Composition
Tab 10 mg/ 25 mg/75 mg: Clomipramine HCI 10 mg/25 mg/75 mg.
Indications & Dosage
Depressive illness: Adult: Initially 10 mg daily, then increased if necessary to 30-150 mg daily in divided doses, dose to be increased gradually, alternatively increased if necessary to 30-150 mg once daily, dose to be taken at bedtime; max. 250 mg per day. Elderly: Initially 10 mg daily, then increased to 30-75 mg daily, dose to be increased carefully over approximately 10 days. Phobic and obsessional states: Adult: Initially 25 mg daily, then increased to 100-150 mg daily, dose to be increased gradually over 2 weeks; max. 250 mg per day. Elderly: Initially 10 mg daily, then increased to 100-150 mg daily, dose to be increased gradually over 2 weeks; max. 250 mg per day. Children 10 yr: Initially 25 mg/day, increase to 3 mg/kg/day or 100 mg/day within 1st 2 wk, increase over several wk. Max: 3 mg/kg/day.pr 200 mg/day. Adjunctive treatment of cataplexy associated with narcolepsy: Adult: Initially 10 mg daily, dose to be gradually increased until satisfactory response; increased if necessary to 10-75 mg daily. Children 10 yrs: Initially 25 mg/day, increase to 3 mg/kg/day or 100 mg/day within 1st 2 wk, increase over several wk. Max: 3 mg/kg/day.pr 200 mg/day.
Contraindications
Arrhythmias, acute porphyrias, during manic phase of bipolar disorder, heart block, immediate recovery period after myocardial infarction, severe liver disorder
Precautions
Cardiovascular disease (risk of sudden death), hepatic impairment (avoid if severe), diabetes, epilepsy, history of bipolar disorder, history of psychosis or mania, chronic constipation, hyperthyroidism, increased intra-ocular pressure, patients with risk of suicide, phaeochromocytoma, prostatic hypertrophy, susceptibility to angle-closure glaucoma, urinary retention, withdraw gradually.
Interactions
With or within 3 weeks of MAOls, other antidepressants, CNS depressants, antipsychotics, anticoagulants, anticholinergics, antihypertensives, sympathomimetics, drugs prolonging QT interval (e.g. antiarrhythmics), anticonvulsants, diuretics.
Pregnancy
Avoid unless potential benefit outweighs risk
Lactation
Contraindicated, avoid
Side Effects
Agitation, anorexia, fatigue, hypertension, mydriasis, oedema, palpitation, restlessness, stomatitis, blurred vision, confusion, constipation, convulsions, delusions, dizziness, drowsiness, dry mouth, ECG changes, gynaecomastia, haematological reactions, hallucinations, headache, heart block, hepatic reactions, hypomania, hyponatraemia, increased intra-ocular pressure, irritability, mania, movement disorders, myalgia, paraesthesia, photosensitivity, postural hypotension, pruritus, rash, sexual dysfunction, sleep disturbances, suicidal behavior, sweating, tachycardia, tinnitus, urinary retention, urticaria, vomiting, weight changes. Rare: Alopecia, arrhythmia, dysarthria, extrapyramidal symptoms, paralytic ileus, tremor