Drug interactions
Clozapine + Desipramine
Severity: Major
Clozapine and Desipramine: 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 cause sedation and anticholinergic effects, and each can prolong the QT interval and lower the seizure threshold. Desipramine may also raise clozapine levels through CYP2D6 competition, and the combination raises the risk of arrhythmia, seizures and constipation or ileus.
What this interaction means in plain words
Clozapine and Desipramine 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.
Clozapine belongs to Central Nervous System; Desipramine belongs to Central Nervous System.
Why it happens
Additive QT prolongation, sedation, anticholinergic effects and seizure-threshold lowering, with possible minor metabolic competition.
What to do
Obtain baseline and follow-up ECGs and electrolytes, and monitor for seizures, constipation and sedation; consider clozapine levels and use the lowest effective doses.
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 Desipramine
- Desipramine + Disopyramide Contraindicated
- Desipramine + Dofetilide Contraindicated
- Desipramine + Ibutilide Contraindicated
- Desipramine + Isocarboxazid Contraindicated
- Desipramine + Methylene blue Contraindicated
- Desipramine + Pentamidine Contraindicated
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Clozapine with Desipramine?
MediHelp rates the interaction as major. Clozapine and Desipramine 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 cause sedation and anticholinergic effects, and each can prolong the QT interval and lower the seizure threshold. Desipramine may also raise clozapine levels through CYP2D6 competition, and the combination raises the risk of arrhythmia, seizures and constipation or ileus.
How serious is the interaction between Clozapine and Desipramine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain baseline and follow-up ECGs and electrolytes, and monitor for seizures, constipation and sedation; consider clozapine levels and use the lowest effective doses.
What other medicines interact with Desipramine?
MediHelp also lists interactions of Desipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Desipramine page.
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