Clomipramine Hcl (clomipramine HCl)

Dosage of clomipramine hydrochloride is expressed in terms of the hydrochloride.

Because there is wide interindividual variation in dosage and dosage may differ in various disease states, the dosage of clomipramine hydrochloride must be individualized carefully.

Patients receiving clomipramine should be monitored for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustment. (See Cautions: Precautions and Contraindications.)

The manufacturers and some clinicians recommend selecting an initial clomipramine dosage at the lower end of the recommended range since decreased hepatic, renal, or cardiac function and concomitant illness and medications are more frequent in geriatric patients.

Clomipramine hydrochloride is administered orally. The drug also has been administered IM+ or IV+, but a parenteral dosage form is not commercially available in the US.

During initial therapy when the dosage is being titrated, the manufacturers recommend that clomipramine be given in divided doses with meals to lessen adverse GI effects. After dosage titration, the total daily dose may be given once daily at bedtime to minimize adverse effects such as sedation during waking hours and enhance patient compliance.

No dosing information is available for this tab.

No dosing information is available for this tab.

Because of the similarity of clomipramine to other tricyclic antidepressants, all drug interactions that may occur with this class of drugs should be considered when clomipramine is used. (See Drug Interactions in the Tricyclic Antidepressants General Statement 28:16.04.28.) In addition, the possibility that clomipramine may interact with any concomitantly administered drug has not been evaluated systematically but should be considered.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

Teratogenic effects were not observed in rats and mice receiving clomipramine hydrochloride dosages up to 20 times the maximum human daily dosage. Slight, nonspecific fetotoxic effects were observed in the offspring of pregnant mice receiving 10 times the maximum human daily dosage. Slight, nonspecific embryotoxicity occurred in rats receiving 5-10 times the maximum human daily dosage.

There are no adequate and controlled studies using clomipramine in pregnant women, and the drug should be used during pregnancy only if the possible benefits justify the potential risk to the fetus. Women should be advised to notify their physician if they are or plan to become pregnant during clomipramine therapy. Neonates whose mothers had received clomipramine throughout pregnancy in dosages of 75-250 mg daily have exhibited withdrawal manifestations or adverse effects, including jitteriness, tremor, seizures, twitching, hypertonia, hypotonia, tachypnea, respiratory acidosis, cyanosis, feeding difficulties, hypothermia, lethargy, and diaphoresis. Phenobarbital has been recommended by some clinicians for the management of neurologic withdrawal symptoms. Abrupt discontinuance of clomipramine at 32 weeks of pregnancy resulted in premature birth of a neonate who developed seizures soon after delivery. Because of the risk of neonatal withdrawal, some clinicians state that clomipramine therapy particularly should be avoided during late pregnancy.

Clomipramine is distributed into milk. (See Pharmacokinetics: Distribution.) Adverse effects were absent in an infant who was breast-feeding from a woman who continued treatment with clomipramine at a dosage of 150 mg daily. However, because of the potential for adverse reactions, including concern about the potential for tricyclic antidepressants to affect development of the CNS of infants, a decision should be made whether to discontinue nursing or clomipramine, taking into account the importance of the drug to the woman. Women should be advised to notify their physician if they are breast-feeding.

No enhanced messaging available.