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Drug Interactions between clomipramine and Ritalin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

clomiPRAMINE methylphenidate

Applies to: clomipramine and Ritalin (methylphenidate)

MONITOR: The coadministration with methylphenidate may increase the serum concentrations of tricyclic antidepressants (TCAs). Case reports involving primarily methylphenidate and imipramine have suggested favorable as well as unfavorable clinical effects from this combination. In vitro studies suggest that methylphenidate may inhibit the metabolism of imipramine and other TCAs, although the extent is probably subject to considerable interindividual variation.

MANAGEMENT: Pharmacologic response to TCAs should be monitored more closely whenever methylphenidate (racemic) or dexmethylphenidate (the more pharmacologically active d-enantiomer) is added to or withdrawn from therapy, and the TCA dosage adjusted as necessary.

References

  1. Meyers B (1978) "Treatment of imipramine-resistant depression and lithium-refractory mania through drug interactions." Am J Psychiatry, 135, p. 1420-1
  2. Zeidenberg P, Perel JM, Kanzler M, Wharton RN, Malitz S (1971) "Clinical and metabolic studies with imipramine in man." Am J Psychiatry, 127, p. 1321-6
  3. Wharton RN, Perel JM, Dayton PG, Malitz S (1971) "A potential clinical use for methylphenidate with tricyclic antidepressants." Am J Psychiatry, 127, p. 1619-25
  4. Cooper TB, Simpson GM (1973) "Concomitant imipramine and methylphenidate administration: a case report." Am J Psychiatry, 130, p. 721
  5. Grob CS, Coyle JT (1986) "Suspected adverse methylphenidate-imipramine interactions in children." J Dev Behav Pediatr, 7, p. 265-7
  6. Gwirtsman HE, Szuba MP, Toren L, Feist M (1994) "The antidepressant response to tricyclics in major depressives is accelerated with adjunctive use of methylphenidate." Psychopharmacol Bull, 30, p. 157-64
  7. Burke MS, Josephson A, Lightsey A (1995) "Combined methylphenidate and imipramine complication." J Am Acad Child Adolesc Psychiatry, 34, p. 403-4
View all 7 references

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Drug and food interactions

Moderate

clomiPRAMINE food

Applies to: clomipramine

MONITOR: Limited data suggest that the administration of clomipramine with grapefruit juice or cranberry juice may significantly increase plasma drug concentrations of clomipramine. Clomipramine is initially demethylated by CYP450 1A2, 3A3 and 3A4 before undergoing further metabolism to 8-hydroxyclomipramine. The increase in clomipramine bioavailability may stem from inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The precise mechanism by which cranberry juice exerts its effects is unknown, but may involve inhibition of CYP450 isoenzymes. This interaction has occasionally been exploited in attempts to improve symptomatic control of obsessive compulsive disorder.

MANAGEMENT: Patients receiving clomipramine therapy who ingest cranberry juice, grapefruits, or grapefruit juice should be monitored for adverse effects and undue fluctuations in plasma drug levels.

References

  1. Oesterheld J, Kallepalli BR (1997) "Grapefruit juice and clomipramine: shifting metabolitic ratios." J Clin Psychopharmacol, 17, p. 62-3
  2. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
View all 4 references

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Moderate

methylphenidate food

Applies to: Ritalin (methylphenidate)

GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of psychoactive drugs, including methylphenidate.

GENERALLY AVOID: Consumption of alcohol while taking certain sustained-release formulations of methylphenidate may cause rapid release of the drug, resulting in increased systemic levels of methylphenidate. In vitro studies have been conducted using Metadate CD 60 mg and Ritalin LA 40 mg capsules, as well as Concerta 18 mg tablet. At an alcohol concentration of 40%, an increase in the release rate of methylphenidate was observed in the first hour for Metadate CD and Ritalin LA, resulting in 84% and 98% of the methylphenidate being released, respectively. In contrast, there was no increased release of methylphenidate in the first hour for Concerta. These results are considered to be representative of the other available strengths of the corresponding product.

MANAGEMENT: Patients treated with methylphenidate should be advised to avoid alcohol or medications that contain alcohol.

References

  1. (2022) "Product Information. Metadate CD (methylphenidate)." Celltech Pharmaceuticals Inc
  2. (2002) "Product Information. Concerta (methylphenidate)." Alza
  3. (2013) "Product Information. Ritalin LA (methylphenidate)." Quality Care Products/Lake Erie Medical

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Moderate

clomiPRAMINE food

Applies to: clomipramine

GENERALLY AVOID: The combination of ethanol and a tricyclic antidepressant may result in additive impairment of motor skills, especially driving skills. Also, one study has suggested that clomipramine metabolism is significantly impaired for several weeks or more following discontinuation of chronic alcohol consumption.

MANAGEMENT: Patients should be warned of this interaction and advised to limit their ethanol intake while taking tricyclic antidepressants. Monitoring for TCA toxicity (CNS depression, excessive anticholinergic effects, hypotension, arrhythmias) is recommended during alcohol withdrawal.

References

  1. Seppala T, Linnoila M, Elonen E, Mattila MJ, Makl M (1975) "Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving." Clin Pharmacol Ther, 17, p. 515-22
  2. Berlin I, Cournot A, Zimmer R, et al. (1990) "Evaluation and comparison of the interaction between alcohol and moclobemide or clomipramine in healthy subjects." Psychopharmacology (Berl), 100, p. 40-5
  3. Balant-Gorgia AE, Gay M, Gex-Fabry M, Balant LP (1992) "Persistent impairment of clomipramine demethylation in recently detoxified alcoholic patients." Ther Drug Monit, 14, p. 119-24

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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