CLOMIPRAMINE HCL

Indications & Dose:

Depressive illness

•   BY MOUTH

Adult: Initially 10 mg daily, then increased if necessary to 30–150 mg daily in divided doses, dose to be increased gradually, alternatively increased if necessary to 30–150 mg once daily, dose to be taken at bedtime; maximum 250 mg per day

Elderly: Initially 10 mg daily, then increased to 30–75 mg daily, dose to be increased carefully over approximately 10 days

Phobic and obsessional states

•  BY MOUTH

Adult: Initially 25 mg daily, then increased to 100–150 mg daily, dose to be increased gradually over 2 weeks; maximum 250 mg per day

Elderly: Initially 10 mg daily, then increased to 100–150 mg daily, dose to be increased gradually over 2 weeks; maximum 250 mg per day

Adjunctive treatment of cataplexy associated with narcolepsy

•   BY MOUTH

Adult: Initially 10 mg daily, dose to be gradually increased until satisfactory response; increased if necessary to 10–75 mg daily

Contraindications:

Administration within 14 days of MAOI therapy, acute recovery period following MI 

Side Effects:

Cautions:

Precautions:

Seizure disorder, suicidal patients, elderly, cardiac disease 

Interaction:

Drugs

Barbiturates: Reduced serum concentrations of cyclic antidepressants

Bethanidine: Reduced antihypertensive effect of bethanidine

Carbamazepine: Reduced cyclic antidepressant serum concentrations

Clonidine: Reduced antihypertensive response to clonidine; enhanced hypertensive response with abrupt clonidine withdrawal

Debrisoquin: Inhibited antihypertensive response of debrisoquin

Epinephrine: Markedly enhanced pressor response to IV epinephrine

Ethanol: Additive impairment of motor skills; abstinent alcoholics may eliminate cyclic antidepressants more rapidly than nonalcoholics

Fluoxetine, fuvoxamine, grapefruit juice: Marked increases in cyclic antidepressant plasma concentrations

Guanethidine: Inhibited antihypertensive response to guanethidine

MAOIs: Excessive sympathetic response mania, or hyperpyrexia possible

Maclobemide: Potential association with fatal or non-fatal serotonin syndrome

Neuroleptics: Increased therapeutic and toxic effects of both drugs

Norepinephrine: Markedly enhanced pressor response to norepinephrine

Phenylephrine: Enhanced pressor response to IV phenylephrine

Prdpoxyphene: Enhanced effect o f cyclic antidepressants

Quinidine: Increased cyclic antidepressant serum concentrations 

Warnings:

Adverse Effects:

Lactations:

Withdrawal symptoms, including jitteriness, tremor, and seizures have been reported in neonates whose mothers had taken clomipramine until delivery; has been found in human milk; use caution in nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Abnormal dreaming, agitation, anxiety, confusion, depersonalization, depression, dizziness, emotional lability headache, hypertonia; impairel concentration, increased appetite, insomnia, irritability, libido change, memory impairment, migraine, myoclonus, nervousness, panic reaction, paresthesia, psychosomatic disorder, somnolence, speech disorder, tremor, weight gain, yawning

CV: Bradycardia, dysrhythmia, pallor, palpitations, postural hypotension, syncope, tachycardia

EENT: Abnormal vision, tinnitus

GI: Abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia, dysphagia, esophagitis, flatulence, nausea, tooth disorder, ulcerative stomatitis, vomiting

GU: Ejaculation disorder, impotence,urinary retention

MS: Arthralgia, back pain, myalgia

RESP: Bronchospasm, coughing, pharyngitis, rhinitis, sinusitis

SKIN: Abnormal skin odor, acne, dermatitis, dry skin, increased sweating, pruritus, rash, urticaria

Patient And Carer Advice: