prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.ketamineMonitor Closely (1)ketamine and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)ketamine, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.ketoconazoleMonitor Closely (1)ketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.ketoprofenMonitor Closely (1)clomipramine, 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.ketorolacMonitor Closely (1)clomipramine, 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 intranasalMonitor Closely (1)clomipramine, 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, ophthalmicMonitor Closely (1)clomipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.L-tryptophanMonitor Closely (1)clomipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.lapatinibMonitor Closely (1)clomipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.lasmiditanMonitor Closely (2)lasmiditan, 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.lemborexantMonitor Closely (1)lemborexant, 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.leniolisibSerious - Use Alternative (1)leniolisib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid leniolisib with CYP1A2 substrates that have a narrow therapeutic indexletermovirMonitor Closely (1)letermovir increases levels of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levalbuterolMonitor Closely (1)clomipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, levalbuterol. 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.levofloxacinMonitor Closely (1)clomipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.levoketoconazoleMonitor Closely (1)levoketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.levomilnacipranSerious - Use Alternative (1)levomilnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.levorphanolMonitor Closely (1)levorphanol and clomipramine both increase sedation. Use Caution/Monitor.levothyroxineMonitor Closely (1)levothyroxine increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.linezolidSerious - Use Alternative (1)linezolid and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.liothyronineMonitor Closely (1)liothyronine increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.liotrixMonitor Closely (1)liotrix increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.lisdexamfetamineMonitor Closely (2)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). clomipramine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, lisdexamfetamine. 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.lithiumMonitor Closely (2)clomipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.lofepramineMonitor Closely (2)clomipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor. clomipramine and lofepramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug. clomipramine and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.lofexidineMonitor Closely (2)clomipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor. clomipramine and lofexidine both increase sedation. Use Caution/Monitor.lonafarnibSerious - Use Alternative (1)lonafarnib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.lonapegsomatropinMonitor Closely (1)lonapegsomatropin 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 substratesloprazolamMonitor Closely (1)loprazolam and clomipramine both increase sedation. Use Caution/Monitor.lorazepamMonitor Closely (1)lorazepam and clomipramine both increase sedation. Use Caution/Monitor.lorcaserinMonitor Closely (1)lorcaserin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.lormetazepamMonitor Closely (1)lormetazepam and clomipramine both increase sedation. Use Caution/Monitor.lornoxicamMonitor Closely (1)clomipramine, 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.loxapineMonitor Closely (1)loxapine and clomipramine both increase sedation. Use Caution/Monitor.loxapine inhaledMonitor Closely (1)loxapine inhaled and clomipramine both increase sedation. Use Caution/Monitor.lsdMonitor Closely (1)clomipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.lumacaftor/ivacaftorMonitor Closely (1)lumacaftor/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. .lumefantrineContraindicated (1)lumefantrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Serious - Use Alternative (1)clomipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)lumefantrine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.lurasidoneMonitor Closely (1)lurasidone 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.macimorelinSerious - Use Alternative (1)macimorelin and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.maprotilineMonitor Closely (2)clomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor. clomipramine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug. clomipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.maravirocMonitor Closely (1)maraviroc will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.marijuanaMonitor Closely (2)marijuana 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.Minor (1)marijuana will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.meclizineMonitor Closely (1)meclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.meclofenamateMonitor Closely (1)clomipramine, 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 acidMonitor Closely (1)clomipramine, 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.mefloquineSerious - Use Alternative (1)mefloquine increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.melatoninMonitor Closely (1)clomipramine and melatonin both increase sedation. Use Caution/Monitor.meloxicamMonitor Closely (1)clomipramine, 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.meperidineMonitor Closely (1)meperidine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meprobamateMonitor Closely (1)clomipramine and meprobamate both increase sedation. Use Caution/Monitor.mestranolMinor (1)mestranol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.metaproterenolMonitor Closely (1)clomipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, metaproterenol. 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.metaxaloneMonitor Closely (1)metaxalone and clomipramine both increase sedation. Use Caution/Monitor.metforminMinor (1)clomipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.methadoneMonitor Closely (2)clomipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely. methadone and clomipramine both increase sedation. Use Caution/Monitor.methamphetamineMonitor Closely (1)clomipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, methamphetamine. 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.methocarbamolMonitor Closely (1)methocarbamol and clomipramine both increase sedation. Use Caution/Monitor.methscopolamineMonitor Closely (1)methscopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.methylene blueSerious - Use Alternative (1)methylene blue and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.methylenedioxymethamphetamineMonitor Closely (1)clomipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, methylenedioxymethamphetamine. 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.methylphenidateMonitor Closely (1)clomipramine, 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 transdermalMonitor Closely (1)methylphenidate 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. methylprednisoloneMinor (1)methylprednisolone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.metoclopramide intranasalSerious - Use Alternative (1)clomipramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.metronidazoleMinor (1)metronidazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.mexiletineMonitor Closely (1)mexiletine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.miconazole vaginalMinor (1)miconazole vaginal will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.midazolamMonitor Closely (1)midazolam and clomipramine both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam 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.midodrineMonitor Closely (1)clomipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, midodrine. 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.mifepristoneMonitor Closely (1)mifepristone, clomipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.miglitolMinor (1)clomipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.milnacipranMonitor Closely (1)milnacipran, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Risk