Tricyclic agents are known to lower the convulsive threshold and clomipramine should, therefore, be used with extreme caution in patients with a history of convulsive disorders and other predisposing factors, e.g., brain damage of varying etiology, alcoholism, and concomitant use with other drugs that lower the seizure threshold. 

Physicians should discuss with patients the risk of taking clomipramine while engaging in activities in which a sudden loss of consciousness could result in serious injury to the patient or others e.g. the operation of complex machinery, driving, swimming, or climbing.

Tricyclic antidepressants, particularly in high doses, have been reported to produce sinus tachycardia, changes in conduction time and arrhythmias. 

Use in Concomitant Illness:
Caution should be observed in prescribing clomipramine in hyperthyroid patients or in patients receiving thyroid medication conjointly.

Because of its anticholinergic properties, clomipramine should be used with caution in patients with increased intraocular pressure or a history of urinary retention, particularly in the presence of prostatic hypertrophy.

Particularly in the elderly and in hospitalized patients the tricyclic antidepressants may give rise to paralytic ileus and, therefore, appropriate measures should be taken if constipation occurs.

Caution is called for when employing clomipramine in patients with tumours of the adrenal medulla (e.g. pheochromocytoma, neuroblastoma) in whom the drug may provoke hypertensive crisis.

Clomipramine should be kept in a safe place, well out of the reach of children.

Safe use in pregnant women has not been established. 

Since clomipramine passes into breast milk, nursing mothers receiving it should not breast-feed their infants.


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