| Clomipramine |
Psychosis, Mania-Hypomania, and other Neuropsychiatric Phenomena:
In patients treated with tricyclic antidepressants, activation of latent
schizophrenia or aggravation of existing psychotic manifestations in
schizophrenic patients may occur; patients with manic-depressive tendencies may
experience hypomanic or manic shifts; and hyperactive or agitated patients may
become over-stimulated. A reduction in dose or discontinuation of clomipramine
should be considered under these circumstances.
In predisposed and elderly patients, tricyclic antidepressants may, particularly at night, provoke pharmacogenic (delirious) psychoses which disappear without treatment within a few days of withdrawing the drug.
Since clomipramine may produce sedation, particularly during the initial phase of therapy, patients should be cautioned about the danger of engaging in activities requiring mental alertness, judgement and physical coordination.
Cardiovascular:
Before initiating treatment, it is advisable to check the patient's blood
pressure.
Withdrawal Symptoms:
A variety of withdrawal symptoms have been reported in association with abrupt
discontinuation of clomipramine, including dizziness, nausea, vomiting,
headache, malaise, sleep disturbance, hyperthermia and irritability. In
addition, such patients may experience a worsening of psychiatric status.
Metabolic Effects:
Tricyclic antidepressants have been associated with porphyrinogenicity in
susceptible patients.
Endocrine Effects:
As with certain other psychotherapeutic drugs, clomipramine elevates prolactin
levels.
Children:
As clomipramine has not been studied in patients under 10 years of age, specific
recommendations for use in this age group cannot be provided.
