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Indication & Dosage |
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| Oral |
| TREATMENT OF DEPRESSION |
Adult:
As hydrochloride: Initially, 10 mg daily, gradually increased to 30-150 mg daily if necessary; 250 mg daily given in severe cases.
Elderly: Initially, 10 mg daily gradually increased to 30-75 mg if necessary |
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| Oral |
| ADJUNCTIVE TREATMENT OF CATAPLEXY ASSOCIATED WITH NARCOLEPSY |
| Adult:
Initially, 10 mg daily gradually increased to 10-75 mg daily.
Elderly: Dose reduction may be needed. |
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| Oral |
| MANAGEMENT OF OBSESSIVE-COMPULSIVE DISORDERS |
| Adult:
Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily. |
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| Oral |
| MANAGEMENT OF OBSESSIVE-COMPULSIVE DISORDERS |
| Child:
≥10 yr: Initially, 25 mg daily, increased gradually over 2 wk. Max: 3 mg/kg/day or 100 mg daily, whichever is smaller. Give in divided doses. Once titrated, dose may be given as a single dose at bedtime.
Elderly: Initially, 10 mg daily. |
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| Oral |
| PANIC DISORDER |
| Adult:
Initially, 25 mg daily, gradually increased to 100-150 mg daily over 2 wk. Max: 250 mg daily. |
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| Oral |
| PANIC DISORDER |
| Child:
≥10 yr: Initially, 25 mg daily, increased gradually over 2 wk. Max: 3 mg/kg/day or 100 mg daily, whichever is smaller. Give in divided doses. Once titrated, dose may be given as a single dose at bedtime.
Elderly: Initially, 10 mg daily. |
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| Oral |
| DEPRESSION |
| Adult:
Initially, 10 mg daily; may increase gradually to 30-150 mg daily if needed. Up to 250 mg daily or more may be required in more severe cases.
Elderly: Initially, 10 mg daily; may increase gradually over 10 days to 30-75 mg daily. |
| Max Dosage: 100-150 mg daily. |
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| Intravenous |
| DEPRESSION |
| Adult:
Initially, 50-75 mg diluted in 250-500 ml of 0.9% sodium chloride or 5% glucose infused over 1.5-3 hr. Substitute with oral therapy when a satisfactory response has been achieved. The initial oral dose can be double the max parenteral dose; adjust subsequently according to response. |
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| Intravenous |
| OBSESSIVE COMPULSIVE DISORDER |
| Adult:
Initially, 50-75 mg diluted in 250-500 ml of 0.9% sodium chloride or 5% glucose infused over 1.5-3 hr. Substitute with oral therapy when a satisfactory response has been achieved. The initial oral dose can be double the max parenteral dose; adjust subsequently according to response. |
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| Intramuscular |
| DEPRESSION |
| Adult:
Initially, 25-50 mg daily, may increase dose gradually. Max: 100-150 mg daily. Substitute with oral dosage as soon as possible.
Elderly: Initially, 10 mg daily gradually increased to 30-75 mg if necessary. |
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| Intramuscular |
| OBSESSIVE COMPULSIVE DISORDER |
| Adult:
Initially, 25-50 mg daily, may increase dose gradually. Max: 100-150 mg daily. Substitute with oral dosage as soon as possible.
Elderly: Initially, 10 mg daily gradually increased to 30-75 mg if necessary. |
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| Administration |
Should be taken with food. |
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| Precautions |
Cardiovascular insufficiency; narrow-angle glaucoma; urinary retention; history of epilepsy; renal or hepatic dysfunction; electroconvulsive therapy; hypotension; hyperthyroidism or concomitant treatment with thyroid preparations; suicidal tendencies; surgery; pregnancy and lactation; tasks requiring mental alertness; elderly; avoid abrupt withdrawal. |
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Potentially Life-threatening
Adverse Drug Reactions |
Dryness of mouth; disturbances in micturition; drowsiness, increased sweating; sexual dysfunction; confusion, paraesthesia, ataxia, tremors; extrapyramidal symptoms; tinnitus, dizziness, fatigue, headache; wt gain esp in women; gynaecomastia and galactorrhoea. |
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| Adverse Drug Reactions |
Death, rare (except in patients with preexisting significant heart block and patients on MAOI therapy). Induction of mania in individuals with underlying manic-depressive illness or worsening of psychoses in already psychotic individuals. |
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| Interactions |
If clomipramine is to be substituted for MAOIs, at least 3 wk should elapse after discontinuing MAOIs. Risk of hypertension and arrhythmias if co-administered with adrenaline and noradrenaline. Barbiturates increase metabolism of tricyclic antidepressants; conversely cimetidine, guanethidine, haloperidol and phenothiazines block the tricyclic metabolism. CNS effects of alcohol enhanced. |
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