Drug interactions
Clomipramine + Epinephrine
Severity: Major
Clomipramine and Epinephrine: 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
Tricyclics block norepinephrine reuptake and can exaggerate the pressor and arrhythmogenic effects of systemic epinephrine. This can cause severe hypertension, tachycardia and ventricular arrhythmias.
What this interaction means in plain words
Clomipramine and Epinephrine 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; Epinephrine belongs to Endocrine.
Why it happens
Inhibition of catecholamine reuptake by clomipramine potentiates adrenergic stimulation.
What to do
Avoid systemic epinephrine where alternatives exist, and use the lowest dose with continuous blood pressure and ECG monitoring when needed, such as in anaphylaxis. Limit epinephrine in local anesthetic preparations.
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 Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Clomipramine with Epinephrine?
MediHelp rates the interaction as major. Clomipramine and Epinephrine 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. Tricyclics block norepinephrine reuptake and can exaggerate the pressor and arrhythmogenic effects of systemic epinephrine. This can cause severe hypertension, tachycardia and ventricular arrhythmias.
How serious is the interaction between Clomipramine and Epinephrine?
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 systemic epinephrine where alternatives exist, and use the lowest dose with continuous blood pressure and ECG monitoring when needed, such as in anaphylaxis. Limit epinephrine in local anesthetic preparations.
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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