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For fluoxetine, a wash-out period of two to three weeks is advised before and after treatment with fluoxetine.Co-administration of clomipramine with terbinafine, a strong inhibitor of CYP2D6, may result in increased exposure and accumulation of clomipramine and its N-demethylated metabolite. The European Association of Urology 2014 guidelines on male sexual dysfunction recommend that pharmacological treatment options include 'on demand' dapoxetine, daily use of a longer-acting selective serotonin reuptake inhibitor (SSRI) [off-label use], daily use of clomipramine (off-label use), 'on demand' topical local anaesthetic agents (off-label use) and 'on demand' tramadol (off-label use). Although, in a few cases with high dose oestrogen (50 micrograms daily) and the tricyclic antidepressant imipramine, increased side effects and therapeutic response were noted, it is unclear as to the relevance of these cases to clomipramine and lower dose oestrogen regimens. Patients should also be warned that alcohol or other drugs may potentiate these effects (see section 4.5).This medicine can impair cognitive function and can affect a patient's ability to drive safely. This should be attained gradually over a period of 2 weeks starting with 1 x 25 mg clomipramine daily. Patients with a history of recurrence require maintenance treatment for a longer duration. Clomipramine and desmethylclomipramine are widely distributed throughout the body and is 97.6% bound to plasma and tissue protein. It allows continued monitoring of the benefit/risk balance of the medicinal product. Where necessary, therapy may be combined with capsules up to the maximum dose of 75 mg per day.Abrupt withdrawal should be avoided because of possible adverse reactions. If the patient has impaired consciousness, secure the airway with a cuffed endotracheal tube before beginning lavage, and do not induce vomiting. It is suggested that treatment is commenced with 10 mg clomipramine daily and gradually increased until a satisfactory response occurs. Higher doses may be needed in some patients, particularly those suffering from obsessional or phobic disorders. Therefore concomitant use of such agents with clomipramine is not recommended (see section 4.4). These disappear within a few days of withdrawing the drug.As improvement in depression may not occur for the first two to four weeks treatment, patients should be closely monitored during this period.Elderly patients are particularly liable to experience adverse effects, especially agitation, confusion, and postural hypotension.Clomipramine should be administered with particular precaution in patients with cardiovascular disorders, especially those with cardiovascular insufficiency, conduction disorders, (There may be a risk of QTc prolongation and torsades de pointes, particularly at supra-therapeutic doses or supra-therapeutic plasma concentrations of clomipramine, as occur in the case of co- medication with selective serotonin reuptake inhibitors (SSRIs).
There is evidence to suggest that clomipramine may be given as little as 24 hours after a reversible MAO-A inhibitor such as moclobemide, but the 3-week wash-out period must be observed if the MAO-A inhibitor is used after clomipramine.Diuretics may lead to hypokalaemia, which increases the risk of QTc prolongation and torsades de pointes. Continue typing to refine. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. Clomipramine is not recommended during pregnancy and in women of childbearing potential not using contraception.Clomipramine passes into the breast milk in small quantities. It may increase the risk of suicide in those over the age of 20. Distribution. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcardThe signs and symptoms of overdose with clomipramine are similar to those reported with other tricyclic antidepressants.
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