Drug interactions
Clozapine + Imipramine
Severity: Major
Clozapine and Imipramine: major interaction.
Last updated Sources: Base de donnees publique des medicaments (France)
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 are sedating, strongly anticholinergic and can lower the seizure threshold, so combining them raises the risk of excessive sedation, constipation or ileus, tachycardia and seizures. Imipramine may also raise clozapine concentrations through CYP inhibition, and both can affect cardiac conduction.
What this interaction means in plain words
Clozapine and Imipramine 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; Imipramine belongs to Central Nervous System.
Why it happens
Additive CNS depressant, anticholinergic, proconvulsant and cardiac effects, with possible pharmacokinetic competition at CYP enzymes.
What to do
Monitor for sedation, bowel function, seizures and ECG changes, and use the lowest effective doses. Consider checking clozapine levels and adjusting the dose if toxicity is suspected.
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 Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide 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 Imipramine?
MediHelp rates the interaction as major. Clozapine and Imipramine 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 are sedating, strongly anticholinergic and can lower the seizure threshold, so combining them raises the risk of excessive sedation, constipation or ileus, tachycardia and seizures. Imipramine may also raise clozapine concentrations through CYP inhibition, and both can affect cardiac conduction.
How serious is the interaction between Clozapine and Imipramine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for sedation, bowel function, seizures and ECG changes, and use the lowest effective doses. Consider checking clozapine levels and adjusting the dose if toxicity is suspected.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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