Drug interactions
Clomipramine + Doxepin
Severity: Major
Clomipramine and Doxepin: major interaction.
Last updated Sources: US FDA label
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
Both are tricyclic antidepressants, so combining them duplicates therapy and adds QT prolongation, anticholinergic burden, sedation and serotonergic effects. Doxepin can also raise clomipramine levels through shared CYP2D6 metabolism.
What this interaction means in plain words
Clomipramine and Doxepin 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; Doxepin belongs to Dermatology.
Why it happens
Additive pharmacodynamic effects (QT, anticholinergic, serotonergic) plus competition for CYP2D6 metabolism.
What to do
Avoid concurrent use of two tricyclics. If a switch is needed, taper one before starting the other and monitor 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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References
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 Doxepin
- Doxepin + Isocarboxazid Contraindicated
- Doxepin + Phenelzine Contraindicated
- Doxepin + Procarbazine Contraindicated
- Doxepin + Safinamide Contraindicated
- Doxepin + Selegiline Contraindicated
- Doxepin + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Clomipramine with Doxepin?
MediHelp rates the interaction as major. Clomipramine and Doxepin 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. Both are tricyclic antidepressants, so combining them duplicates therapy and adds QT prolongation, anticholinergic burden, sedation and serotonergic effects. Doxepin can also raise clomipramine levels through shared CYP2D6 metabolism.
How serious is the interaction between Clomipramine and Doxepin?
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 concurrent use of two tricyclics. If a switch is needed, taper one before starting the other and monitor 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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