clomipramine (Rx)

Obsessive-Compulsive Disorder

25 mg PO qDay initially

Gradually increase to 100 mg/day (divided with meals) over 2 weeks, THEN

May increase further to 250 mg/day maximum; may give as single daily dose qHS once tolerated

Other Indications & Uses

Off-label: premature ejaculation

Obsessive-Compulsive Disorder

<10 years: Safety and efficacy not established

≥10 years: 25 mg PO qDay initially

Gradually increase to maximum 3 mg/kg/day or 100 mg/day, whichever is less  

May further increase to maximum 3 mg/kg/day or 200 mg/day, whichever is less; may give as single dose qHS once tolerated

Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)

Consider alternatives; if must use, initiate with lower initial dose

25 mg PO qDay initially

Gradually increase to 100 mg/day (divided with meals) over 2 weeks, THEN

May increase further to 250 mg/day maximum; may give as single daily dose qHS once tolerated

Contraindicated (20)

• artemether/lumefantrine

  artemether/lumefantrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• disopyramide

  clomipramine and disopyramide both increase QTc interval. Contraindicated.

• dronedarone

  dronedarone will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• eliglustat

  clomipramine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

• ibutilide

  clomipramine and ibutilide both increase QTc interval. Contraindicated.

• indapamide

  clomipramine and indapamide both increase QTc interval. Contraindicated.

• iobenguane I 123

  clomipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• isocarboxazid

  isocarboxazid and clomipramine both increase serotonin levels. Contraindicated.

• lumefantrine

  lumefantrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• pentamidine

  clomipramine and pentamidine both increase QTc interval. Contraindicated.

• phenelzine

  phenelzine and clomipramine both increase serotonin levels. Contraindicated.

• pimozide

  clomipramine and pimozide both increase QTc interval. Contraindicated.

• procainamide

  clomipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  procarbazine and clomipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• quinidine

  quinidine and clomipramine both increase QTc interval. Contraindicated.

• safinamide

  clomipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• selegiline

  selegiline and clomipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• sotalol

  clomipramine and sotalol both increase QTc interval. Contraindicated.

• thioridazine

  thioridazine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• tranylcypromine

  tranylcypromine and clomipramine both increase serotonin levels. Contraindicated.

Serious - Use Alternative (150)

• abametapir

  abametapir will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

• adagrasib

  adagrasib, clomipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  clomipramine, albuterol. 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.

• amiodarone

  clomipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amitriptyline

  amitriptyline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

• arformoterol

  clomipramine, arformoterol. 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.

• arsenic trioxide

  clomipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  clomipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  clomipramine, benzphetamine. 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.

• buprenorphine

  buprenorphine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine subdermal implant and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  buprenorphine transdermal and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine transdermal and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• bupropion

  bupropion will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• buspirone

  clomipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• calcium/magnesium/potassium/sodium oxybates

  clomipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• chlorpromazine

  chlorpromazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• ciprofloxacin

  ciprofloxacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concurrent use of drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias. It is important to monitor therapy carefully.

• citalopram

  citalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• clonidine

  clomipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• cyclobenzaprine

  clomipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dasatinib

  dasatinib will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• degarelix

  degarelix and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  clomipramine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  clomipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dexfenfluramine

  clomipramine, dexfenfluramine. 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.

• dexmethylphenidate

  clomipramine, dexmethylphenidate. 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.

• dextroamphetamine

  clomipramine, dextroamphetamine. 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.

• dextromethorphan

  clomipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• diethylpropion

  clomipramine, diethylpropion. 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.

• dobutamine

  clomipramine, dobutamine. 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.

• dofetilide

  clomipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  dolasetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• dopamine

  clomipramine, dopamine. 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.

• dopexamine

  clomipramine, dopexamine. 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.

• dosulepin

  clomipramine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  clomipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

• dronedarone

  clomipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  clomipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  duloxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  clomipramine, ephedrine. 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.

• epinephrine

  epinephrine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, epinephrine. 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.

• epinephrine racemic

  epinephrine racemic and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, epinephrine racemic. 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.

• erythromycin base

  erythromycin base will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fenfluramine

  clomipramine, fenfluramine. 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.

• fexinidazole

  fexinidazole and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fluconazole

  fluconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  fluoxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  clomipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, formoterol. 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.

• fosamprenavir

  fosamprenavir increases levels of clomipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• givosiran

  givosiran will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
  
  givosiran will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• granisetron

  granisetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  granisetron and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• guanfacine

  clomipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  haloperidol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• imipramine

  clomipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• iobenguane I 131

  clomipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• isoproterenol

  clomipramine, isoproterenol. 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.

• ivosidenib

  ivosidenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoconazole

  clomipramine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• leniolisib

  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 index

• levalbuterol

  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.

• levoketoconazole

  clomipramine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  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.

• lisdexamfetamine

  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.

• lofepramine

  clomipramine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lonafarnib

  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.

• lorcaserin

  clomipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lumefantrine

  clomipramine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  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.

• maprotiline

  clomipramine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• mefloquine

  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.

• meperidine

  clomipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• metaproterenol

  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.

• methamphetamine

  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.

• methylene blue

  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.

• methylenedioxymethamphetamine

  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.

• metoclopramide intranasal

  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.

• midodrine

  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.

• milnacipran

  milnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  clomipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nefazodone

  nefazodone will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  nefazodone and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• netupitant/palonosetron

  netupitant/palonosetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nilotinib

  clomipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• norepinephrine

  clomipramine, norepinephrine. 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.

• nortriptyline

  clomipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  clomipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  clomipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• olopatadine intranasal

  clomipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  clomipramine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of clomipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palonosetron

  palonosetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• paroxetine

  paroxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  paroxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• pefloxacin

  pefloxacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  clomipramine, phendimetrazine. 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.

• phentermine

  clomipramine, phentermine. 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.

• phenylephrine

  clomipramine, phenylephrine. 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.

• phenylephrine PO

  clomipramine, phenylephrine PO. 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.

• pirbuterol

  clomipramine, pirbuterol. 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.

• pitolisant

  clomipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• promazine

  promazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  promethazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• propylhexedrine

  clomipramine, propylhexedrine. 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.

• protriptyline

  clomipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  clomipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• quinidine

  quinidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Avoid combination within 14 days of MAOI use.

• ribociclib

  ribociclib increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug.

• salmeterol

  clomipramine, salmeterol. 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.

• selegiline transdermal

  selegiline transdermal and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, clomipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• serdexmethylphenidate/dexmethylphenidate

  clomipramine, serdexmethylphenidate/dexmethylphenidate. 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.

• sertraline

  sertraline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  clomipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• St John's Wort

  clomipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• tedizolid

  tedizolid, clomipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• terbutaline

  clomipramine, terbutaline. 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.

• thioridazine

  thioridazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• toremifene

  clomipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• trazodone

  clomipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  clomipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• umeclidinium bromide/vilanterol inhaled

  clomipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  clomipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• vandetanib

  clomipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  venlafaxine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  clomipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  clomipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  clomipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vortioxetine

  clomipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• xylometazoline

  clomipramine, xylometazoline. 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.

• yohimbe

  yohimbe, clomipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  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.

• ziprasidone

  clomipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (441)

• 5-HTP

  clomipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  abiraterone increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  abobotulinumtoxinA increases effects of clomipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• aceclofenac

  clomipramine, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• acemetacin

  clomipramine, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aclidinium

  aclidinium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  acrivastine and clomipramine both increase sedation. Use Caution/Monitor.

• albuterol

  clomipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  alfentanil and clomipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  clomipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  alprazolam and clomipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  clomipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  amiodarone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• amisulpride

  clomipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.

• amitriptyline

  amitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and clomipramine both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  amobarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  amobarbital and clomipramine both increase sedation. Use Caution/Monitor.

• amoxapine

  amoxapine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and clomipramine both increase sedation. Use Caution/Monitor.

• anagrelide

  anagrelide and clomipramine both increase QTc interval. Use Caution/Monitor.

• anticholinergic/sedative combos

  anticholinergic/sedative combos and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apomorphine

  clomipramine and apomorphine both increase sedation. Use Caution/Monitor.

• aprepitant

  aprepitant will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• arformoterol

  clomipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aripiprazole

  aripiprazole and clomipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and clomipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  armodafinil will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  clomipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  asenapine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and clomipramine both increase QTc interval. Use Caution/Monitor.
  
  asenapine and clomipramine both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and clomipramine both increase QTc interval. Use Caution/Monitor.
  
  asenapine transdermal and clomipramine both increase sedation. Use Caution/Monitor.

