle rigidity, athetoid and choreiform movements. Respiratory depression, cyanosis, shock, vomiting, hyperpyrexia, mydriasis, and oliguria or anuria may also be present. Gastric lavage or induction of emesis with ipecac syrup, preferably accompanied by the instillation of activated charcoal. A minimum of 6 hr of observation with cardiac monitoring, blood pressure and respiratory function and look out for signs of CNS or respiratory depression, hypotension, cardiac dysrhythmias and/or conduction blocks, and seizures is necessary. If signs of toxicity occur at any time during this period, extended monitoring is required. Treatment is symptomatic and supportive. Plasma concentrations should not guide management of the patient. Peritoneal dialysis and hemodialysis are not effective in removing the drugs as it is highly protein bound. V diazepam to be used with caution for treatment of seizures.
Drug 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.
See Below for More clomipramine Drug Interactions
Mechanism of Actions
 Clomipramine is a potent inhibitor of serotonin re-uptake in the brain. Significant antagonism at cholinergic and α1-receptors. Weak antagonism at dopamine receptors. It has also antidepressant, sedative and anticholinergic effects.
Absorption: Readily absorbed from the GIT (oral).
Distribution: Widely distributed; crosses the placenta; enters breast milk. Protein-binding: Extensive.
Metabolism: Extensively hepatic by hydroxylation and N-oxidation.
Excretion: Urine (as metabolites); faeces (remaining dose). Elimination half-life: 21 hrs (clomipramine); 36 hrs (desmethylclomipramine).
Administration
 Should be taken with food.
Storage Conditions
 Intramuscular: Store below 30°C. Intravenous: Store below 30°C. Oral: Store below 30°C.
ATC Classification
 N06AA04 - clomipramine ; Belongs to the class of non-selective monoamine reuptake inhibitors. Used in the management of depression.
Storage
 Intramuscular: Store below 30°C. Intravenous: Store below 30°C. Oral: Store below 30°C.
Available As
  • Clomipramine 10 mg
  • Clomipramine 25 mg
  • Clomipramine 50 mg
  • Clomipramine 75 mg

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