Drug interactions
Clomipramine + Cocaine
Severity: Major
Clomipramine and Cocaine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Cocaine blocks reuptake of norepinephrine, dopamine and serotonin, and clomipramine has similar actions on serotonin and norepinephrine. The combination can increase sympathomimetic and serotonergic effects, including hypertension, arrhythmias and serotonin toxicity. Topical use at a clinical dose has lower systemic exposure, but significant absorption can occur from mucosal use.
What this interaction means in plain words
Clomipramine and Cocaine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clomipramine belongs to Central Nervous System; Cocaine belongs to Central Nervous System.
Why it happens
Additive monoamine reuptake inhibition, with potentiated adrenergic effects and arrhythmia risk.
What to do
Avoid cocaine, including recreational use, in patients taking clomipramine. If topical cocaine is required, use the minimum dose and monitor blood pressure and ECG.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine Contraindicated
Other interactions of Cocaine
- Cocaine + Isocarboxazid Contraindicated
- Cocaine + Phenelzine Contraindicated
- Cocaine + Procarbazine Contraindicated
- Amitriptyline + Cocaine Major
- Bisoprolol + Cocaine Major
- Citalopram + Cocaine Major
Frequently asked questions
Can I take Clomipramine with Cocaine?
MediHelp rates the interaction as major. Clomipramine and Cocaine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cocaine blocks reuptake of norepinephrine, dopamine and serotonin, and clomipramine has similar actions on serotonin and norepinephrine. The combination can increase sympathomimetic and serotonergic effects, including hypertension, arrhythmias and serotonin toxicity. Topical use at a clinical dose has lower systemic exposure, but significant absorption can occur from mucosal use.
How serious is the interaction between Clomipramine and Cocaine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid cocaine, including recreational use, in patients taking clomipramine. If topical cocaine is required, use the minimum dose and monitor blood pressure and ECG.
What other medicines interact with Clomipramine?
MediHelp also lists interactions of Clomipramine with, for example, Arsenic trioxide, Dofetilide, Droperidol. The full list is on the Clomipramine page.
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