Dosing & Uses
Dosage Forms & Strengths
capsule
- 25mg
- 50mg
- 75mg
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
Dosage Forms & Strengths
capsule
- 25mg
- 50mg
- 75mg
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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

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 (153)
- 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.
buprenorphine, long-acting injection and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - 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.
- fentanyl
fentanyl and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl intranasal
fentanyl intranasal and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
fentanyl transdermal and clomipramine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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 (449)
- 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. - elranatamab
elranatamab will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- 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.
- epcoritamab
epcoritamab, clomipramine. affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- 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.
- 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.
- gepirone
gepirone and clomipramine both increase QTc interval. Modify Therapy/Monitor Closely.
gepirone and clomipramine both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug. - gilteritinib
gilteritinib and clomipramine both increase QTc interval. Use Caution/Monitor.
- glofitamab
glofitamab, clomipramine. affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- 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.
- icosapent
icosapent, clomipramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.
- 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
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. - lonapegsomatropin
lonapegsomatropin will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- 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
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.
- quizartinib
quizartinib, clomipramine. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- 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. - ritlecitinib
ritlecitinib will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP1A2 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP1A2 substrates.
- 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 chloride/magnesium sulfate/polyethylene glycol
clomipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sodium sulfate/potassium sulfate/magnesium 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.
- solifenacin
solifenacin and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
solifenacin and clomipramine both increase QTc interval. Use Caution/Monitor. - somapacitan
somapacitan will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- somatrogon
somatrogon will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- somatropin
somatropin will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- 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.
- talquetamab
talquetamab will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- 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.
Adverse Effects
>10%
Xerostomia (84%)
Headache (50-55%)
Constipation (47%)
Ejaculation failure (42%)
Fatigue (35-40%)
Nausea (30-35%)
Impotence (20-25%)
Weight gain (18%)
1-10%
Weight loss (5%)
Hepatotoxicity (1-3%)
Frequency Not Defined
Common
- Dizziness, mainia, somnolence, tremor
- Dyspepsia
- Blurred vision
- Urinary retention
- Orgasm incapacity, libido change
Rare
- Myocardial infarction, orthostatic hypotension
- Depression worsening, suicidal thoughts suicide, seizure
- Hyperglycemia
- Agranulocytosis, leukopenia, pancytopenia, thrombocytopenia
- Body temperature above normal
- Drug rash with eosinophilia and systemic symptoms (DRESS)
Postmarketing Reports
Metabolism and Nutrition Disorders: Hyponatremia
Endocrine Disorders: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Warnings
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses
This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years
In children and young adults, risks must be weighed against the benefits of taking antidepressants
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments
The patient’s family should communicate any abrupt changes in behavior to the healthcare provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
This drug is not approved for use in pediatric patients
Contraindications
Hypersensitivity
Severe cardiovascular disorder
Narrow angle glaucoma
Any drugs or conditions that prolong QT interval
Acute recovery post-MI
Coadministration with serotonergic drugs
- Concomitant with or within 14 d of MAOIs (serotonin syndrome)
- Starting clomipramine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
- If linezolid or IV methylene blue must be administered, discontinue clomipramine immediately and monitor for CNS toxicity; may resume clomipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first
Cautions
BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment
Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy
Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 yr)
Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)
Risk of anticholinergic side-effects
Rare cases of drug rash with eosinophilia and systemic symptoms (DRESS) reported with use; in event of severe acute reactions such as DRESS, discontinue clomipramine therapy immediately and institute appropriate treatment
Hyponatremia
- Appears to be the result of syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Elderly patients may be at greater risk of developing hyponatremia, especially with a serotonergic antidepressant
- Patients taking diuretics or who are otherwise volume-depleted can be at greater risk
- Discontinue therapy in patients with symptomatic hyponatremia and institute appropriate medical intervention
- Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which can lead to falls
- More severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death
Pregnancy & Lactation
Pregnancy Category: C
Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Parent drug may affect serotonin uptake; active metabolite may may affect norepinephrine uptake
Pharmacokinetics
Peak Plasma Time: 2-6 hr
Concentration: 56-154 ng/mL
Half-Life: 32 hr (parent drug), 69 hr (metabolite)
Excretion: Urine (60%); feces (32%)
Steady-state therpaeutic plasma concentration: 100-250 ng/mL (parent drug), 230-550 ng/mL (metabolite)
Bioavailability: 50%
Protein Bound: 97-98%
Vd: 17 L/kg
Metabolism: Hepatic CYP2D6
Metabolites: Desmethylclomipramine
Dialyzable: No
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
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clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 25 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 50 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
clomipramine oral - | 75 mg capsule | ![]() | |
Anafranil oral - | 50 mg capsule | ![]() | |
Anafranil oral - | 75 mg capsule | ![]() | |
Anafranil oral - | 25 mg capsule | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
clomipramine oral
CLOMIPRAMINE - ORAL
(klo-MIP-ruh-meen)
COMMON BRAND NAME(S): Anafranil
WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
USES: Clomipramine is used to treat obsessive compulsive disorder (OCD). It helps decrease thoughts that are unwanted or that don't go away (obsessions), and it helps reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, checking) that interfere with daily living.This medication belongs to a class of medications called tricyclic antidepressants. It works by restoring the balance of certain natural substances (serotonin, among others) in the brain.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking clomipramine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor. To lessen side effects such as stomach upset, clomipramine may be started at a low dose, given in several doses during the day with meals, and slowly increased as your body gets used to it. After you have reached the best dose for you, the total dose can be taken once daily as directed by your doctor, usually at bedtime to prevent daytime drowsiness.Follow your doctor's instructions carefully. Do not take more or less medication or take it more often than prescribed. Your condition will not improve any faster and your risk of side effects such as seizures may be increased. The dosage is based on your medical condition and response to treatment.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.Use this medication regularly in order to get the most benefit from it. Keep taking it even if you feel well. To help you remember, use it at the same time(s) each day.Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. You may experience sweating, dizziness, nausea, vomiting, headache, or irritability if you suddenly stop taking this drug. Your dose may need to be gradually decreased.It may take 2 to 3 weeks or longer before the full effects of this medication are noticed. Inform your doctor if your condition lasts or gets worse.
