Drug interactions
Clomipramine + Imipramine
Severity: Major
Clomipramine and Imipramine: 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
Combining two tricyclics increases the risk of QT prolongation, anticholinergic toxicity, seizures and serotonin syndrome. Clomipramine is strongly serotonergic and the duplication is not justified.
What this interaction means in plain words
Clomipramine and Imipramine 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; Imipramine belongs to Central Nervous System.
Why it happens
Additive sodium channel blockade, anticholinergic and serotonergic effects, with competing hepatic metabolism.
What to do
Avoid concurrent use; cross-taper when switching. If unavoidable, monitor ECG and tricyclic concentrations.
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 Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Other interactions of Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine Contraindicated
Frequently asked questions
Can I take Clomipramine with Imipramine?
MediHelp rates the interaction as major. Clomipramine and Imipramine 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. Combining two tricyclics increases the risk of QT prolongation, anticholinergic toxicity, seizures and serotonin syndrome. Clomipramine is strongly serotonergic and the duplication is not justified.
How serious is the interaction between Clomipramine and Imipramine?
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; cross-taper when switching. If unavoidable, monitor ECG and tricyclic concentrations.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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