• aspirin

  clomipramine, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aspirin rectal

  clomipramine, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  clomipramine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• atazanavir

  atazanavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  atazanavir increases levels of clomipramine by unspecified interaction mechanism. Use Caution/Monitor.

• atomoxetine

  clomipramine increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  atomoxetine and clomipramine both increase QTc interval. Use Caution/Monitor.

• atracurium

  atracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  atropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine IV/IM

  atropine IV/IM and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• avapritinib

  avapritinib and clomipramine both increase sedation. Use Caution/Monitor.

• azelastine

  azelastine and clomipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  clomipramine and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  baclofen and clomipramine both increase sedation. Use Caution/Monitor.

• bedaquiline

  clomipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  belladonna alkaloids and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  belladonna and opium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and clomipramine both increase sedation. Use Caution/Monitor.

• benazepril

  clomipramine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

• benperidol

  benperidol and clomipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, 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.

• benzphetamine

  clomipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benztropine

  benztropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• bethanechol

  bethanechol increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexpiprazole

  clomipramine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
  
  brexpiprazole and clomipramine both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and clomipramine both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and clomipramine both increase sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and clomipramine both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and clomipramine both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  clomipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  clomipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  clomipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.

• butabarbital

  butabarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  butabarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  butabarbital and clomipramine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  butalbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  butalbital and clomipramine both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and clomipramine both increase sedation. Use Caution/Monitor.

• caffeine

  clomipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cannabidiol

  cannabidiol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• captopril

  clomipramine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

• carbachol

  carbachol increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbamazepine

  carbamazepine will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  carbamazepine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and clomipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and clomipramine both increase sedation. Use Caution/Monitor.

• celecoxib

  celecoxib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  clomipramine, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• cenobamate

  cenobamate, clomipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  ceritinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• cevimeline

  cevimeline increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and clomipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and clomipramine both increase sedation. Use Caution/Monitor.

• chloroquine

  chloroquine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  chloroquine increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and clomipramine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and clomipramine both increase sedation. Use Caution/Monitor.

• choline magnesium trisalicylate

  clomipramine, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• cigarette smoking

  cigarette smoking will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  cinnarizine and clomipramine both increase sedation. Use Caution/Monitor.

• cisatracurium

  cisatracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• clemastine

  clemastine and clomipramine both increase sedation. Use Caution/Monitor.

• clobazam

  clobazam will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  clomipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clonazepam

  clonazepam and clomipramine both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and clomipramine both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and clomipramine both increase sedation. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of clomipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

• cocaine topical

  clomipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  codeine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• conivaptan

  conivaptan will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• crizotinib

  crizotinib and clomipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  cyclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and clomipramine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and clomipramine both increase sedation. Use Caution/Monitor.

• cyclosporine

  cyclosporine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and clomipramine both increase sedation. Use Caution/Monitor.

• dantrolene

  dantrolene and clomipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  clomipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  darifenacin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  darifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• darunavir

  darunavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dasatinib

  clomipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• debrisoquine

  clomipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• deferasirox

  deferasirox increases levels of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• desflurane

  desflurane and clomipramine both increase sedation. Use Caution/Monitor.
  
  desflurane and clomipramine both increase QTc interval. Use Caution/Monitor.

• desipramine

  clomipramine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and desipramine both increase sedation. Use Caution/Monitor.

• desvenlafaxine

  desvenlafaxine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• deutetrabenazine

  clomipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  clomipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmedetomidine

  dexmedetomidine and clomipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  clomipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  clomipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  clomipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.

• dextroamphetamine transdermal

  clomipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromoramide

  dextromoramide and clomipramine both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and clomipramine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and clomipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  dichlorphenamide and clomipramine both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  clomipramine, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• dicyclomine

  dicyclomine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  clomipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and clomipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and clomipramine both increase sedation. Use Caution/Monitor.

• diflunisal

  clomipramine, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• dihydroergotamine

  clomipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  clomipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  dimenhydrinate and clomipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  diphenhydramine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and clomipramine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and clomipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and clomipramine both increase sedation. Use Caution/Monitor.

• dobutamine

  clomipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dolasetron

  clomipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  donepezil increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  donepezil and clomipramine both increase QTc interval. Use Caution/Monitor.

• dopamine

  clomipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  clomipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  clomipramine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  clomipramine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and clomipramine both increase sedation. Use Caution/Monitor.

• dronedarone

  dronedarone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• droperidol

  droperidol and clomipramine both increase sedation. Use Caution/Monitor.

• echothiophate iodide

  echothiophate iodide increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  efavirenz and clomipramine both increase QTc interval. Use Caution/Monitor.

• elagolix

  elagolix will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

• eletriptan

  eletriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  eliglustat increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and clomipramine both increase QTc interval. Use Caution/Monitor.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• entrectinib

  entrectinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  clomipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

• epinephrine

  clomipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

• epinephrine inhaled

  clomipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  clomipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.

• ergotamine

  clomipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  eribulin and clomipramine both increase QTc interval. Use Caution/Monitor.

• erythromycin base

  erythromycin base will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• escitalopram

  escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, clomipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  eslicarbazepine acetate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• estazolam

  estazolam and clomipramine both increase sedation. Use Caution/Monitor.

• ethanol

  clomipramine and ethanol both increase sedation. Use Caution/Monitor.

• etodolac

  clomipramine, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• etomidate

  etomidate and clomipramine both increase sedation. Use Caution/Monitor.

• ezogabine

  ezogabine, clomipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenbufen

  clomipramine, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fenfluramine

  clomipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  clomipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, clomipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fenoprofen

  clomipramine, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fesoterodine

  fesoterodine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fexinidazole

  fexinidazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  fexinidazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• fingolimod

  fingolimod and clomipramine both increase QTc interval. Use Caution/Monitor.

• flavoxate

  flavoxate and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  clomipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluoxetine

  clomipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  fluphenazine and clomipramine both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and clomipramine both increase sedation. Use Caution/Monitor.

• flurbiprofen

  clomipramine, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fluvoxamine

  fluvoxamine and clomipramine both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  clomipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fosaprepitant

  fosaprepitant will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• foscarnet

  clomipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin

  fosphenytoin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• frovatriptan

  frovatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, 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.

• gabapentin enacarbil

  gabapentin enacarbil, 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.

• galantamine

  galantamine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  clomipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  gemifloxacin and clomipramine both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  gilteritinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• glycopyrrolate

  glycopyrrolate and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  glycopyrrolate 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 topical

  glycopyrronium 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.

• grapefruit

  grapefruit will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• haloperidol

  haloperidol and clomipramine both increase sedation. Use Caution/Monitor.

• henbane

  henbane and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  homatropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  huperzine A increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  hydrocodone, 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.

• hydromorphone

  hydromorphone and clomipramine both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and clomipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and clomipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  hyoscyamine spray and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibuprofen

  clomipramine, 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 IV

  clomipramine, 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.

• iloperidone

  clomipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and clomipramine both increase sedation. Use Caution/Monitor.

• imatinib

  imatinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  clomipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and imipramine both increase sedation. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, 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.

• indinavir

  indinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• indomethacin

  clomipramine, 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.

• ipratropium

  ipratropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isoflurane

  isoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  isoniazid 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.

• isoproterenol

  clomipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• itraconazole

  itraconazole and clomipramine both increase QTc interval. Use Caution/Monitor.

• ketamine

  ketamine and clomipramine both increase sedation. Use Caution/Monitor.

• ketoconazole

  ketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketoprofen

  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.

• ketorolac

  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 intranasal

  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, ophthalmic

  clomipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  clomipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  clomipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  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.

• lemborexant

  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.

• letermovir

  letermovir increases levels of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  clomipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  clomipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  levoketoconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levorphanol

  levorphanol and clomipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  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.

• liothyronine

  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.

• liotrix

  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.

• lisdexamfetamine

  clomipramine 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).

• lithium

  clomipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  lithium and clomipramine both increase QTc interval. Use Caution/Monitor.

• lofepramine

  clomipramine and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  clomipramine and lofexidine both increase sedation. Use Caution/Monitor.
  
  clomipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.