SIDE EFFECTS: See also Warning section.Dizziness, drowsiness, dry mouth, constipation, stomach upset, nausea, vomiting, changes in appetite/weight, flushing, sweating, tiredness and blurred vision may occur. Anxiety symptoms may temporarily worsen when you first start taking clomipramine. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, depression, memory problems), enlarged/painful breasts, unwanted breast milk production, irregular/painful menstrual periods, muscle stiffness, ringing in the ears, sexual problems (such as decreased sexual ability, changes in desire), shakiness (tremors), numbness/tingling of the hands/feet, trouble urinating, easy bleeding/bruising, unusual/uncontrolled movements (especially of the tongue/face/lips), severe stomach/abdominal pain, dark urine, yellowing of eyes/skin.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take. Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.Get medical help right away if you have any very serious side effects, including: black stools, chest pain, fainting, slow/fast/irregular heartbeat, seizures, vomit that looks like coffee grounds, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also Warning section.Before taking clomipramine, tell your doctor or pharmacist if you are allergic to it; or to other tricyclic antidepressants (such as imipramine, nortriptyline); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, blood problems (such as purpura, thrombocytopenia), breathing problems (such as asthma, chronic bronchitis), personal or family history of glaucoma (angle-closure type), eating disorders (such as bulimia), heart problems (such as arrhythmias, coronary artery disease, recent heart attack), intestinal problems (such as chronic constipation, ileus), liver problems, kidney problems, personal or family history of other mental/mood conditions (such as bipolar disorder, schizophrenia), history of hospitalization for a very serious reaction to certain medications (neuroleptic malignant syndrome), heartburn/stomach acid in the esophagus (such as due to hiatal hernia), seizures, overactive thyroid (hyperthyroidism), trouble urinating (urinary retention, enlarged prostate), any condition that may increase your risk of seizures (such as alcohol/sedative dependency, use of electroconvulsive therapy, brain injury/disease), certain types of tumors (such as pheochromocytoma, neuroblastoma).Clomipramine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using clomipramine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using clomipramine safely.This drug may make you dizzy or drowsy or temporarily blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially bleeding, confusion, dizziness, and QT prolongation (see above). Dizziness and confusion can increase the risk of falling. Older adults may also be more likely to develop low sodium in the blood, especially if they are taking "water pills" (diuretics).During pregnancy, this medication should be used only when clearly needed. Newborns exposed to clomipramine during pregnancy may experience withdrawal symptoms or side effects. Discuss the risks and benefits with your doctor. Tell your doctor right away if you notice jitteriness, shaking, feeding problems, fast breathing, or seizures in your newborn.Since untreated mental/mood problems (such as obsessive compulsive disorder, depression, panic attack) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also the How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: certain drugs for high blood pressure (such as clonidine, guanethidine), digoxin, thyroid supplements, valproic acid, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as dabigatran/warfarin).Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Many drugs besides clomipramine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, quinidine, sotalol, pimozide, procainamide, macrolide antibiotics (such as erythromycin), among others. Before using clomipramine, report all medications you are currently using to your doctor or pharmacist.Other medications can affect the removal of clomipramine from your body, which may affect how clomipramine works. Examples include artemether/lumefantrine, barbiturates (such as phenobarbital), cimetidine, haloperidol, certain drugs for heart rhythm (such as flecainide/propafenone), certain HIV protease inhibitors (such as fosamprenavir), phenothiazines (such as thioridazine), certain anti-seizure drugs (such as phenytoin).Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/irregular heartbeat, severe dizziness, fainting, delirium, seizures, loss of consciousness.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as EKG, liver function, blood counts) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised September 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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