Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.oxazepamoxazepam and clomipramine both increase sedation. Use Caution/Monitor.oxybutyninoxybutynin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicaloxybutynin topical and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermaloxybutynin transdermal and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.oxycodoneoxycodone and clomipramine both increase sedation. Use Caution/Monitor.oxymetazoline intranasalclomipramine increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. TCAs inhibit norepinephrine uptake in adrenergic neurons, thereby increasing synaptic norepinephrine levels. Coadministration with alpha1 agonists may cause increased adrenergic receptor stimulation. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use alternant anesthetic in patients taking TCAs.oxymorphoneoxymorphone and clomipramine both increase sedation. Use Caution/Monitor.ozanimodozanimod and clomipramine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.paliperidoneclomipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and clomipramine both increase sedation. Use Caution/Monitor.pancuroniumpancuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.papaveretumpapaveretum and clomipramine both increase sedation. Use Caution/Monitor.papaverineclomipramine and papaverine both increase sedation. Use Caution/Monitor.parecoxibparecoxib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.clomipramine, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.paroxetineclomipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.pasireotideclomipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.pazopanibclomipramine and pazopanib both increase QTc interval. Use Caution/Monitor.peginterferon alfa 2apeginterferon alfa 2a will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.peginterferon alfa 2bpeginterferon alfa 2b, clomipramine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentazocinepentazocine and clomipramine both increase sedation. Use Caution/Monitor.clomipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.pentobarbitalpentobarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.pentobarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.pentobarbital and clomipramine both increase sedation. Use Caution/Monitor.perphenazineperphenazine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.perphenazine and clomipramine both increase sedation. Use Caution/Monitor.phendimetrazineclomipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalphenobarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.phenobarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.phenobarbital and clomipramine both increase sedation. Use Caution/Monitor.phentermineclomipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineclomipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine ophthalmicclomipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.phenylephrine POclomipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinphenytoin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodineclomipramine and pholcodine both increase sedation. Use Caution/Monitor.physostigminephysostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pilocarpinepilocarpine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.pimozidepimozide and clomipramine both increase sedation. Use Caution/Monitor.pipemidic acidpipemidic acid will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.pirbuterolclomipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.piroxicamclomipramine, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.posaconazoleclomipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.pralidoximepralidoxime and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.pregabalinpregabalin, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneprimidone will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.primidone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.primidone and clomipramine both increase sedation. Use Caution/Monitor.prochlorperazineprochlorperazine and clomipramine both increase QTc interval. Use Caution/Monitor.prochlorperazine and clomipramine both increase sedation. Use Caution/Monitor.promethazinepromethazine and clomipramine both increase sedation. Use Caution/Monitor.propafenonepropafenone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.propanthelinepropantheline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.propofolpropofol and clomipramine both increase sedation. Use Caution/Monitor.propylhexedrineclomipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineclomipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and protriptyline both increase sedation. Use Caution/Monitor.pyridostigminepyridostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.quazepamquazepam and clomipramine both increase sedation. Use Caution/Monitor.quetiapinequetiapine and clomipramine both increase sedation. Use Caution/Monitor.quetiapine, clomipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.quinacrinequinacrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.quinineclomipramine and quinine both increase QTc interval. Use Caution/Monitor.ramelteonclomipramine and ramelteon both increase sedation. Use Caution/Monitor.ranolazineranolazine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.clomipramine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.rapacuroniumrapacuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.remifentanilclomipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.remimazolamremimazolam, clomipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.rifabutinrifabutin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutin decreases levels of clomipramine by increasing metabolism. Use Caution/Monitor.rifampinrifampin will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentinerifapentine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rilpivirinerilpivirine increases toxicity of clomipramine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.risperidoneclomipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.risperidone and clomipramine both increase sedation. Use Caution/Monitor.ritlecitinibritlecitinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP1A2 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP1A2 substrates. ritonavirritonavir will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.ritonavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rivastigminerivastigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.rizatriptanrizatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.rocuroniumrocuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.rolapitantrolapitant will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinclomipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.salicylates (non-asa)clomipramine, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.salmeterolclomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.salsalateclomipramine, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.SAMeclomipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.scopolaminescopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.scullcapclomipramine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.secobarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.secobarbital and clomipramine both increase sedation. Use Caution/Monitor.selpercatinibselpercatinib increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.sertralinesertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.sevofluranesevoflurane and clomipramine both increase sedation. Use Caution/Monitor.sevoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.shepherd's purseclomipramine and shepherd's purse both increase sedation. Use Caution/Monitor.smokingsmoking will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.sodium sulfate/?magnesium sulfate/potassium chloridesodium sulfate/?magnesium sulfate/potassium chloride increases effects of clomipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolclomipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfatesodium sulfate/potassium sulfate/magnesium sulfate increases effects of clomipramine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using higher dose of magnesium sulfate together with drugs that lower the seizure threshold.solifenacinsolifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.solifenacin and clomipramine both increase QTc interval. Use Caution/Monitor.somapacitansomapacitan will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatrogonsomatrogon will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatropinsomatropin will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessorafenibsorafenib and clomipramine both increase QTc interval. Use Caution/Monitor.sparsentansparsentan will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates. St John's WortSt John's Wort will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.stiripentolstiripentol, clomipramine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.stiripentol will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.stiripentol, clomipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.succinylcholinesuccinylcholine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilsufentanil and clomipramine both increase sedation. Use Caution/Monitor.sufentanil SLsufentanil SL, clomipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sulfamethoxazoleclomipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.sulfasalazineclomipramine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.sulindacclomipramine, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.sumatriptansumatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.sumatriptan intranasalsumatriptan intranasal and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.suvorexantsuvorexant and clomipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments