Drug interactions
Clomipramine + Levomilnacipran
Severity: Major
Clomipramine and Levomilnacipran: 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 serotonergic antidepressants increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. Levomilnacipran may also add to blood pressure and heart rate increases.
What this interaction means in plain words
Clomipramine and Levomilnacipran 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; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive inhibition of serotonin and norepinephrine reuptake, producing excess serotonergic activity.
What to do
Avoid the combination where possible. If a switch is needed, taper and allow appropriate washout, and monitor for serotonin toxicity during overlap.
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 Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Clomipramine with Levomilnacipran?
MediHelp rates the interaction as major. Clomipramine and Levomilnacipran 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 serotonergic antidepressants increases the risk of serotonin syndrome, with agitation, tremor, hyperthermia, clonus and autonomic instability. Levomilnacipran may also add to blood pressure and heart rate increases.
How serious is the interaction between Clomipramine and Levomilnacipran?
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 the combination where possible. If a switch is needed, taper and allow appropriate washout, and monitor for serotonin toxicity during overlap.
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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