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Action/Kinetics:
Significant anticholinergic and sedative effects as well as moderate orthostatic hypotension. Significant serotonin uptake blocking activity and moderate blocking activity for norepinephrine.
t
1/2: 19-37 hr.
Effective plasma levels: 80-100 ng/mL.
Time to reach steady state: 7-14 days. Metabolized to the active desmethylclomipramine.
Uses:
Obsessive-compulsive disorder in which the obsessions or compulsions cause marked distress, significantly interfere with social or occupational activities, or are time-consuming to meet the DSM-IV diagnosis. Panic attacks and cataplexy associated with narcolepsy.
Contraindications:
To relieve symptoms of depression.
Special Concerns:
Hyperthermia has occurred, usually when used with neuroleptics. Safety has not been established for use during lactation or in children less than 10 years of age.
Additional Side Effects:
Hyperthermia, especially when used with other drugs. Increased risk of
seizures. Aggressive reactions, asthenia, anemia, eructation, failure to ejaculate, sexual dysfunction in males, laryngitis, vestibular disorders, muscle weakness.
Laboratory Test Alterations:
AST, ALT.
Drug Interactions:
Possible
clomipramine plasma levels when taken with St. John's wort; R/T
metabolism.
How Supplied:
Capsule: 25 mg, 50 mg, 75 mg
Dosage
?Capsules
Adult, initial: 25 mg/day;
then, increase gradually to approximately 100 mg during the first 2 weeks (depending on client tolerance). The dose may then be increased slowly to a maximum of 250 mg/day over the next several weeks.
Adolescents, children, initial: 25 mg/day;
then, increase gradually during the first 2 weeks to a maximum of 100 mg or 3 mg/kg, whichever is less. The dose may then be increased to a maximum daily dose of 3 mg/kg or 200 mg, whichever is less.
Maintenance, adults and children: Adjust the dose to the lowest effective dose with periodic reassessment to determine need for continued therapy.
