(1)clomipramine, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.zafirlukastMinor (1)zafirlukast will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ziconotideMonitor Closely (1)clomipramine and ziconotide both increase sedation. Use Caution/Monitor.zileutonMonitor Closely (1)zileuton will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.zolpidemMinor (1)zolpidem, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. >10% Xerostomia (84%) Headache (50-55%) Constipation (47%) Ejaculation failure (42%) Fatigue (35-40%) Nausea (30-35%) Impotence (20-25%) Weight gain (18%) 1-10% Weight loss (5%) Hepatotoxicity (1-3%) Frequency Not Defined Common Dizziness, mainia, somnolence, tremor Dyspepsia Blurred vision Urinary retention Orgasm incapacity, libido change Rare Myocardial infarction, orthostatic hypotension Depression worsening, suicidal thoughts suicide, seizure Hyperglycemia Agranulocytosis, leukopenia, pancytopenia, thrombocytopenia Body temperature above normal Drug rash with eosinophilia and systemic symptoms (DRESS) Postmarketing Reports Metabolism and Nutrition Disorders: Hyponatremia Endocrine Disorders: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior 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 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 patientsContraindications Hypersensitivity Severe cardiovascular disorder Narrow angle glaucoma Any drugs or conditions that prolong QT interval Acute recovery post-MI Coadministration with serotonergic drugs Concomitant with or within 14 d of MAOIs (serotonin syndrome) Starting clomipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue clomipramine immediately and monitor for CNS toxicity; may resume clomipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Cautions BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 yr) Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue) Risk of anticholinergic side-effects 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 Hyponatremia Appears to be the result of syndrome of inappropriate antidiuretic hormone secretion (SIADH) Elderly patients may be at greater risk of developing hyponatremia, especially with a serotonergic antidepressant Patients taking diuretics or who are otherwise volume-depleted can be at greater risk Discontinue therapy in patients with symptomatic hyponatremia and institute appropriate medical intervention Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which can lead to falls More severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death Pregnancy Category: C Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Parent drug may affect serotonin uptake; active metabolite may may affect norepinephrine uptake Pharmacokinetics Peak Plasma Time: 2-6 hr Concentration: 56-154 ng/mL Half-Life: 32 hr (parent drug), 69 hr (metabolite) Excretion: Urine (60%); feces (32%) Steady-state therpaeutic plasma concentration: 100-250 ng/mL (parent drug), 230-550 ng/mL (metabolite) Bioavailability: 50% Protein Bound: 97-98% Vd: 17 L/kg Metabolism: Hepatic CYP2D6 Metabolites: Desmethylclomipramine Dialyzable: No BRAND FORM. UNIT PRICE PILL IMAGE Anafranil oral- 50 mg capsuleAnafranil oral- 75 mg capsuleAnafranil oral- 25 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 25 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 50 mg capsuleclomipramine oral- 75 mg capsuleclomipramine oral- 75 mg capsuleCopyright © 2010 First DataBank, Inc.Print Patient Educationclomipramine oral CLOMIPRAMINE - ORAL (klo-MIP-ruh-meen) COMMON BRAND NAME(S): Anafranil WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: Clomipramine is used to treat obsessive compulsive disorder (OCD). It helps decrease thoughts that are unwanted or that don't go away (obsessions), and it helps reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, checking) that interfere with daily living.This medication belongs to a class of medications called tricyclic antidepressants. It works by restoring the balance of certain natural substances (serotonin, among others) in the brain. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking clomipramine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor. To lessen side effects such as stomach upset, clomipramine may be started at a low dose, given in several doses during the day with meals, and slowly increased as your body gets used to it. After you have reached the best dose for you, the total dose can be taken once daily as directed by your doctor, usually at bedtime to prevent daytime drowsiness.Follow your doctor's instructions carefully. Do not take more or less medication or take it more often than prescribed. Your condition will not improve any faster and your risk of side effects such as seizures may be increased. The dosage is based on your medical condition and response to treatment.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.Use this medication regularly in order to get the most benefit from it. Keep taking it even if you feel well. To help you remember, use it at the same time(s) each day.Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. You may experience sweating, dizziness, nausea, vomiting, headache, or irritability if you suddenly stop taking this drug. Your dose may need to be gradually decreased.It may take 2 to 3 weeks or longer before the full effects of this medication are noticed. Inform your doctor if your condition lasts or gets worse. SIDE EFFECTS: See also Warning section.Dizziness, drowsiness, dry mouth, constipation, stomach upset, nausea, vomiting, changes in appetite/weight, flushing, sweating, tiredness and blurred vision may occur. Anxiety symptoms may temporarily worsen when you first start taking clomipramine. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, depression, memory problems), enlarged/painful breasts, unwanted breast milk production, irregular/painful menstrual periods, muscle stiffness, ringing in the ears, sexual problems (such as decreased sexual ability, changes in desire), shakiness (tremors), numbness/tingling of the hands/feet, trouble urinating, easy bleeding/bruising, unusual/uncontrolled movements (especially of the tongue/face/lips), severe stomach/abdominal pain, dark urine, yellowing of eyes/skin.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take. Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Get medical help right away if you have any very serious side effects, including: black stools, chest pain, fainting, slow/fast/irregular heartbeat, seizures, vomit that looks like coffee grounds, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: See also Warning section.Before taking clomipramine, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as imipramine, nortriptyline); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, blood problems (such as purpura, thrombocytopenia), breathing problems (such as