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Clomipramine – Usages, Side effects, Risk factors, Precautions
Here in this post, we are discussing “Clomipramine“. You can read usages, side effects, Risk factors, and warning information. Keep visiting Psychology Roots.
About Clomipramine
Clomipramine is an antidepressant TCAs.
Brand name
Clomipramine is available with the following brand name.
● Anafranil
Forms of Clomipramine
Clomipramine is available in the following form
● Capsule
Capsule
Clomipramine capsules are available in the following doses
● 25mg
● 50mg
● 75mg
Disorder to treat
It is used for the treatment of the following disorder
● Obsessive-compulsive disorder
OCD
Adults
● Initially, 25 mg orally is given every day.
● Gradually increase to 100 mg/day (divided with meals) over 2 weeks.
● It may increase further to 250 mg per day maximum. It may give a single daily dose at bedtime every day once tolerated.
Adolescents
● <10 years: Safety and efficacy not established
● ≥10 years: initially 25 mg is orally given per day.
● It may gradually increase to a maximum of 3 mg per kg per day or 100 mg per day which is less.
● It may further increase to a maximum of 3 mg per kg per day or 200 mg per day whichever is less. It may give a single dose at bedtime per day once it is tolerated.
Older Adults
● Avoid the use of clomipramine in older adults due to strong anticholinergic and sedative effects. It may cause orthostatic hypotension.
● Consider alternative medicine if clomipramine must be used, it must initiate with a lower dose.
● Initially 25 mg orally is given every day.
● Gradually increase to 100 mg/day (divided with meals) over 2 weeks.
● It may increase further to 250 mg per day maximum. It may be given as a single daily dose at bedtime every day once tolerated.
Adverse effects
There are the following side effects of Clomipramine:
● Fatigue
● Xerostomia
● Weight gain
● Constipation
● Headache
● Nausea
● Hepatotoxicity
● Ejaculation failure
● Impotence
● Weight loss
Common
● Dizziness
● Mania
● Dyspepsia
● Somnolence
● Urinary retention
● Tremor
● Orgasm incapacity, libido change
● Blurred vision
Rare
● Myocardial infarction
● Orthostatic hypotension
● Depression worsening
● Suicidal thoughts
● Seizure
● Suicide
● Hyperglycemia
● Drug rash with eosinophilia and systemic symptoms (DRESS)
● Agranulocytosis
● Endocrine Disorders: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
● Leukopenia
● Pancytopenia
● Metabolism and Nutrition Disorders: Hyponatremia
● Thrombocytopenia
● Body temperature above normal
Warnings
Following are the warnings that must know while using clomipramine
- In short-term studies, antidepressants increased the risk of suicidal thinking and behaviour in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses.
- This increase was not seen in patients aged >24 years. A slight decrease in suicidal thinking was seen in adults >65 years.
- ● In children and young adults, risks must be weighed against the benefits of taking antidepressants.
- ● Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies. This should be done during the initial 1-2 months of therapy and dosage adjustments.
- ● The patient’s family should communicate any abrupt changes in behavior to the healthcare provider.
- ● Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy.
- ● This drug is not approved for use in pediatric patients.
Contraindications
There are the following contraindications of Clomipramine
● Hypersensitivity.
● Severe cardiovascular disorder
● Narrow-angle glaucoma.
● Any drugs or conditions that prolong QT interval.
● Acute recovery post-MI
Cautions
● BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumour, respiratory impairment.
● Risk of anticholinergic side effects
● Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy
● Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including non-psychiatric MAOIs, such as linezolid and IV methylene blue)
● Rare cases of drug rash with eosinophilia and systemic symptoms (DRESS) reported with use; in event of severe acute reactions such as DRESS, discontinue clomipramine therapy immediately and institute appropriate treatment
Pregnancy
Lactation
It is distributed in breast milk.
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