• loprazolam

  loprazolam and clomipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and clomipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lormetazepam

  lormetazepam and clomipramine both increase sedation. Use Caution/Monitor.

• lornoxicam

  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.

• loxapine

  loxapine and clomipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and clomipramine both increase sedation. Use Caution/Monitor.

• lsd

  clomipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  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. .

• lurasidone

  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.

• maprotiline

  clomipramine and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and maprotiline both increase sedation. Use Caution/Monitor.

• maraviroc

  maraviroc will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• marijuana

  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.

• meclizine

  meclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• meclofenamate

  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 acid

  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.

• melatonin

  clomipramine and melatonin both increase sedation. Use Caution/Monitor.

• meloxicam

  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.

• meperidine

  meperidine and clomipramine both increase sedation. Use Caution/Monitor.

• meprobamate

  clomipramine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  clomipramine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and clomipramine both increase sedation. Use Caution/Monitor.

• methadone

  clomipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and clomipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  clomipramine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and clomipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylenedioxymethamphetamine

  clomipramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylphenidate

  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 transdermal

  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.

• mexiletine

  mexiletine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• midazolam

  midazolam and clomipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  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.

• midodrine

  clomipramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  mifepristone, clomipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• milnacipran

  milnacipran, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Risk of euphoria, postural hypot'n when switching from clomipramine to milnacipran.

• mirabegron

  mirabegron will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  clomipramine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  clomipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• modafinil

  modafinil 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.

• morphine

  morphine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• motherwort

  clomipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  clomipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  clomipramine and nabilone both increase sedation. Use Caution/Monitor.

• nabumetone

  clomipramine, 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.

• nalbuphine

  nalbuphine and clomipramine both increase sedation. Use Caution/Monitor.

• naproxen

  clomipramine, 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.

• naratriptan

  naratriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nefopam

  nefopam, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  nelfinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• neostigmine

  neostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nilotinib

  nilotinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• norepinephrine

  clomipramine 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.

• nortriptyline

  clomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.

• ofloxacin

  clomipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  olanzapine and clomipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and clomipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  clomipramine 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 inhaled

  clomipramine 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 arrhythmias

• onabotulinumtoxinA

  onabotulinumtoxinA and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• opium tincture

  opium tincture and clomipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  clomipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and clomipramine both increase sedation. Use Caution/Monitor.

• osimertinib

  osimertinib 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.

• oxaprozin

  clomipramine, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• oxazepam

  oxazepam and clomipramine both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  oxybutynin topical and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  oxybutynin transdermal and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  oxycodone and clomipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  clomipramine 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.

• oxymorphone

  oxymorphone and clomipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod 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.

• paliperidone

  clomipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and clomipramine both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  papaveretum and clomipramine both increase sedation. Use Caution/Monitor.

• papaverine

  clomipramine and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib

  parecoxib 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.

• paroxetine

  clomipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  clomipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  clomipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• peginterferon alfa 2a

  peginterferon alfa 2a will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• peginterferon alfa 2b

  peginterferon 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.

• pentazocine

  pentazocine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital 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.

• perphenazine

  perphenazine 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.

• phendimetrazine

  clomipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  phenobarbital 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.

• phentermine

  clomipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  clomipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine ophthalmic

  clomipramine, 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 PO

  clomipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  phenytoin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pholcodine

  clomipramine and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  physostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  pilocarpine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  pimozide and clomipramine both increase sedation. Use Caution/Monitor.

• pipemidic acid

  pipemidic acid will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• pirbuterol

  clomipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  clomipramine, 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.

• posaconazole

  clomipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  pralidoxime and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• pregabalin

  pregabalin, 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.

• primidone

  primidone 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.

• prochlorperazine

  prochlorperazine and clomipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and clomipramine both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and clomipramine both increase sedation. Use Caution/Monitor.

• propafenone

  propafenone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propantheline

  propantheline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  propofol and clomipramine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  clomipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  clomipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and protriptyline both increase sedation. Use Caution/Monitor.

• pyridostigmine

  pyridostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  quazepam and clomipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine 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.

• quinacrine

  quinacrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quinine

  clomipramine and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  clomipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  ranolazine 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.

• rapacuronium

  rapacuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• remifentanil

  clomipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

• remimazolam

  remimazolam, 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.

• rifabutin

  rifabutin 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.

• rifampin

  rifampin 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.

• rifapentine

  rifapentine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine 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.

• risperidone

  clomipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and clomipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  ritonavir 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.

• rivastigmine

  rivastigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• rizatriptan

  rizatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  rocuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  rolapitant 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.

• romidepsin

  clomipramine 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.

• salmeterol

  clomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  clomipramine, 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.

• SAMe

  clomipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• scopolamine

  scopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  clomipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital 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.

• selpercatinib

  selpercatinib increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• sevoflurane

  sevoflurane and clomipramine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.

• shepherd's purse

  clomipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• smoking

  smoking will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium 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 sulfate/magnesium sulfate

  sodium 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.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  clomipramine, sodium sulfate/potassium sulfate/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.

• solifenacin

  solifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  solifenacin and clomipramine both increase QTc interval. Use Caution/Monitor.

• sorafenib

  sorafenib and clomipramine both increase QTc interval. Use Caution/Monitor.

• sparsentan

  sparsentan 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 Wort

  St John's Wort will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• stiripentol

  stiripentol, 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.

• succinylcholine

  succinylcholine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  sufentanil and clomipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  sufentanil 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.

• sulfamethoxazole

  clomipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

• sulfasalazine

  clomipramine, 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.

• sulindac

  clomipramine, 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.

• sumatriptan

  sumatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  suvorexant and clomipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  tacrolimus and clomipramine both increase QTc interval. Use Caution/Monitor.

• tamsulosin

  clomipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  tapentadol and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tecovirimat

  tecovirimat will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

• telavancin

  clomipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and clomipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  clomipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• teriflunomide

  teriflunomide decreases levels of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tetrabenazine

  tetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  thioridazine and clomipramine both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and clomipramine both increase sedation. Use Caution/Monitor.

• thyroid desiccated

  thyroid desiccated increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  tiotropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tobacco use

  tobacco use will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tolfenamic acid

  clomipramine, tolfenamic 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.

• tolmetin

  clomipramine, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• tolterodine

  tolterodine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  clomipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• trazodone

  clomipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and clomipramine both increase sedation. Use Caution/Monitor.

• triclabendazole

  triclabendazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• triclofos

  triclofos and clomipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and clomipramine both increase sedation. Use Caution/Monitor.

• trihexyphenidyl

  trihexyphenidyl and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  clomipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  clomipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and clomipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  clomipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  trospium chloride and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• valbenazine

  valbenazine and clomipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  valerian and clomipramine both increase sedation. Use Caution/Monitor.

• vecuronium

  vecuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• venlafaxine

  venlafaxine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  clomipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• verapamil

  verapamil will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• voclosporin

  voclosporin, clomipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  clomipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• xylometazoline

  clomipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  clomipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  clomipramine and ziconotide both increase sedation. Use Caution/Monitor.

• zileuton

  zileuton will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• ziprasidone

  ziprasidone and clomipramine both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (103)

• acarbose

  clomipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• amobarbital

  amobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• armodafinil

  armodafinil will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atropine

  clomipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  clomipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• bazedoxifene/conjugated estrogens

  bazedoxifene/conjugated estrogens, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bosentan

  bosentan will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brimonidine

  clomipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• budesonide

  budesonide will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butabarbital

  butabarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  butalbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• carbamazepine

  carbamazepine decreases levels of clomipramine by increasing metabolism. Minor/Significance Unknown.

• chlorpromazine

  clomipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  clomipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• conjugated estrogens

  conjugated estrogens, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  conjugated estrogens, vaginal, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• cortisone

  cortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• desflurane

  desflurane, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• dexamethasone

  dexamethasone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexmethylphenidate

  dexmethylphenidate increases effects of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• DHEA, herbal

  DHEA, herbal will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• efavirenz

  efavirenz will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• esomeprazole

  esomeprazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• estradiol

  estradiol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  estrogens conjugated synthetic, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  estrogens esterified, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  estropipate, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethinylestradiol

  ethinylestradiol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• etomidate

  etomidate, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• etravirine

  etravirine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  clomipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluphenazine

  clomipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• glimepiride

  clomipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  clomipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  clomipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• griseofulvin

  griseofulvin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydroxyprogesterone caproate (DSC)

  hydroxyprogesterone caproate (DSC), clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• insulin aspart

  clomipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  clomipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  clomipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  clomipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  clomipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  clomipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  clomipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• isoniazid

  isoniazid will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isoproterenol

  isoproterenol, clomipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• itraconazole

  itraconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ketamine

  ketamine, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• lithium

  lithium, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

• lumefantrine

  lumefantrine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• marijuana

  marijuana will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mestranol

  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.

