Clomipramine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Depression

Initial dose: 25 mg orally once a day at bedtime.
Maintenance dose: May increase to 100 mg per day during the first 2 weeks.
Maximum dose: 250 mg per day

Usual Adult Dose for Obsessive Compulsive Disorder

Initial dose: 25 mg orally once a day at bedtime.
Maintenance dose: May increase to 100 mg per day during the first 2 weeks.
Maximum dose: 250 mg per day

Usual Adult Dose for Panic Disorder

Initial dose: 25 mg orally once a day at bedtime.
Maintenance dose: May increase to 100 mg per day during the first 2 weeks.
Maximum dose: 250 mg per day

Usual Pediatric Dose for Obsessive Compulsive Disorder

10 to 17 years:
Initial dose: 25 mg orally once a day at bedtime.
Maintenance dose: May increase to 3 mg/kg or 100 mg, whichever is smaller during the first 2 weeks.
Maximum dose: 3 mg/kg/day or 200 mg, whichever is the smaller dose

Renal Dose Adjustments

There are no data regarding exact dosage adjustments. However, caution is recommended in patients with significant renal dysfunction.

Liver Dose Adjustments

There are no data regarding exact dosage adjustments. However, caution is recommended in patients with liver dysfunction.

Dose Adjustments

During initial titration clomipramine should be given in divided doses with meals to reduce gastrointestinal side effects.

Steady-state plasma levels may not be achieved until 2 to 3 weeks after a dosage change. Therefore, after initial titration, it may be appropriate to wait 2 to 3 weeks before proceeding with further dosage adjustments.

Precautions

Use with caution in patients with renal dysfunction and/or hepatic disease.

The concomitant administration of monoamine oxidase inhibitors and tricyclic antidepressants is considered contraindicated.

Children, adolescents, and young adults (18 to 24 years of age) with major depressive disorder and other psychiatric disorders may be at an increased risk of suicidal thinking and suicidality with antidepressant use, particularly during the first few months of treatment. Medical evidence has not shown this increased risk to exist in adults older than 24 years of age, but adults 65 years of age and older taking antidepressants appear to have a decreased risk of suicidality. The results of a meta-analysis indicate an overall favorable risk-to-benefit profile for the use of antidepressants (i.e., selective serotonin and/or norepinephrine reuptake inhibitors) in the treatment of pediatric patients (less than 19- years- old) with major depressive disorders (MDD), obsessive-compulsive disorder (OCD), or non- OCD anxiety disorders. Although this study also reports an overall increased risk of suicidal ideation/suicide attempt associated with the use of antidepressants in pediatric patients, the risk may be less than originally estimated. Additional prospective studies are warranted in order to confirm these findings.

Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications, particularly those being treated for depression. Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. It is unknown if these symptoms are a precursor to either worsening of depression or the emergence of suicidal impulses; however, there is concern that patients who experience one or more of these symptoms may be at increased risk for worsening depression or suicidality. Although the FDA has not concluded that antidepressant drugs cause worsening depression or suicidality, health care providers should be aware that worsening of symptoms could be due to the underlying disease or might be a result of drug therapy.

Health care providers should carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. If symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms, the health care provider will need to determine what intervention, including discontinuing or modifying the current drug therapy, is indicated. Prescriptions should be written for small quantities of drug to reduce the risk of an attempt to overdose. Health care providers should instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider.

Because antidepressants are believed to have the potential for inducing manic episodes in patients with bipolar disorder, there is a concern about using antidepressants alone in this population. Therefore, patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Dialysis

No adjustment recommended

Other Comments

After titration, the total daily dose may be given once a day at bedtime.

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