Adult Dosing
Obsessive-compulsive disorder
- Start: 25 mg PO qd, gradually increase to 100 mg/day PO during the first 2 wks
- Increase to max. 250 mg/day in divided doses over the next several wks
- Maintenance dose: 250 mg qhs after stabilizing dose is reached
- Give in divided doses with food during initial titration
- Taper dose gradually to discontinue
Pediatric Dosing
Obsessive-compulsive disorder
- Safety and effectiveness in pediatric patients in =<10 yrs have not been established
Child >10 yrs
- Start: 25 mg PO qd, increased over 2-wk period to 3 mg/kg/day or 100 mg/day (whichever is smaller) in divided doses
- Gradually increase to maximum 3 mg/kg/day or 200 mg/day (whichever is smaller) in divided doses over the next several wks
- Maintenance dose: 3 mg/kg/day or 200 mg/day (whichever is smaller) in divided doses qhs after stabilizing dose is reached
- Give in divided doses with food during initial titration
- Taper dose gradually to discontinue
- Risk of suicidality with antidepressants use increased in children, adolescents and young adults with major depressive or other psychiatric disorders especially during 1st month of therapy. In short-term studies of antidepressants vs placebo, suicidality risk not increased in patients >24 yrs, and risk decreased in patients >65 yrs. Therefore, closely monitor all patients for clinical worsening, suicidality, or unusual behavior changes [US Black Box Warning]
- Therapy is not approved for use in treating bipolar depression; prior to initiating treatment, adequately screen patients to determine if they are at risk for bipolar disorder
- Seizure is the most significant risk of clomipramine use. Caution should be exercised in patients with a history of seizures or other predisposing factors and concomitant use with other drugs that lower the seizure threshold
- Caution must be used with potentially hazardous activities such as driving and operating machinery
- To reduce the risk of overdose and suicidality, prescribe smallest quantity of clomipramine as much as possible consistent with good patient management
- Therapy may cause modest orthostatic decreases in blood pressure and modest tachycardia. Therefore caution is necessary in treating patients with known cardiovascular disease, and gradual dose titration is recommended
- Therapy may show a variety of neuropsychiatric signs and symptoms and may precipitate an acute psychotic episode in patients with unrecognized schizophrenia
- Closely monitor for hypomania or mania, which can be therapy associated
- Elevations in SGOT and SGPT levels have been reported. Therefore caution is advised in treating patients with known liver disease, and periodic monitoring of hepatic enzyme levels is recommended in such patients
- To detect hematologic toxicity during therapy, differential blood counts should be obtained in patients who develop fever and sore throat
- Concomitant use with neuroleptics may result in a neuroleptic malignant syndrome and hyperthermia
- Monitor for sexual dysfunction and weight changes during therapy
- Concurrent administration of Anafranil with electroconvulsive therapy may increase the risks. Limit the use to those patients for whom it is essential
- Discontinue therapy for as long as is clinically feasible prior to elective surgery with general anesthetics
- To avoid withdrawal symptoms, taper dosage gradually and closely monitor the patients during discontinuation
Cautions: Use cautiously in
- Severe renal impairment
- Hepatic impairment
- Urinary retention
- Prostatic hypertrophy
- Hyperthyroidism
- Pheochromocytoma, neuroblastoma
- Elderly patients
- Cardiovascular disorders
- GI/GU obstruction
- Diabetes mellitus
- Asthma
- Parkinson disease
- Schizophrenia
- Angle-closure glaucoma
- Increased IOP
- Seizure disorder
- Bipolar disorder
- Electroconvulsive therapy
- Alcohol abuse
Pregnancy Category:C
Breastfeeding: Limited evidence indicates that use of clomipramine during breastfeeding is acceptable. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 December 2010).According to manufacturer's data, clomipramine has been found in human milk. Because of the potential for adverse reactions, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- ClomiPRAMINE HCl 50 MG CAPS [Bottle] (TARO)
60 mg = $40.99
180 mg = $106.96 - Anafranil 50 MG CAPS [Bottle] (MALLINCKRODT)
30 mg = $383.39
90 mg = $1124.57 - Anafranil 25 MG CAPS [Bottle] (MALLINCKRODT)
60 mg = $829.02
180 mg = $2384.88
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