• metformin

  clomipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole

  metronidazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miglitol

  clomipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• nateglinide

  clomipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nevirapine

  nevirapine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  nifedipine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  nilotinib will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• omeprazole

  omeprazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• panax ginseng

  panax ginseng increases effects of clomipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  clomipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phenobarbital

  phenobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• pioglitazone

  clomipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of clomipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  posaconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• prednisone

  prednisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primidone

  primidone, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• prochlorperazine

  clomipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  progesterone micronized, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  clomipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  clomipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propofol

  propofol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• repaglinide

  clomipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• rosiglitazone

  clomipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• rufinamide

  rufinamide will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

  clomipramine and sage both increase sedation. Minor/Significance Unknown.

• saxagliptin

  clomipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• secobarbital

  secobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate increases effects of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• sevoflurane

  sevoflurane, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• sitagliptin

  clomipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• sulfamethoxazole

  sulfamethoxazole decreases levels of clomipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• thioridazine

  clomipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• tolazamide

  clomipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  clomipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• topiramate

  topiramate will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• trifluoperazine

  clomipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• vasopressin

  clomipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• verapamil

  verapamil will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
  
  verapamil increases levels of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• vildagliptin

  clomipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• voriconazole

  voriconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zafirlukast

  zafirlukast will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zolpidem

  zolpidem, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• 5-HTP

  Monitor Closely (1)clomipramine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abametapir

  Serious - Use Alternative (1)abametapir will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• abobotulinumtoxinA

  Monitor Closely (1)abobotulinumtoxinA increases effects of clomipramine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects. .

• acarbose

  Minor (1)clomipramine increases effects of acarbose by pharmacodynamic synergism. Minor/Significance Unknown.

• aceclofenac

  Monitor Closely (1)clomipramine, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• acemetacin

  Monitor Closely (1)clomipramine, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aclidinium

  Monitor Closely (1)aclidinium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• acrivastine

  Monitor Closely (1)acrivastine and clomipramine both increase sedation. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib, clomipramine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albuterol

  Monitor Closely (1)clomipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, albuterol. 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.

• alfentanil

  Monitor Closely (1)alfentanil and clomipramine both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)clomipramine and alfuzosin both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  Monitor Closely (1)alprazolam and clomipramine both increase sedation. Use Caution/Monitor.

• amifampridine

  Monitor Closely (1)clomipramine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Monitor Closely (1)amiodarone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Monitor Closely (1)clomipramine and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (2)amitriptyline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amitriptyline and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amitriptyline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amitriptyline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (3)amobarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  amobarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  amobarbital and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)amobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• amoxapine

  Monitor Closely (2)amoxapine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  amoxapine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)amoxapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  amoxapine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• anagrelide

  Monitor Closely (1)anagrelide and clomipramine both increase QTc interval. Use Caution/Monitor.

• anticholinergic/sedative combos

  Monitor Closely (1)anticholinergic/sedative combos and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

• apomorphine

  Monitor Closely (1)clomipramine and apomorphine both increase sedation. Use Caution/Monitor.

• aprepitant

  Monitor Closely (1)aprepitant will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)clomipramine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, arformoterol. 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.

• aripiprazole

  Monitor Closely (2)aripiprazole and clomipramine both increase sedation. Use Caution/Monitor.
  
  aripiprazole and clomipramine both increase QTc interval. Use Caution/Monitor.

• armodafinil

  Monitor Closely (2)armodafinil will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  clomipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arsenic trioxide

  Serious - Use Alternative (1)clomipramine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Contraindicated (1)artemether/lumefantrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Serious - Use Alternative (1)clomipramine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)artemether/lumefantrine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• asenapine

  Monitor Closely (3)asenapine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and clomipramine both increase sedation. Use Caution/Monitor.
  
  asenapine and clomipramine both increase QTc interval. Use Caution/Monitor.

• asenapine transdermal

  Monitor Closely (2)asenapine transdermal and clomipramine both increase sedation. Use Caution/Monitor.
  
  asenapine transdermal and clomipramine both increase QTc interval. Use Caution/Monitor.

• aspirin

  Monitor Closely (1)clomipramine, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aspirin rectal

  Monitor Closely (1)clomipramine, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)clomipramine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• atazanavir

  Monitor Closely (2)atazanavir increases levels of clomipramine by unspecified interaction mechanism. Use Caution/Monitor.
  
  atazanavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (2)clomipramine increases levels of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  atomoxetine and clomipramine both increase QTc interval. Use Caution/Monitor.

• atracurium

  Monitor Closely (1)atracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• atropine

  Monitor Closely (1)atropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)clomipramine increases levels of atropine by unknown mechanism. Minor/Significance Unknown.

• atropine IV/IM

  Monitor Closely (1)atropine IV/IM and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (1)clomipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.

• avapritinib

  Monitor Closely (1)avapritinib and clomipramine both increase sedation. Use Caution/Monitor.

• azelastine

  Monitor Closely (1)azelastine and clomipramine both increase sedation. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)clomipramine and azithromycin both increase QTc interval. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and clomipramine both increase sedation. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  Minor (1)bazedoxifene/conjugated estrogens, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• bedaquiline

  Monitor Closely (1)clomipramine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Monitor Closely (1)belladonna alkaloids and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (2)belladonna and opium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  belladonna and opium and clomipramine both increase sedation. Use Caution/Monitor.

• benazepril

  Monitor Closely (1)clomipramine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

• benperidol

  Monitor Closely (1)benperidol and clomipramine both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, 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.Serious - Use Alternative (1)benzhydrocodone/acetaminophen and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  Monitor Closely (1)clomipramine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, benzphetamine. 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.

• benztropine

  Monitor Closely (1)benztropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• bethanechol

  Monitor Closely (1)bethanechol increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bosentan

  Minor (1)bosentan will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brexpiprazole

  Monitor Closely (2)brexpiprazole and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.

• brimonidine

  Monitor Closely (1)brimonidine and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)clomipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

• brivaracetam

  Monitor Closely (1)brivaracetam and clomipramine both increase sedation. Use Caution/Monitor.

• brompheniramine

  Monitor Closely (1)brompheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• budesonide

  Minor (1)budesonide will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• buprenorphine

  Monitor Closely (1)buprenorphine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)clomipramine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (2)buprenorphine subdermal implant and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine subdermal implant and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  Serious - Use Alternative (2)buprenorphine transdermal and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine transdermal and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  Monitor Closely (1)clomipramine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine, long-acting injection and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• bupropion

  Monitor Closely (1)clomipramine increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.Serious - Use Alternative (1)bupropion will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• buspirone

  Serious - Use Alternative (1)clomipramine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (3)butabarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  butabarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  butabarbital and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butalbital

  Monitor Closely (3)butalbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  butalbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
  
  butalbital and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)butalbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• butorphanol

  Monitor Closely (1)butorphanol and clomipramine both increase sedation. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)clomipramine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)clomipramine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• cannabidiol

  Monitor Closely (1)cannabidiol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• captopril

  Monitor Closely (1)clomipramine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

• carbachol

  Monitor Closely (1)carbachol increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbamazepine

  Monitor Closely (2)carbamazepine will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  carbamazepine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)carbamazepine decreases levels of clomipramine by increasing metabolism. Minor/Significance Unknown.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and clomipramine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and clomipramine both increase sedation. Use Caution/Monitor.

• celecoxib

  Monitor Closely (2)celecoxib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  clomipramine, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• cenobamate

  Monitor Closely (1)cenobamate, clomipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  Monitor Closely (1)ceritinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• cevimeline

  Monitor Closely (1)cevimeline increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and clomipramine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and clomipramine both increase sedation. Use Caution/Monitor.

• chloroquine

  Monitor Closely (2)chloroquine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  chloroquine increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, chlorpromazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, chlorpromazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• chlorpropamide

  Minor (1)clomipramine increases effects of chlorpropamide by pharmacodynamic synergism. Minor/Significance Unknown.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and clomipramine both increase sedation. Use Caution/Monitor.

