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Can you take Clomipramine with Selgene?

1 drug interaction and 53 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

clomiPRAMINE selegiline

Applies to: clomipramine and Selgene (selegiline)

Using selegiline together with clomiPRAMINE is not recommended.

Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as:

  • confusion
  • hallucination
  • seizure
  • extreme changes in blood pressure
  • increased heart rate
  • fever
  • excessive sweating
  • shivering or shaking
  • blurred vision
  • muscle spasm or stiffness
  • tremor
  • incoordination
  • stomach cramp
  • nausea
  • vomiting
  • diarrhea

Severe cases may result in coma and even death.

In general, you should wait at least 14 days after stopping selegiline before you start treatment with clomiPRAMINE.

Conversely, if you have recently been on clomiPRAMINE and are now starting treatment with selegiline, you should check with your doctor or pharmacist to see how long you should wait before it is safe for you to use selegiline, as some medications can take a while to clear from your body.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Major food/lifestyle interactions

Major:

selegiline Food/Lifestyle

Applies to: Selgene (selegiline)

While you are taking selegiline, you must not eat or drink certain foods and beverages that are high in tyramine. Eating these foods while you are taking selegiline can raise your blood pressure to dangerous levels.

This may cause life threatening symptoms such as:

  • sudden and severe headache
  • confusion
  • blurred vision
  • problems with speech or balance
  • nausea
  • vomiting
  • chest pain
  • seizure (convulsions)
  • sudden numbness or weakness (especially on one side of the body)

Call your doctor at once if you have any of these symptoms.

Foods that are high in tyramine include:

  • air dried meats
  • aged or fermented meats
  • sausage or salami
  • pickled herring
  • and any spoiled or improperly stored beef, poultry, fish, or liver
  • red wine
  • beer from a tap
  • beer that has not been pasteurize
  • aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss
  • sauerkraut
  • over the counter supplements or cough and cold medicines that contain tyramine
  • soy beans
  • soy sauce
  • tofu
  • miso soup
  • bean curd
  • fava beans
  • yeast extracts (such as Marmite)

Moderate food/lifestyle interactions

Moderate:

clomiPRAMINE Food/Lifestyle

Applies to: clomipramine

Grapefruit, grapefruit juice, and cranberry juice may cause the clomiPRAMINE levels in your body to increase. This may lead to potentially dangerous adverse effects.

If you are receiving clomiPRAMINE therapy and consume cranberry juice or grapefruit products, you should be monitored for adverse effects and changes in clomiPRAMINE levels.

Do not increase or decrease the amount of cranberry juice or grapefruit products in your diet without first talking to your doctor.

Moderate:

clomiPRAMINE Alcohol (Ethanol)

Applies to: clomipramine

Ask your doctor before using clomiPRAMINE together with ethanol (alcohol), this can alter the effects of clomiPRAMINE and increase the side effects.

Call the doctor if you experience:

  • uneven heartbeats
  • extreme drowsiness
  • confusion
  • agitation
  • vomiting
  • blurred vision
  • sweating
  • muscle stiffness
  • feeling light-headed
  • seizures

You should be warned not to exceed recommended dosages, to avoid alcohol, and to avoid activities requiring mental alertness.

If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Moderate:

selegiline Alcohol (Ethanol)

Applies to: Selgene (selegiline)

Using selegiline together with ethanol (alcohol) may increase side effects such as:

  • dizziness
  • drowsiness
  • confusion
  • difficulty concentrating

Some people may also experience impairment in thinking, judgment, and motor coordination.

You should avoid or limit the use of alcohol while being treated with selegiline.

Do not use more than the recommended dose of selegiline, and avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until you know how the medication affects you.

Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Disease interactions

49 potential interactions Applies to: 31 conditions, including High Blood Pressure, Bipolar Disorder, Heart Attack, Arrhythmia, and Schizophrenia.

Adrenal Tumor

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Adrenal Tumor.

Clomipramine should be used with caution in patients with tumors of the adrenal medulla (such as pheochromocytoma, neuroblastoma), as the drug can provoke hypertensive crises.

Alcoholism

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Alcoholism.

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Alcoholism.

Tricyclic antidepressants can enhance the response to alcohol. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.

Arrhythmia

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Arrhythmia.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Bipolar Disorder

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Bipolar Disorder.

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Bipolar Disorder.

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tricyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tricyclic antidepressants are not approved for use in treating bipolar depression.

Bone Marrow Depression/Low Blood Counts

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

Cardiovascular Conditions and Disorders

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Cardiovascular Conditions and Disorders.

Tricyclic antidepressants should be used with extreme caution in patients with evidence of cardiovascular disease because of the possibility of fluctuations in the blood pressure, arrhythmias, conduction defects, tachycardia, myocardial infarction and stroke. This also applies to patients who have family history of sudden death, cardiac dysrhythmias, or conduction disturbances. In some cases a gradual dose titration is recommended.

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Cardiovascular Conditions and Disorders.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Cardiovascular Conditions and Disorders.

The use of selegiline has been associated with cardiovascular events such as tachycardia, bradycardia, syncope, hypertension, hypotension, arrhythmias, and aggravation of angina pectoris. Therapy with selegiline should be administered cautiously in patients with cardiac disease.

Central Nervous System Disorders

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Central Nervous System Disorders.

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

Cerebrovascular Insufficiency

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Cerebrovascular Insufficiency.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Dehydration

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Dehydration.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Diabetes Mellitus

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Diabetes Mellitus.

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Diabetes Mellitus.

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

Gastrointestinal Obstruction

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Gastrointestinal Obstruction.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

Glaucoma, Narrow Angle

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Glaucoma, Narrow Angle.

Tricyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma. Doxepin hydrochloride capsules are contraindicated in patients with glaucoma.

Glaucoma/Intraocular Hypertension

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Glaucoma/Intraocular Hypertension.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

The use of selegiline may exacerbate glaucoma. Therapy with selegiline should be administered cautiously in patients with glaucoma.

Heart Attack

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Heart Attack.

The use of most tricyclic antidepressants is contraindicated in patients that are going through the acute recovery period after a myocardial infarction.

High Blood Pressure

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with High Blood Pressure.

Selegiline can cause hypertensive reactions and it should be used with caution in patients with hypertension. Patients should report any symptoms such as occipital headache, palpitations, neck stiffness or soreness, nausea, sweating, dilated pupils and photophobia. Patients receiving therapy need to have monitored their blood pressure frequently to detect any evidence of pressor response. Additionally, patients should be advised to avoid foods and drinks with high tyramine content such as cheese, sour cream, beer, liver, bananas and others, as these might trigger a hypertensive crisis.

History - Cerebrovascular Disease

Major:

clomipramine

clomiPRAMINE has a major potential interaction with History - Cerebrovascular Disease.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

History - Myocardial Infarction

Major:

clomipramine

clomiPRAMINE has a major potential interaction with History - Myocardial Infarction.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Hyperthyroidism

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Hyperthyroidism.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Hyperthyroidism.

Most tricyclic antidepressants should be administered with caution in hyperthyroid patients or those receiving thyroid medication as they may develop arrhythmias when these drugs are given.

Hypoglycemia

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Hypoglycemia.

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

Hypotension

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Hypotension.

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Hypotension.

Dopamine agonists may impair the systemic regulation of blood pressure, with resultant orthostatic hypotension at any time, but especially during dose escalation. Additionally, patients with Parkinson's disease may have an impaired capacity to respond to an orthostatic challenge. For these reasons, patients with Parkinson's disease (or restless legs syndrome) who are being treated with dopaminergic agonists typically require careful monitoring for signs/symptoms of orthostatic hypotension, especially during dose escalation, and should be advised of this risk.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Hypotension.

Hypotension has been observed during therapy with monoamine oxidase inhibitors. These drugs should be used with caution, especially in patients with tendency towards hypotension or taking other drugs known to cause hypotension.

Liver Disease

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Liver Disease.

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Liver Disease.

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Liver Disease.

Patients with mild to moderate hepatic impairment (Child-Pugh 5 to 9), may require a dose reduction of selegiline depending on their clinical response. Selegiline is not recommended in patients with severe hepatic impairment (Child-Pugh >9).

Mania

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Mania.

Premarketing studies reported activation of mania/hypomania in patients with affective disorders treated with clomipramine. Clomipramine should be used carefully in patients with history of mania/hypomania.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Mania.

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

Neutropenia

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Neutropenia.

The use of some tricyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3). Leukocyte and differential blood counts should be performed in patients that develop fever and sore throat during treatment. Therapy should be discontinued if there is evidence of pathologic neutrophil depression.

Pheochromocytoma

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Pheochromocytoma.

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Pheochromocytoma.

Clomipramine should be used with caution in patients with tumors of the adrenal medulla (such as pheochromocytoma, neuroblastoma), as the drug can provoke hypertensive crises.

Psychosis

Major:

Selgene

The selegiline in Selgene has a major potential interaction with Psychosis.

Patients with major psychotic disorders should ordinarily not be treated with selegiline because of the risk of exacerbating psychosis.

Renal Dysfunction

Major:

Selgene

The selegiline in Selgene has a major potential interaction with Renal Dysfunction.

Small increments in serum BUN and creatinine have been observed in patients treated with high dose of selegiline. Treatment with selegiline is not recommended in patients with severe renal impairment and end-stage renal disease (CrCl <30 mL/min).

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Renal Dysfunction.

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Renal Dysfunction.

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

Schizophrenia

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Schizophrenia.

Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients. A dosage reduction might be required.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Schizophrenia.

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

Skin Cancer

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Skin Cancer.

Patients with Parkinson's disease have a higher risk of developing melanoma than the general population. Patients and providers should be advised to monitor for melanoma frequently and regularly when using selegiline. Skin examinations should be performed by qualified individuals (e.g., dermatologists).

Sleep Disorders

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Sleep Disorders.

Selegiline should be used with caution in patients with sleep disorders as it can cause somnolence. Patients should exercise caution when driving, operating machines, or working at heights during treatment. Treatment should be discontinued if patients develop daytime sleepiness with episodes of falling asleep during activities such as conversation, eating, etc. If not discontinued, patients should be very cautious about the activities that they engage in that could be potentially dangerous. Prescribers should question the patients specifically about somnolence, as it is rarely reported by patients, and ask about sleep disorders and the use of concomitant sedating medications.

Tardive Dyskinesia

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Tardive Dyskinesia.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

Urinary Retention

Major:

clomipramine

clomiPRAMINE has a major potential interaction with Urinary Retention.

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

Moderate:

clomipramine

clomiPRAMINE has a moderate potential interaction with Urinary Retention.

Due to their anticholinergic properties, tricyclic antidepressants should be administered with caution in patients with history of urinary retention. Particularly doxepin hydrochloride capsules are contraindicated in patients with tendency to urinary retention.

Moderate:

Selgene

The selegiline in Selgene has a moderate potential interaction with Urinary Retention.

The use of selegiline may exacerbate urinary retention. Therapy with selegiline should be administered cautiously in patients with urinary retention or obstruction.

More resources

clomipramine

A total of 831 drugs are known to interact with clomipramine.

Selgene

A total of 537 drugs are known to interact with Selgene.

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.