Drug interactions
Clomipramine + Tapentadol
Severity: Major
Clomipramine and Tapentadol: 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
Both drugs increase serotonergic activity and cause sedation, so the combination can lead to serotonin syndrome and additive CNS depression. Clomipramine also lowers the seizure threshold, as does tapentadol, and it inhibits CYP2D6, although tapentadol is mainly glucuronidated.
What this interaction means in plain words
Clomipramine and Tapentadol 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; Tapentadol belongs to Musculoskeletal.
Why it happens
Additive serotonergic effects from tapentadol's noradrenaline reuptake inhibition and clomipramine's strong serotonin reuptake inhibition, plus additive CNS depression.
What to do
Avoid the combination where alternatives exist; if used, start with low doses and monitor for agitation, tremor, hyperreflexia, clonus, hyperthermia and sedation. Stop treatment if serotonin toxicity occurs.
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 Tapentadol
- Calcium / magnesium / potassium / sodium oxybates + Tapentadol Contraindicated
- Isocarboxazid + Tapentadol Contraindicated
- Linezolid + Tapentadol Contraindicated
- Methylene blue + Tapentadol Contraindicated
- Olanzapine / samidorphan + Tapentadol Contraindicated
- Phenelzine + Tapentadol 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 Tapentadol?
MediHelp rates the interaction as major. Clomipramine and Tapentadol 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. Both drugs increase serotonergic activity and cause sedation, so the combination can lead to serotonin syndrome and additive CNS depression. Clomipramine also lowers the seizure threshold, as does tapentadol, and it inhibits CYP2D6, although tapentadol is mainly glucuronidated.
How serious is the interaction between Clomipramine and Tapentadol?
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 alternatives exist; if used, start with low doses and monitor for agitation, tremor, hyperreflexia, clonus, hyperthermia and sedation. Stop treatment if serotonin toxicity occurs.
What other medicines interact with Tapentadol?
MediHelp also lists interactions of Tapentadol with, for example, Calcium / magnesium / potassium / sodium oxybates, Isocarboxazid, Linezolid. The full list is on the Tapentadol page.
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