• choline magnesium trisalicylate

  Monitor Closely (1)clomipramine, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• cigarette smoking

  Monitor Closely (1)cigarette smoking will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• cimetidine

  Monitor Closely (3)cimetidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  cimetidine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and clomipramine both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  Serious - Use Alternative (1)ciprofloxacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Concurrent use of drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias. It is important to monitor therapy carefully.

• cisatracurium

  Monitor Closely (1)cisatracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• citalopram

  Serious - Use Alternative (2)citalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Citalopram may increase TCA levels. Increased risk of serotonin syndrome or neuroleptic malignant syndrome. Potential risk for QT prolongation. ECG monitoring is recommended.
  
  citalopram and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (2)clomipramine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
  
  clarithromycin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and clomipramine both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (2)clobazam will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
  
  clomipramine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clonazepam

  Monitor Closely (1)clonazepam and clomipramine both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)clomipramine decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• clorazepate

  Monitor Closely (1)clorazepate and clomipramine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)clozapine and clomipramine both increase sedation. Use Caution/Monitor.

• cobicistat

  Monitor Closely (2)cobicistat will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Carefully titrate antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response
  
  cobicistat will increase the level or effect of clomipramine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with TCAs and cobicistat.

• cocaine topical

  Monitor Closely (1)clomipramine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (2)codeine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• conivaptan

  Monitor Closely (1)conivaptan will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conjugated estrogens

  Minor (1)conjugated estrogens, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• cortisone

  Minor (1)cortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• crizotinib

  Monitor Closely (1)crizotinib and clomipramine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  Monitor Closely (2)cyclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclizine and clomipramine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (2)cyclobenzaprine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  cyclobenzaprine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyclosporine

  Monitor Closely (1)cyclosporine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and clomipramine both increase sedation. Use Caution/Monitor.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and clomipramine both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)clomipramine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (3)darifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  darifenacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  darifenacin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• darunavir

  Monitor Closely (1)darunavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dasatinib

  Monitor Closely (1)clomipramine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dasatinib will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• debrisoquine

  Monitor Closely (1)clomipramine decreases effects of debrisoquine by Other (see comment). Use Caution/Monitor. Comment: Inhibition of uptake by adrenergic neurons.

• deferasirox

  Monitor Closely (1)deferasirox increases levels of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• degarelix

  Serious - Use Alternative (1)degarelix and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  Monitor Closely (2)desflurane and clomipramine both increase sedation. Use Caution/Monitor.
  
  desflurane and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)desflurane, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• desipramine

  Monitor Closely (2)clomipramine and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  Monitor Closely (1)desvenlafaxine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)clomipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (2)clomipramine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Minor (1)dexamethasone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and clomipramine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)clomipramine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  clomipramine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dexfenfluramine. 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.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and clomipramine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)clomipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dexmethylphenidate. 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.Minor (1)dexmethylphenidate increases effects of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine

  Monitor Closely (3)clomipramine increases effects of dextroamphetamine by unknown mechanism. Use Caution/Monitor.
  
  clomipramine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  clomipramine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dextroamphetamine. 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.

• dextroamphetamine transdermal

  Monitor Closely (1)clomipramine will increase the level or effect of dextroamphetamine transdermal by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May enhance the activity of tricyclic or sympathomimetic agents causing striking and sustained increases in dextroamphetamine levels in brain; May be potentiate cardiovascular effects. Monitor frequently and adjust or use an alternant based on clinical response.

• dextromethorphan

  Serious - Use Alternative (1)clomipramine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromoramide

  Monitor Closely (1)dextromoramide and clomipramine both increase sedation. Use Caution/Monitor.

• DHEA, herbal

  Minor (1)DHEA, herbal will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• diamorphine

  Monitor Closely (1)diamorphine and clomipramine both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and clomipramine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide and clomipramine both decrease serum potassium. Use Caution/Monitor.

• diclofenac

  Monitor Closely (1)clomipramine, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• dicyclomine

  Monitor Closely (1)dicyclomine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• diethylpropion

  Monitor Closely (1)clomipramine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, diethylpropion. 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.

• difelikefalin

  Monitor Closely (1)difelikefalin and clomipramine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and clomipramine both increase sedation. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)clomipramine, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• dihydroergotamine

  Monitor Closely (1)clomipramine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)clomipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and clomipramine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (3)diphenhydramine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  diphenhydramine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  diphenhydramine and clomipramine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and clomipramine both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and clomipramine both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)clomipramine and disopyramide both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)clomipramine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dobutamine. 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.

• dofetilide

  Serious - Use Alternative (2)clomipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
  
  dofetilide increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)clomipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)dolasetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  Monitor Closely (2)donepezil increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  donepezil and clomipramine both increase QTc interval. Use Caution/Monitor.

• dopamine

  Monitor Closely (1)clomipramine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dopamine. 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.

• dopexamine

  Monitor Closely (1)clomipramine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, dopexamine. 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.

• dosulepin

  Monitor Closely (2)clomipramine and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and dosulepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  Monitor Closely (2)clomipramine and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and clomipramine both increase sedation. Use Caution/Monitor.

• dronedarone

  Contraindicated (1)dronedarone will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.Monitor Closely (1)dronedarone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  Monitor Closely (1)droperidol and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Serious - Use Alternative (2)duloxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  duloxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• echothiophate iodide

  Monitor Closely (1)echothiophate iodide increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• efavirenz

  Monitor Closely (1)efavirenz and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)efavirenz will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• elagolix

  Monitor Closely (1)elagolix will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

• eletriptan

  Monitor Closely (1)eletriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  Contraindicated (1)clomipramine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.Monitor Closely (2)eliglustat increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
  
  eliglustat and clomipramine both increase QTc interval. Use Caution/Monitor.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Serious - Use Alternative (1)encorafenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Monitor Closely (1)entrectinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• ephedrine

  Monitor Closely (2)clomipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.
  
  clomipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, ephedrine. 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.

• epinephrine

  Monitor Closely (2)clomipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.
  
  clomipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, epinephrine. 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.

• epinephrine inhaled

  Monitor Closely (1)clomipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

• epinephrine racemic

  Monitor Closely (2)clomipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor.
  
  clomipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, epinephrine racemic. 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.

• ergotamine

  Monitor Closely (1)clomipramine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Monitor Closely (1)eribulin and clomipramine both increase QTc interval. Use Caution/Monitor.

• erythromycin base

  Monitor Closely (1)erythromycin base will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin base will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin ethylsuccinate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin stearate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• escitalopram

  Monitor Closely (1)escitalopram increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)escitalopram and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, clomipramine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Minor (1)eslicarbazepine acetate will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• esomeprazole

  Minor (1)esomeprazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• estazolam

  Monitor Closely (1)estazolam and clomipramine both increase sedation. Use Caution/Monitor.

• estradiol

  Minor (1)estradiol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• estrogens esterified

  Minor (1)estrogens esterified, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens may inhibit hepatic metabolism of tricyclic antidepressants. However, interactions are not common.

• estropipate

  Minor (1)estropipate, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• ethanol

  Monitor Closely (1)clomipramine and ethanol both increase sedation. Use Caution/Monitor.

• ethinylestradiol

  Minor (1)ethinylestradiol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• etodolac

  Monitor Closely (1)clomipramine, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• etomidate

  Monitor Closely (1)etomidate and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)etomidate, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• etravirine

  Minor (1)etravirine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  Minor (1)clomipramine and eucalyptus both increase sedation. Minor/Significance Unknown.

• ezogabine

  Monitor Closely (1)ezogabine, clomipramine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenbufen

  Monitor Closely (1)clomipramine, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fenfluramine

  Monitor Closely (3)fenfluramine, clomipramine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  clomipramine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  clomipramine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, fenfluramine. 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.

• fenoprofen

  Monitor Closely (1)clomipramine, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fesoterodine

  Monitor Closely (1)fesoterodine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• fexinidazole

  Monitor Closely (2)fexinidazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  fexinidazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fexinidazole and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fingolimod

  Monitor Closely (1)fingolimod and clomipramine both increase QTc interval. Use Caution/Monitor.

