causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .glycopyrrolateglycopyrrolate and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.glycopyrrolate inhaledglycopyrrolate inhaled and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine increases levels of glycopyrrolate inhaled by unknown mechanism. Use Caution/Monitor.glycopyrronium tosylate topicalglycopyrronium tosylate topical, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.grapefruitgrapefruit will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.haloperidolhaloperidol and clomipramine both increase sedation. Use Caution/Monitor.henbanehenbane and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.homatropinehomatropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.huperzine Ahuperzine A increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.hydrocodonehydrocodone, 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.hydromorphonehydromorphone and clomipramine both increase sedation. Use Caution/Monitor.hydroxyzinehydroxyzine and clomipramine both increase sedation. Use Caution/Monitor.hydroxyzine and clomipramine both increase QTc interval. Use Caution/Monitor.hyoscyaminehyoscyamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.hyoscyamine sprayhyoscyamine spray and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.ibuprofenclomipramine, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.ibuprofen IVclomipramine, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.iloperidoneclomipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.iloperidone and clomipramine both increase sedation. Use Caution/Monitor.imatinibimatinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.imipramineclomipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and imipramine both increase sedation. Use Caution/Monitor.indacaterol, inhaledindacaterol, inhaled, clomipramine. QTc interval. Use Caution/Monitor. Indacaterol should be administered with extreme caution to patients treated with TCAs. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.indinavirindinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.indomethacinclomipramine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.ipratropiumipratropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.isofluraneisoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.isoniazidisoniazid will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.clomipramine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.isoproterenolclomipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.itraconazoleitraconazole and clomipramine both increase QTc interval. Use Caution/Monitor.ketamineketamine and clomipramine both increase sedation. Use Caution/Monitor.ketoconazoleketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ketoprofenclomipramine, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.ketorolacclomipramine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.ketorolac intranasalclomipramine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.ketotifen, ophthalmicclomipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.L-tryptophanclomipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.lapatinibclomipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.lasmiditanlasmiditan, clomipramine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.clomipramine increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.lemborexantlemborexant, clomipramine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.letermovirletermovir increases levels of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levalbuterolclomipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.levofloxacinclomipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.levoketoconazolelevoketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levorphanollevorphanol and clomipramine both increase sedation. Use Caution/Monitor.levothyroxinelevothyroxine increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.liothyronineliothyronine increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.liotrixliotrix increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.lisdexamfetamineclomipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clomipramine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).lithiumclomipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.lithium and clomipramine both increase QTc interval. Use Caution/Monitor.lofepramineclomipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and lofepramine both increase sedation. Use Caution/Monitor.lofexidineclomipramine and lofexidine both increase sedation. Use Caution/Monitor.clomipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.lonapegsomatropinlonapegsomatropin 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 substratesloprazolamloprazolam and clomipramine both increase sedation. Use Caution/Monitor.lorazepamlorazepam and clomipramine both increase sedation. Use Caution/Monitor.lorcaserinlorcaserin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.lormetazepamlormetazepam and clomipramine both increase sedation. Use Caution/Monitor.lornoxicamclomipramine, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.loxapineloxapine and clomipramine both increase sedation. Use Caution/Monitor.loxapine inhaledloxapine inhaled and clomipramine both increase sedation. Use Caution/Monitor.lsdclomipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.lumacaftor/ivacaftorlumacaftor/ivacaftor, clomipramine. affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .lurasidonelurasidone increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.maprotilineclomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and maprotiline both increase sedation. Use Caution/Monitor.maravirocmaraviroc will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.marijuanamarijuana will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.clomipramine and marijuana both increase sedation. Use Caution/Monitor.meclizinemeclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.meclofenamateclomipramine, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.mefenamic acidclomipramine, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.melatoninclomipramine and melatonin both increase sedation. Use Caution/Monitor.meloxicamclomipramine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.meperidinemeperidine and clomipramine both increase sedation. Use Caution/Monitor.meprobamateclomipramine and meprobamate both increase sedation. Use Caution/Monitor.metaproterenolclomipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.metaxalonemetaxalone and clomipramine both increase sedation. Use Caution/Monitor.methadoneclomipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.methadone and clomipramine both increase sedation. Use Caution/Monitor.methamphetamineclomipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methocarbamolmethocarbamol and clomipramine both increase sedation. Use Caution/Monitor.methscopolaminemethscopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.methylenedioxymethamphetamineclomipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methylphenidateclomipramine, methylphenidate. 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.methylphenidate transdermalmethylphenidate transdermal will increase the level or effect of clomipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. mexiletinemexiletine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.midazolammidazolam and clomipramine both increase sedation. Use Caution/Monitor.midazolam intranasalmidazolam intranasal, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineclomipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mifepristonemifepristone, clomipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.milnacipranmilnacipran, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Risk of euphoria, postural hypot'n when switching from clomipramine to milnacipran.mirabegronmirabegron will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mirtazapineclomipramine and mirtazapine both increase sedation. Use Caution/Monitor.clomipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.modafinilmodafinil will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.clomipramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphinemorphine and clomipramine both increase sedation. Use Caution/Monitor.clomipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.motherwortclomipramine and motherwort both increase sedation. Use Caution/Monitor.moxonidineclomipramine and moxonidine both increase sedation. Use Caution/Monitor.nabiloneclomipramine and nabilone both increase sedation. Use Caution/Monitor.nabumetoneclomipramine, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.nalbuphinenalbuphine and clomipramine both increase sedation. Use Caution/Monitor.naproxenclomipramine, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.naratriptannaratriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.nefopamnefopam, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.nelfinavirnelfinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.neostigmineneostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.nilotinibnilotinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.norepinephrineclomipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clomipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.nortriptylineclomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.ofloxacinclomipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.olanzapineolanzapine and clomipramine both increase sedation. Use Caution/Monitor.olanzapine and clomipramine both increase QTc interval. Use Caution/Monitor.oliceridineclomipramine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. clomipramine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.clomipramine increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.olodaterol inhaledclomipramine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. TCAs prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmiasonabotulinumtoxinAonabotulinumtoxinA and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.opium tinctureopium tincture and clomipramine both increase sedation. Use Caution/Monitor.orphenadrineclomipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.orphenadrine and clomipramine both increase sedation. Use Caution/Monitor.osimertinibosimertinib and clomipramine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.oxaprozinclomipramine, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use