Drug interactions
Clomipramine + Duloxetine
Severity: Major
Clomipramine and Duloxetine: 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
Duloxetine inhibits CYP2D6 and can raise clomipramine and its metabolite levels, and both drugs enhance serotonergic activity. The combination increases the risk of serotonin syndrome, seizures and cardiac toxicity.
What this interaction means in plain words
Clomipramine and Duloxetine 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; Duloxetine belongs to Central Nervous System.
Why it happens
Moderate CYP2D6 inhibition by duloxetine plus additive serotonergic reuptake inhibition.
What to do
Avoid if possible. If combined, start with low clomipramine doses, monitor for serotonin toxicity and tricyclic adverse effects, and consider plasma levels 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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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 Duloxetine
- Duloxetine + Isocarboxazid Contraindicated
- Duloxetine + Linezolid Contraindicated
- Duloxetine + Methylene blue Contraindicated
- Duloxetine + Phenelzine Contraindicated
- Duloxetine + Procarbazine Contraindicated
- Duloxetine + Rasagiline Contraindicated
Frequently asked questions
Can I take Clomipramine with Duloxetine?
MediHelp rates the interaction as major. Clomipramine and Duloxetine 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. Duloxetine inhibits CYP2D6 and can raise clomipramine and its metabolite levels, and both drugs enhance serotonergic activity. The combination increases the risk of serotonin syndrome, seizures and cardiac toxicity.
How serious is the interaction between Clomipramine and Duloxetine?
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 if possible. If combined, start with low clomipramine doses, monitor for serotonin toxicity and tricyclic adverse effects, and consider plasma levels 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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