Drug interactions
Clomipramine + Ritonavir
Severity: Major
Clomipramine and Ritonavir: 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
Ritonavir inhibits CYP2D6 and CYP3A4 and can substantially raise tricyclic antidepressant concentrations. This increases the risk of anticholinergic effects, sedation, seizures and cardiac arrhythmias including QT prolongation.
What this interaction means in plain words
Clomipramine and Ritonavir 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; Ritonavir belongs to Anti Virals.
Why it happens
Inhibition of CYP2D6 and CYP3A4 metabolism of clomipramine and its active metabolite by ritonavir.
What to do
Start clomipramine at a reduced dose and titrate carefully, monitoring ECG and tricyclic plasma levels where available. Watch for signs of toxicity during and after ritonavir therapy.
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
Other interactions of Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Clomipramine with Ritonavir?
MediHelp rates the interaction as major. Clomipramine and Ritonavir 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. Ritonavir inhibits CYP2D6 and CYP3A4 and can substantially raise tricyclic antidepressant concentrations. This increases the risk of anticholinergic effects, sedation, seizures and cardiac arrhythmias including QT prolongation.
How serious is the interaction between Clomipramine and Ritonavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start clomipramine at a reduced dose and titrate carefully, monitoring ECG and tricyclic plasma levels where available. Watch for signs of toxicity during and after ritonavir therapy.
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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