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Clomipramine

Clomipramine is categorized as tricyclic anti-depressant. It is a good mood elevator but not euphorient which has a potent anti depressant effect. Tolerance to the anticholinergic & hyposensitive effect of the drug develops gradually, though anti depressant action is sustained. There are some evidence of physical dependence occurring when high doses have been used for long period-malaise, chills muscle pain may occur on discontinuation & have been considered withdrawal phenomena, cardiovascular effects are prominent, occur at therapeutic concentration & may be dangerous in over dose.

Indications: Endogenous depression, obsessive compulsive neurosis states.

Contradictions: Epilepsy, cardiovascular disease, narrow angle glaucoma, MAOIs, urinary retention, ischaemic heart disease.

Safety Profile: Myocardial infarction, hyperthyroidism, elderly patients, concurrent administration of CNS depressants, alcohol, antihypertensives.

Adverse Effects: Postural hypotension, jaundice, rashes, tremors, convulsions, sedation, drowsiness, altered alertness, constipation, dry mouth, cardiac arrhythmias.

Drug Interactions: Strokes, hyperpyrexia, convulsions & death can occur if taken concurrently with MAOI’s. In combination with adrenaline & noradrenaline. It causes hypertension & arrhythmias. Barbiturates increase metabolism. Conversely cimetidine, guanethidine, haloperidol & phenothiazines block the metabolism.

Dosage: Obsession & phobic state: 25mg increasing gradually to 100-150 mg daily. Depression: 10 mg increasing gradually to 30-150mg daily in divided doses or as a single dose at night. Max. 250 mg daily. Elderly: Initially 10mg daily, Max. 75mg daily.