Drug Index

Clomipramine

 
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Mechanism :

Clomipramine is a tricyclic anti-depressant. The clinical effect is due to potentiation of adrenergic synapses by blocking uptake of norepinephrine at nerve endings.


Indication :

• Depression

• Obsessive compulsive disorder


Contraindications :

Clomipramine is contraindicated in patients who have shown prior hypersensitivity to it and in acute porphyria, hepatic impairment and cardiovascular disease.


Dosing :

<10 years: Safety and efficacy not established.

≥10 years: Initially 25 mg/day PO and gradually increase up to 100 mg/day or 3 mg/kg/day, whichever is less. Usually as single dose at bedtime but may be given in divided doses.


Adverse Effect :

Mainly anticholinergic effects, nausea, constipation, sedation, postural hypotension, tremor, sweating, arrhythmia, increased appetite and weight gain, sexual dysfunction and lowered seizure threshold.


Interaction :

MAOIs: Hyperpyretic crises, severe convulsions, and deaths have occurred in patients receiving tricyclic antidepressant and monoamine oxidase inhibiting drugs simultaneously.
Oral Contraceptives, Calcium Channel Blockers, Cimetidine, Phenothiazines, SSRIs: Plasma concentration of clomipramine increased.
Rifampicin, Anti-Coagulants: Decreased plasma concentration of clomipramine.
Sedatives, Hypotensives, drugs that prolong QT interval: Increased effects of these drugs.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Start at lower doses and increase according to response
<10Start at lower doses and increase according to response

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in GFR<10 mL/min
HDNot dialysed. Dose as in GFR<10 mL/min
HDF/High fluxUnknown dialysability. Dose as in GFR<10 mL/min
CAV/VVHDNot dialysed. Dose as in GFR=10– 20 mL/min

Hepatic Dose :

Use with caution. Start with lower dose and adjust as per clinical response.
05/30/2020 04:45:27 Clomipramine
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