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HOME >> API >> API List1 >> Clomipramine HCL >> Dosage

Formula C19H23ClN2

Clomipramine CAS number 17321-77-6

Initial doses are usually 25 mg 2 or 3 times daily or 75 mg once daily in slow released form. The dose may be increased in regular intervals (the usual dose per day is 100 to 225 mg). Doses up to 300 mg may be used, but these are associated with an increased risk of seizures. This medication may be taken with food to prevent stomach upset.

In hospitalized patients initial intramuscular injections and very slow intravenous infusions can be used, but the risk of hypotension and seizures may be increased with parenteral drug use. The advantage is that the onset of action may be faster.

Usually, clomipramine needs some weeks to reach its maximum effects and needs to be given as longterm treatment, sometimes for life (narcolepsy). Sometimes, in patients with narcolepsy the full effect of clomipramine is not sufficient. In these cases treatment with clomipramine should be terminated gradually and a commonly used central stimulant (e.g. modafinil, methylphenidate or methamphetamine) tried instead.

Clomipramine is not able to elevate the mood of non-depressive persons and any unindicated use may be dangerous.

Dosage should be individualized according to the requirements of each patient. Treatment should be initiated at the lowest recommended dose and increased gradually, noting carefully the clinical response and any evidence of intolerance. During the initial dose titration phase, the total daily dose of clomipramine should be divided and served with meals to reduce gastrointestinal side-effects.

Owing to the long elimination half-lives of clomipramine and its active metabolite, desmethylclomipramine, steady-state plasma levels may not be achieved until 2 to 3 weeks after a dosage adjustment. It may thus be advisable to wait 2 to 3 weeks after the initial dose titration phase, before attempting further dosage adjustments. It should be kept in mind that a lag in therapeutic response usually occurs at the onset of therapy, lasting from several days to a few weeks. Increasing the dosage does not normally shorten this latent period and may increase the incidence of side effects.

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