• flavoxate

  Monitor Closely (1)flavoxate and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• flecainide

  Monitor Closely (1)clomipramine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fluconazole

  Serious - Use Alternative (2)clomipramine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
  
  fluconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fludrocortisone

  Minor (1)fludrocortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluoxetine

  Monitor Closely (1)clomipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  fluoxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (1)fluphenazine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, fluphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, fluphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• flurazepam

  Monitor Closely (1)flurazepam and clomipramine both increase sedation. Use Caution/Monitor.

• flurbiprofen

  Monitor Closely (1)clomipramine, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and clomipramine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluvoxamine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• formoterol

  Monitor Closely (1)clomipramine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine, formoterol. 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.

• fosamprenavir

  Monitor Closely (1)fosamprenavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fosamprenavir increases levels of clomipramine by decreasing metabolism. Avoid or Use Alternate Drug.

• fosaprepitant

  Monitor Closely (1)fosaprepitant will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• foscarnet

  Monitor Closely (1)clomipramine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• frovatriptan

  Monitor Closely (1)frovatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  Monitor Closely (1)gabapentin, 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.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, 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.

• galantamine

  Monitor Closely (1)galantamine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ganaxolone

  Monitor Closely (1)clomipramine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and clomipramine both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Monitor Closely (1)gilteritinib and clomipramine both increase QTc interval. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (2)givosiran will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
  
  givosiran will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glimepiride

  Minor (1)clomipramine increases effects of glimepiride by pharmacodynamic synergism. Minor/Significance Unknown.

• glipizide

  Minor (1)clomipramine increases effects of glipizide by pharmacodynamic synergism. Minor/Significance Unknown.

• glyburide

  Minor (1)clomipramine increases effects of glyburide by pharmacodynamic synergism. Minor/Significance Unknown.

• glycopyrrolate

  Monitor Closely (2)glycopyrrolate and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine increases levels of glycopyrrolate by unknown mechanism. Use Caution/Monitor.

• glycopyrrolate inhaled

  Monitor Closely (2)glycopyrrolate 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 topical

  Monitor Closely (1)glycopyrronium 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.

• granisetron

  Serious - Use Alternative (2)granisetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  granisetron and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit

  Monitor Closely (1)grapefruit will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• griseofulvin

  Minor (1)griseofulvin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• guanfacine

  Serious - Use Alternative (1)clomipramine decreases effects of guanfacine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• haloperidol

  Monitor Closely (1)haloperidol and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
  
  haloperidol will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• henbane

  Monitor Closely (1)henbane and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• homatropine

  Monitor Closely (1)homatropine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• huperzine A

  Monitor Closely (1)huperzine A increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocodone

  Monitor Closely (1)hydrocodone, 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.

• hydrocortisone

  Minor (1)hydrocortisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydromorphone

  Monitor Closely (1)hydromorphone and clomipramine both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  Minor (1)hydroxyprogesterone caproate (DSC), clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and clomipramine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and clomipramine both increase QTc interval. Use Caution/Monitor.

• hyoscyamine

  Monitor Closely (1)hyoscyamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• hyoscyamine spray

  Monitor Closely (1)hyoscyamine spray and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ibuprofen

  Monitor Closely (1)clomipramine, 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 IV

  Monitor Closely (1)clomipramine, 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.

• ibutilide

  Contraindicated (1)clomipramine and ibutilide both increase QTc interval. Contraindicated.

• iloperidone

  Monitor Closely (2)clomipramine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and clomipramine both increase sedation. Use Caution/Monitor.

• imatinib

  Monitor Closely (1)imatinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  Monitor Closely (2)clomipramine and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, 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.

• indapamide

  Contraindicated (1)clomipramine and indapamide both increase QTc interval. Contraindicated.

• indinavir

  Monitor Closely (1)indinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• indomethacin

  Monitor Closely (1)clomipramine, 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.

• insulin aspart

  Minor (1)clomipramine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin detemir

  Minor (1)clomipramine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glargine

  Minor (1)clomipramine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin glulisine

  Minor (1)clomipramine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin lispro

  Minor (1)clomipramine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin NPH

  Minor (1)clomipramine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown.

• insulin regular human

  Minor (1)clomipramine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown.

• iobenguane I 123

  Contraindicated (1)clomipramine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.

• iobenguane I 131

  Serious - Use Alternative (1)clomipramine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• ipratropium

  Monitor Closely (1)ipratropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

• isocarboxazid

  Contraindicated (1)isocarboxazid and clomipramine both increase serotonin levels. Contraindicated.

• isoflurane

  Monitor Closely (1)isoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.

• isoniazid

  Monitor Closely (2)isoniazid 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.Minor (1)isoniazid will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isoproterenol

  Monitor Closely (1)clomipramine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, isoproterenol. 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.Minor (1)isoproterenol, clomipramine. Mechanism: unknown. Minor/Significance Unknown. Risk of cardiac arrhythmias.

• itraconazole

  Monitor Closely (1)itraconazole and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)itraconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ivosidenib

  Serious - Use Alternative (1)ivosidenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketamine

  Monitor 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.

• ketoconazole

  Monitor 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.

• ketoprofen

  Monitor 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.

• ketorolac

  Monitor 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 intranasal

  Monitor 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, ophthalmic

  Monitor Closely (1)clomipramine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  Monitor Closely (1)clomipramine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lapatinib

  Monitor Closely (1)clomipramine and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  Monitor 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.

• lemborexant

  Monitor 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.

• leniolisib

  Serious - 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 index

• letermovir

  Monitor Closely (1)letermovir increases levels of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  Monitor 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.

• levofloxacin

  Monitor Closely (1)clomipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Monitor 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.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)levorphanol and clomipramine both increase sedation. Use Caution/Monitor.

• levothyroxine

  Monitor 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.

• linezolid

  Serious - 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.

• liothyronine

  Monitor 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.

• liotrix

  Monitor 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.

• lisdexamfetamine

  Monitor 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.

• lithium

  Monitor 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.

• lofepramine

  Monitor 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.

• lofexidine

  Monitor Closely (2)clomipramine decreases effects of lofexidine by unspecified interaction mechanism. Use Caution/Monitor.
  
  clomipramine and lofexidine both increase sedation. Use Caution/Monitor.

• lonafarnib

  Serious - 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.

• loprazolam

  Monitor Closely (1)loprazolam and clomipramine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and clomipramine both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor 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.

• lormetazepam

  Monitor Closely (1)lormetazepam and clomipramine both increase sedation. Use Caution/Monitor.

• lornoxicam

  Monitor 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.

• loxapine

  Monitor Closely (1)loxapine and clomipramine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled and clomipramine both increase sedation. Use Caution/Monitor.

• lsd

  Monitor Closely (1)clomipramine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  Monitor 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. .

• lumefantrine

  Contraindicated (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.

• lurasidone

  Monitor 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.

• macimorelin

  Serious - 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.

• maprotiline

  Monitor 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.

• maraviroc

  Monitor Closely (1)maraviroc will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• marijuana

  Monitor 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.

• meclizine

  Monitor Closely (1)meclizine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• meclofenamate

  Monitor 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 acid

  Monitor 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.

• mefloquine

  Serious - 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.

• melatonin

  Monitor Closely (1)clomipramine and melatonin both increase sedation. Use Caution/Monitor.

• meloxicam

  Monitor 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.

• meperidine

  Monitor 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.

• meprobamate

  Monitor Closely (1)clomipramine and meprobamate both increase sedation. Use Caution/Monitor.

• mestranol

  Minor (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.

• metaproterenol

  Monitor 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.

• metaxalone

  Monitor Closely (1)metaxalone and clomipramine both increase sedation. Use Caution/Monitor.

• metformin

  Minor (1)clomipramine increases effects of metformin by pharmacodynamic synergism. Minor/Significance Unknown.

• methadone

  Monitor Closely (2)clomipramine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and clomipramine both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor 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.

• methocarbamol

  Monitor Closely (1)methocarbamol and clomipramine both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (1)methscopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• methylene blue

  Serious - 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.

• methylenedioxymethamphetamine

  Monitor 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.

• methylphenidate

  Monitor 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 transdermal

  Monitor 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.

• methylprednisolone

  Minor (1)methylprednisolone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metoclopramide intranasal

  Serious - 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.

• metronidazole

  Minor (1)metronidazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• mexiletine

  Monitor Closely (1)mexiletine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• miconazole vaginal

  Minor (1)miconazole vaginal will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midazolam

  Monitor Closely (1)midazolam and clomipramine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor 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.

