Clomipramine Hydrochloride

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Generic Name of Clomipramine Hydrochloride - Learn More

Clomipramine Hydrochloride

Clomipramine Hydrochloride Precaution - What You Need to Know

Clomipramine hydrochloride is a tricyclic antidepressant (TCA) primarily used for the treatment of obsessive-compulsive disorder (OCD) and other psychiatric conditions, such as panic disorder and depression. When prescribing clomipramine, it is important to consider the patient’s medical history. Patients with a history of cardiovascular diseases (such as heart attack, arrhythmias, or heart failure) should be monitored closely, as TCAs can affect the heart’s conduction system and may worsen pre-existing conditions. It should be used with caution in individuals with a history of seizures, as clomipramine can lower the seizure threshold. Patients with a history of glaucoma, particularly narrow-angle glaucoma, should avoid using this drug, as TCAs can increase intraocular pressure. The drug may also cause anticholinergic side effects, such as dry mouth, constipation, and urinary retention, which can be problematic for individuals with urinary retention or enlarged prostate. The use of clomipramine should be avoided during pregnancy unless absolutely necessary, and it should be prescribed with caution during breastfeeding, as it can be excreted in breast milk. Close monitoring of mood, especially in adolescents and young adults, is recommended, as there is an increased risk of suicidal thoughts and behaviors during the initial stages of treatment or when doses are adjusted.

Clomipramine Hydrochloride Indication - Uses and Benefits

Clomipramine hydrochloride is primarily indicated for the treatment of obsessive-compulsive disorder (OCD) in adults and children over the age of 10. It is effective in reducing the frequency and severity of obsessive thoughts and compulsive behaviors. In addition to OCD, clomipramine is also indicated for the treatment of panic disorder and generalized anxiety disorder (GAD). It is occasionally used off-label for the treatment of depression, particularly in cases that have not responded to other antidepressants. Clomipramine may also be used for other anxiety-related conditions, such as social anxiety disorder or post-traumatic stress disorder (PTSD), but these are not FDA-approved indications. Its efficacy in treating OCD is well-established, with the drug working by inhibiting the reuptake of serotonin and norepinephrine, two neurotransmitters involved in mood regulation and anxiety responses. Its use for anxiety and depressive disorders is based on its effects on the serotonin system, helping to improve mood and reduce feelings of anxiety or worry.

Clomipramine Hydrochloride Contraindications - Important Warnings

Clomipramine hydrochloride is contraindicated in patients who are hypersensitive to clomipramine or any of the other ingredients in the formulation. It is also contraindicated in patients who are currently taking monoamine oxidase inhibitors (MAOIs) or have taken MAOIs within the last 14 days, as this can result in serious, life-threatening interactions leading to serotonin syndrome. Clomipramine is not recommended for use in patients with a history of or active manic episodes associated with bipolar disorder unless they are specifically treated for bipolar disorder. It is contraindicated in individuals with a known history of seizures, as it may increase the risk of seizure activity. Patients with narrow-angle glaucoma or urinary retention should avoid using clomipramine, as the drug may exacerbate these conditions due to its anticholinergic properties. It is also contraindicated in patients with a history of certain heart conditions, including arrhythmias, as it can affect the conduction system of the heart. Clomipramine should not be used during pregnancy unless the benefits outweigh the potential risks to the fetus, and it should be avoided during breastfeeding.

Clomipramine Hydrochloride Side Effects - What to Expect

Clomipramine hydrochloride, like other tricyclic antidepressants, has a broad range of side effects, both common and severe. The most frequent side effects include anticholinergic effects such as dry mouth, blurred vision, constipation, urinary retention, and dizziness. These can be particularly bothersome in elderly patients and may exacerbate pre-existing conditions like glaucoma or prostate problems. Weight gain and sedation are also common, and some patients may experience drowsiness or fatigue during the day. Other common side effects include nausea, sexual dysfunction, and sweating. In some individuals, clomipramine can cause more severe effects, including orthostatic hypotension (low blood pressure when standing), tachycardia (increased heart rate), or arrhythmias, which can be dangerous in those with cardiovascular conditions. Serious side effects may also include confusion, hallucinations, and seizures, especially if the drug is taken in overdose. A rare but serious side effect is serotonin syndrome, which can occur when clomipramine is combined with other serotonergic drugs, leading to symptoms like hyperreflexia, fever, and agitation. Clomipramine may also increase the risk of suicidal thoughts and behaviors, particularly in young adults, so close monitoring is necessary, especially during the early stages of treatment or when adjusting the dose.

