Clomipramine
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)
| 20-50 | Dose as in normal renal function |
| 10-20 | Start at lower doses and increase according to response |
| <10 | Start at lower doses and increase according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Not dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
Use with caution. Start with lower dose and adjust as per clinical response.