• midodrine

  Monitor 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.

• mifepristone

  Monitor Closely (1)mifepristone, clomipramine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  Minor (1)clomipramine increases effects of miglitol by pharmacodynamic synergism. Minor/Significance Unknown.

• milnacipran

  Monitor Closely (1)milnacipran, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Risk of euphoria, postural hypot'n when switching from clomipramine to milnacipran.Serious - Use Alternative (1)milnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (2)clomipramine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  clomipramine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (2)modafinil 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.

• morphine

  Monitor Closely (2)clomipramine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  morphine and clomipramine both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)clomipramine and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)clomipramine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)clomipramine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)clomipramine and nabilone both increase sedation. Use Caution/Monitor.

• nabumetone

  Monitor Closely (1)clomipramine, 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.

• nalbuphine

  Monitor Closely (1)nalbuphine and clomipramine both increase sedation. Use Caution/Monitor.

• naproxen

  Monitor Closely (1)clomipramine, 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.

• naratriptan

  Monitor Closely (1)naratriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nateglinide

  Minor (1)clomipramine increases effects of nateglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• nefazodone

  Serious - Use Alternative (2)nefazodone and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  nefazodone will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nefopam

  Monitor Closely (1)nefopam, clomipramine. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Use combination with caution.

• nelfinavir

  Monitor Closely (1)nelfinavir will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• neostigmine

  Monitor Closely (1)neostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nevirapine

  Minor (1)nevirapine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  Minor (1)nifedipine will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  Monitor Closely (1)nilotinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)nilotinib will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (2)clomipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
  
  clomipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, norepinephrine. 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.

• nortriptyline

  Monitor Closely (2)clomipramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)clomipramine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)clomipramine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)clomipramine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (2)olanzapine and clomipramine both increase sedation. Use Caution/Monitor.
  
  olanzapine and clomipramine both increase QTc interval. Use Caution/Monitor.

• oliceridine

  Monitor Closely (3)clomipramine 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 inhaled

  Monitor Closely (1)clomipramine 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 arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)clomipramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• omeprazole

  Minor (1)omeprazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.

• onabotulinumtoxinA

  Monitor Closely (1)onabotulinumtoxinA and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• ondansetron

  Serious - Use Alternative (2)clomipramine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• opium tincture

  Monitor Closely (1)opium tincture and clomipramine both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (2)clomipramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  orphenadrine and clomipramine both increase sedation. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib 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.

• oxaprozin

  Monitor Closely (1)clomipramine, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• oxazepam

  Monitor Closely (1)oxazepam and clomipramine both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  Minor (1)oxcarbazepine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxybutynin

  Monitor Closely (1)oxybutynin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin topical

  Monitor Closely (1)oxybutynin topical and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxybutynin transdermal

  Monitor Closely (1)oxybutynin transdermal and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone and clomipramine both increase sedation. Use Caution/Monitor.

• oxymetazoline intranasal

  Monitor Closely (1)clomipramine 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.

• oxymorphone

  Monitor Closely (1)oxymorphone and clomipramine both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod 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.Serious - Use Alternative (1)ozanimod increases toxicity of clomipramine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (2)clomipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and clomipramine both increase sedation. Use Caution/Monitor.

• palonosetron

  Serious - Use Alternative (1)palonosetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng

  Minor (1)panax ginseng increases effects of clomipramine by pharmacodynamic synergism. Minor/Significance Unknown.

• pancuronium

  Monitor Closely (1)pancuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• papaveretum

  Monitor Closely (1)papaveretum and clomipramine both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)clomipramine and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib

  Monitor Closely (2)parecoxib 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.

• paroxetine

  Monitor Closely (1)clomipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  paroxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)clomipramine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)clomipramine and pazopanib both increase QTc interval. Use Caution/Monitor.

• pefloxacin

  Serious - Use Alternative (1)pefloxacin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• peginterferon alfa 2a

  Monitor Closely (1)peginterferon alfa 2a will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon 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.

• pentamidine

  Contraindicated (1)clomipramine and pentamidine both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (2)clomipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and clomipramine both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (3)pentobarbital 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.Minor (1)pentobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• perphenazine

  Monitor Closely (2)perphenazine 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.Serious - Use Alternative (1)perphenazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• phendimetrazine

  Monitor Closely (1)clomipramine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, phendimetrazine. 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.

• phenelzine

  Contraindicated (1)phenelzine and clomipramine both increase serotonin levels. Contraindicated.

• phenobarbital

  Monitor Closely (3)phenobarbital 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.Minor (1)phenobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• phentermine

  Monitor Closely (1)clomipramine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, phentermine. 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.

• phenylephrine

  Monitor Closely (1)clomipramine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, phenylephrine. 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.

• phenylephrine ophthalmic

  Monitor Closely (1)clomipramine, 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 PO

  Monitor Closely (1)clomipramine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Serious - Use Alternative (1)clomipramine, phenylephrine PO. 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.

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pholcodine

  Monitor Closely (1)clomipramine and pholcodine both increase sedation. Use Caution/Monitor.

• physostigmine

  Monitor Closely (1)physostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pilocarpine

  Monitor Closely (1)pilocarpine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pimozide

  Contraindicated (1)clomipramine and pimozide both increase QTc interval. Contraindicated.Monitor Closely (1)pimozide and clomipramine both increase sedation. Use Caution/Monitor.

• pioglitazone

  Minor (1)clomipramine increases effects of pioglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• pipemidic acid

  Monitor Closely (1)pipemidic acid will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• pirbuterol

  Monitor Closely (1)clomipramine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, pirbuterol. 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.

• piroxicam

  Monitor Closely (1)clomipramine, 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.

• pitolisant

  Serious - Use Alternative (1)clomipramine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• pleurisy root

  Minor (1)pleurisy root decreases effects of clomipramine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• posaconazole

  Monitor Closely (1)clomipramine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)posaconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pralidoxime

  Monitor Closely (1)pralidoxime and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• prednisone

  Minor (1)prednisone will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pregabalin

  Monitor Closely (1)pregabalin, 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.

• primidone

  Monitor Closely (3)primidone 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.Minor (1)primidone, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• procainamide

  Contraindicated (1)clomipramine and procainamide both increase QTc interval. Contraindicated.

• procarbazine

  Contraindicated (1)procarbazine and clomipramine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine

  Monitor Closely (2)prochlorperazine and clomipramine both increase QTc interval. Use Caution/Monitor.
  
  prochlorperazine and clomipramine both increase sedation. Use Caution/Monitor.Minor (2)clomipramine, prochlorperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, prochlorperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• progesterone micronized

  Minor (1)progesterone micronized, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.

• promazine

  Serious - Use Alternative (1)promazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, promazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, promazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• promethazine

  Monitor Closely (1)promethazine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)promethazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, promethazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, promethazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• propafenone

  Monitor Closely (1)propafenone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propantheline

  Monitor Closely (1)propantheline and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• propofol

  Monitor Closely (1)propofol and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)propofol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• propylhexedrine

  Monitor Closely (1)clomipramine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, propylhexedrine. 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.

• protriptyline

  Monitor Closely (2)clomipramine and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• pseudoephedrine

  Serious - Use Alternative (1)clomipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• pyridostigmine

  Monitor Closely (1)pyridostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and clomipramine both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (2)quetiapine 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.

• quinacrine

  Monitor Closely (1)quinacrine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quinidine

  Contraindicated (1)quinidine and clomipramine both increase QTc interval. Contraindicated.Serious - Use Alternative (1)quinidine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)clomipramine and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin

  Minor (1)quinupristin/dalfopristin will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ramelteon

  Monitor Closely (1)clomipramine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (2)ranolazine 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.

• rapacuronium

  Monitor Closely (1)rapacuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. Avoid combination within 14 days of MAOI use.

• remifentanil

  Monitor Closely (1)clomipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

• remimazolam

  Monitor Closely (1)remimazolam, 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.

• repaglinide

  Minor (1)clomipramine increases effects of repaglinide by pharmacodynamic synergism. Minor/Significance Unknown.

• ribociclib

  Serious - Use Alternative (1)ribociclib increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (2)rifabutin decreases levels of clomipramine by increasing metabolism. Use Caution/Monitor.
  
  rifabutin will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (2)rifampin 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.

