Drug interactions
Clomipramine + Physostigmine
Severity: Major
Clomipramine and Physostigmine: major interaction.
Last updated
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
Physostigmine increases acetylcholine by inhibiting cholinesterase, while clomipramine has strong anticholinergic activity, so the two have opposing effects. Physostigmine is used to reverse severe tricyclic anticholinergic toxicity, but in tricyclic overdose it can provoke seizures, bradycardia and asystole.
What this interaction means in plain words
Clomipramine and Physostigmine 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.
Why it happens
Pharmacodynamic antagonism between cholinesterase inhibition and muscarinic blockade, with added risk of seizures and conduction disturbances in tricyclic toxicity.
What to do
Avoid physostigmine in suspected tricyclic overdose with QRS widening or seizures. If used for severe isolated anticholinergic toxicity, give slowly with continuous ECG monitoring and atropine available.
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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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 Physostigmine?
MediHelp rates the interaction as major. Clomipramine and Physostigmine 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. Physostigmine increases acetylcholine by inhibiting cholinesterase, while clomipramine has strong anticholinergic activity, so the two have opposing effects. Physostigmine is used to reverse severe tricyclic anticholinergic toxicity, but in tricyclic overdose it can provoke seizures, bradycardia and asystole.
How serious is the interaction between Clomipramine and Physostigmine?
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 physostigmine in suspected tricyclic overdose with QRS widening or seizures. If used for severe isolated anticholinergic toxicity, give slowly with continuous ECG monitoring and atropine available.
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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