Clomipramine Hydrochloride Pregnancy Category ID - Safety Information

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Clomipramine Hydrochloride Mode of Action - How It Works

Clomipramine hydrochloride is a tricyclic antidepressant that exerts its therapeutic effects primarily by inhibiting the reuptake of serotonin and norepinephrine, two neurotransmitters involved in regulating mood, anxiety, and emotional responses. By blocking the reuptake of these neurotransmitters, clomipramine increases their availability in the synaptic cleft, enhancing their action on postsynaptic receptors. The drug’s primary action on serotonin is thought to be responsible for its efficacy in treating obsessive-compulsive disorder (OCD), panic disorder, and other anxiety-related conditions. Clomipramine's ability to increase serotonin levels in the brain is believed to reduce the intensity of obsessive thoughts and compulsive behaviors in patients with OCD. Additionally, its effects on norepinephrine help improve mood and alleviate depressive symptoms. Clomipramine also has affinity for other receptors, including muscarinic, histamine, and alpha-adrenergic receptors, which contribute to its side effects, such as dry mouth, sedation, and potential cardiovascular issues. The combination of these actions results in its therapeutic effects, but also accounts for its broad side effect profile.

Clomipramine Hydrochloride Drug Interactions - What to Avoid

Clomipramine hydrochloride interacts with several classes of medications and substances, which may either increase the risk of side effects or reduce the effectiveness of the drug. Concomitant use with monoamine oxidase inhibitors (MAOIs) can result in a serious and potentially fatal condition called serotonin syndrome, characterized by agitation, hyperthermia, hyperreflexia, and autonomic instability. Therefore, a washout period of at least 14 days is required between stopping an MAOI and starting clomipramine. The combination of clomipramine with other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or other serotonergic drugs, increases the risk of serotonin syndrome. Drugs that inhibit cytochrome P450 enzymes (like fluoxetine or paroxetine) may increase the serum concentration of clomipramine, leading to enhanced effects and increased side effects. Additionally, clomipramine should not be used with other central nervous system depressants (such as alcohol, benzodiazepines, or opioids) unless under strict medical supervision, as the combination may increase the sedative effects and risk of respiratory depression. Caution should also be used when combining clomipramine with other medications that affect the heart, such as antiarrhythmic drugs, as TCAs can affect cardiac conduction and increase the risk of arrhythmias. Grapefruit juice may alter clomipramine metabolism and increase its blood concentration, so patients should avoid consuming large quantities during treatment.

Clomipramine Hydrochloride Adult Dose - Recommended Dosage

The typical starting dose of clomipramine hydrochloride for adults with obsessive-compulsive disorder (OCD) is 25 mg taken orally once daily, usually at bedtime, due to its sedative effects. The dose is then gradually increased in increments of 25 mg at weekly intervals, depending on the patient’s response and tolerance to the medication. The usual therapeutic dose ranges from 100 mg to 200 mg daily, though some patients may require higher doses for optimal effect. The maximum recommended dose is generally 250 mg per day. If clomipramine is being used to treat other conditions like panic disorder or depression, dosing may vary slightly, but the approach remains similar. It is important to adjust the dose according to the patient’s clinical response and side effect profile. Clomipramine should be taken with food to minimize gastrointestinal side effects. Patients should be monitored regularly to assess for efficacy and the development of side effects, particularly cardiovascular or anticholinergic effects.

Clomipramine Hydrochloride Child Dose - Dosage for Children

Clomipramine hydrochloride is typically prescribed for children over the age of 10 years who have obsessive-compulsive disorder (OCD), though the safety and efficacy in children under 10 have not been established. The starting dose for children is typically 25 mg daily, with gradual increases of 25 mg weekly, depending on the clinical response and tolerability. The usual therapeutic dose in children is between 50 mg and 200 mg daily, with the maximum dose not exceeding 200 mg. The medication should be administered in the evening to minimize daytime sedation. As with adults, children on clomipramine should be closely monitored for side effects, particularly sedation, changes in behavior, and signs of increased suicidal thoughts, which may occur in younger patients. Treatment should be initiated and monitored by a pediatric psychiatrist or healthcare provider familiar with child and adolescent psychiatric disorders.

Clomipramine Hydrochloride Renal Dose - Dosage for Kidney Conditions

In patients with renal impairment, the dose of clomipramine hydrochloride should be reduced or adjusted based on renal function. While no specific dose recommendations are available for patients with mild to moderate renal dysfunction, the use of lower doses or less frequent dosing may be warranted, particularly in severe renal insufficiency (creatinine clearance below 30 mL/min). Since clomipramine is primarily metabolized in the liver, renal impairment may prolong the drug’s half-life, increasing the risk of toxicity. Regular monitoring of kidney function is advised in patients with renal impairment. If significant renal dysfunction is present, alternative antidepressants with a more favorable safety profile may be considered.