• rifapentine

  Monitor Closely (1)rifapentine will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)rilpivirine 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.

• risperidone

  Monitor Closely (2)clomipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and clomipramine both increase sedation. Use Caution/Monitor.

• ritonavir

  Monitor Closely (2)ritonavir 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.

• rivastigmine

  Monitor Closely (1)rivastigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• rizatriptan

  Monitor Closely (1)rizatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• rocuronium

  Monitor Closely (1)rocuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• rolapitant

  Monitor Closely (1)rolapitant 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.

• romidepsin

  Monitor Closely (1)clomipramine and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• rosiglitazone

  Minor (1)clomipramine increases effects of rosiglitazone by pharmacodynamic synergism. Minor/Significance Unknown.

• rufinamide

  Minor (1)rufinamide will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• safinamide

  Contraindicated (1)clomipramine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• sage

  Minor (1)clomipramine and sage both increase sedation. Minor/Significance Unknown.

• salicylates (non-asa)

  Monitor Closely (1)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.

• salmeterol

  Monitor Closely (1)clomipramine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, salmeterol. 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.

• salsalate

  Monitor Closely (1)clomipramine, 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.

• SAMe

  Monitor Closely (1)clomipramine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• saxagliptin

  Minor (1)clomipramine increases effects of saxagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• scopolamine

  Monitor Closely (1)scopolamine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)clomipramine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (3)secobarbital 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.Minor (1)secobarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.

• selegiline

  Contraindicated (1)selegiline and clomipramine both increase serotonin levels. Contraindicated. Concurrent use or use within 14 days of selegiline treatment is contraindicated

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  Serious - Use Alternative (1)selinexor, clomipramine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of clomipramine by QTc interval. Use Caution/Monitor.

• serdexmethylphenidate/dexmethylphenidate

  Serious - Use Alternative (1)clomipramine, serdexmethylphenidate/dexmethylphenidate. 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.Minor (1)serdexmethylphenidate/dexmethylphenidate increases effects of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• sertraline

  Monitor Closely (1)sertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Monitor Closely (2)sevoflurane and clomipramine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)sevoflurane, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

• shepherd's purse

  Monitor Closely (1)clomipramine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sitagliptin

  Minor (1)clomipramine increases effects of sitagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• smoking

  Monitor Closely (1)smoking will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• sodium oxybate

  Serious - Use Alternative (1)clomipramine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium 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 sulfate/magnesium sulfate

  Monitor Closely (1)sodium 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.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)clomipramine, sodium sulfate/potassium sulfate/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.

• solifenacin

  Monitor Closely (2)solifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  solifenacin and clomipramine both increase QTc interval. Use Caution/Monitor.

• sorafenib

  Monitor Closely (1)sorafenib and clomipramine both increase QTc interval. Use Caution/Monitor.

• sotalol

  Contraindicated (1)clomipramine and sotalol both increase QTc interval. Contraindicated.

• sparsentan

  Monitor Closely (1)sparsentan 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 Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)clomipramine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (3)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.
  
  stiripentol, 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.

• succinylcholine

  Monitor Closely (1)succinylcholine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)sufentanil and clomipramine both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Monitor Closely (1)sufentanil 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.

• sulfamethoxazole

  Monitor Closely (1)clomipramine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)sulfamethoxazole decreases levels of clomipramine by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfasalazine

  Monitor Closely (1)clomipramine, 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.

• sulindac

  Monitor Closely (1)clomipramine, 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.

• sumatriptan

  Monitor Closely (1)sumatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  Monitor Closely (1)suvorexant and clomipramine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  Monitor Closely (1)tacrolimus and clomipramine both increase QTc interval. Use Caution/Monitor.

• tamsulosin

  Monitor Closely (1)clomipramine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  Monitor Closely (2)clomipramine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tapentadol and clomipramine both increase sedation. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (1)tecovirimat will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

• tedizolid

  Serious - Use Alternative (1)tedizolid, clomipramine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• telavancin

  Monitor Closely (1)clomipramine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam and clomipramine both increase sedation. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (1)clomipramine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, terbutaline. 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.

• teriflunomide

  Monitor Closely (1)teriflunomide decreases levels of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tetrabenazine

  Monitor Closely (1)tetrabenazine and clomipramine both increase QTc interval. Use Caution/Monitor.

• thioridazine

  Contraindicated (1)thioridazine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.Monitor Closely (1)thioridazine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, thioridazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, thioridazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• thiothixene

  Monitor Closely (1)thiothixene and clomipramine both increase sedation. Use Caution/Monitor.

• thyroid desiccated

  Monitor Closely (1)thyroid desiccated increases effects of clomipramine by Other (see comment). Use Caution/Monitor. Comment: Increased catecholamine receptor sensitivity; may increase CNS and cardiovascular effects, including arrhythmias.

• tiotropium

  Monitor Closely (1)tiotropium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tobacco use

  Monitor Closely (1)tobacco use will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• tolazamide

  Minor (1)clomipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolbutamide

  Minor (1)clomipramine increases effects of tolbutamide by pharmacodynamic synergism. Minor/Significance Unknown.

• tolfenamic acid

  Monitor Closely (1)clomipramine, tolfenamic 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.

• tolmetin

  Monitor Closely (1)clomipramine, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• tolterodine

  Monitor Closely (1)tolterodine and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)clomipramine and topiramate both increase sedation. Modify Therapy/Monitor Closely.Minor (1)topiramate will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• toremifene

  Serious - Use Alternative (1)clomipramine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• tramadol

  Monitor Closely (2)clomipramine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  tramadol and clomipramine both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Contraindicated (1)tranylcypromine and clomipramine both increase serotonin levels. Contraindicated.

• trazodone

  Monitor Closely (2)clomipramine and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
  
  trazodone and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and clomipramine both increase sedation. Use Caution/Monitor.

• triclabendazole

  Monitor Closely (1)triclabendazole will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• triclofos

  Monitor Closely (1)triclofos and clomipramine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)clomipramine, trifluoperazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects.
  
  clomipramine, trifluoperazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

• trihexyphenidyl

  Monitor Closely (1)trihexyphenidyl and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor. Potential for additive anticholinergic effects.

• trimethoprim

  Monitor Closely (1)clomipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Monitor Closely (2)clomipramine and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
  
  clomipramine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
  
  clomipramine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• triprolidine

  Monitor Closely (1)triprolidine and clomipramine both increase sedation. Use Caution/Monitor.

• tropisetron

  Monitor Closely (1)clomipramine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  Monitor Closely (1)trospium chloride and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (2)clomipramine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
  
  clomipramine and umeclidinium bromide/vilanterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated

• valbenazine

  Monitor Closely (1)valbenazine and clomipramine both increase QTc interval. Use Caution/Monitor.

• valerian

  Monitor Closely (1)valerian and clomipramine both increase sedation. Use Caution/Monitor.

• vandetanib

  Serious - Use Alternative (1)clomipramine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vasopressin

  Minor (1)clomipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

• vecuronium

  Monitor Closely (1)vecuronium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Monitor Closely (2)venlafaxine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  clomipramine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)venlafaxine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• verapamil

  Monitor Closely (1)verapamil will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Minor (2)verapamil will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
  
  verapamil increases levels of clomipramine by decreasing metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (2)clomipramine and vilanterol/fluticasone furoate inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Exercise extreme caution if vilanterol coadministered with MAOIs or TCAs, or within 2 weeks of discontinuation of these drugs; adrenergic agonist effects on the cardiovascular system may be potentiated
  
  clomipramine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)clomipramine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vildagliptin

  Minor (1)clomipramine increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.

• voclosporin

  Monitor Closely (1)voclosporin, clomipramine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (1)clomipramine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)voriconazole will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vortioxetine

  Serious - Use Alternative (1)clomipramine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• xylometazoline

  Monitor Closely (1)clomipramine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine, xylometazoline. 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.

• yohimbe

  Serious - Use Alternative (1)yohimbe, clomipramine. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.

• yohimbine

  Monitor Closely (1)clomipramine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (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.

• zafirlukast

  Minor (1)zafirlukast will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ziconotide

  Monitor Closely (1)clomipramine and ziconotide both increase sedation. Use Caution/Monitor.

• zileuton

  Monitor Closely (1)zileuton will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• ziprasidone

  Monitor 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.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• zolpidem

  Minor (1)zolpidem, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.