Hypotension clomipramine

Sedation and dry mouth are the most common adverse reactions seen with the use of TCAs. Tolerance to these effects develops with continued use. Orthostatic hypotension can occur with the administration of the TCAs. Orthostatic hypotension is a drop in blood pressure of 20 to 30 points when a person changes position, such as going from a lying position to a standing position. Mental confusion, lethargy, disorientation, rash, nausea, vomiting, constipation, urinary retention, visual disturbances, photosensitivity, and nasal congestion also may be seen. Sexual dysfunction may occur with administration of clomipramine. 

Treatment with imipramine, the most studied TCA, leaves 45% to 70% of patients panic free. Both desipramine and clomipramine have demonstrated effectiveness in PD as well. Despite their efficacy, TCAs are considered second- or third-line pharmacotherapy due to poorer tolerability and toxicity on overdose.48,49 TCAs are associated with a greater rate of discontinuation from treatment than SSRIs.53 PD patients taking TCAs may experience anticholinergic effects, orthostatic hypotension, sweating, sleep disturbances, dizziness, fatigue, sexual dysfunction, and weight gain. Stimulant-like side effects occur in up to 40% of patients.49... 

Tricyclic drugs have, as the name implies, a three-ring structure, and interfere with reuptake of norepinephrine and/or serotonin into axon terminals. Tricyclic drugs include imipramine (Tofranil), amitriptyline (Elavil), clomipramine (Anafranil), and nortriptyline (Pamelor, Aventil). Tricyclics have the occasional but unfortunate cardiovascular side effects of arrhythmia and postural hypotension. Newer, nontricyclic antidepressants have been developed that are collectively referred to as SSRIs. These have a potent and selective action on serotonin, and lack the cardiovascular side effects of the tricyclics. These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). A fifth SSRI, citalopram (Celexa) has been used in Europe and has recently been approved in the United States. Venlafaxine (Effexor) blocks reuptake of norepinephrine and serotonin, while bupropion (Wellbutrin) acts on both dopamine and norepinephrine. 

The adverse effects profile of fixed-dose clomipramine (150 mg/day) has been assessed in 112 hospitalized depressed patients (aged 22-70 years), of whom 38 were over 55 years of age (146). The only adverse effect that distinguished patients over 55 years was orthostatic hypotension older subjects had a significantly greater fall in systolic blood pressure on standing. Orthostatic hypotension can lead to falls and injuries, particularly in patients being... 

At therapeutic doses, tricyclic antidepressants can cause postural hypotension, but they are regarded as being safe in patients who require general anesthesia. However, hypotension during surgery has been associated with clomipramine (12). 

The adverse effects of moclobemide have been well reported in several studies, mainly comparisons of moclobemide with standard antidepressants. The consensus has been that moclobemide produces fewer anticholinergic effects and less orthostatic hypotension and dizziness than clomipramine or imipramine. The main problems... 

A 23-year-old woman with ulcerative colitis and no previous psychiatric disorders developed emotional lability, euphoria, persecutory delusions, irritability, and increased motor and verbal activity 3 weeks after starting to take betamethasone 4 mg/day. She improved within a few weeks with bromperidol 3 mg/ day. After 10 months she became unable to speak and eat, was mute, depressive, and sorrowful, and responded poorly to questions. There were no neurological signs and betamethasone had been withdrawn 10 months before. She was treated with intravenous clomipramine 25 mg/day and became able to speak. Intravenous clomipramine caused dizziness due to hypotension, and amoxapine 150 mg/day was substituted after 6 days. All of her symptoms improved within 10 days. Risperidone was added for mood lability and mild persecutory ideation. 

BETA-BLOCKERS AMITRIPTYUNE, CLOMIPRAMINE Risk of T levels of beta-blockers with amitriptyline and clomipramine These TCAs inhibit CYP2D6-mediated metabolism of beta-blockers Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc)... 

Occasional Confusion amnesia disinhibition paradoxical excitement depression dizziness witiidrawal symptoms, including convulsions, on abrupt discontinuance (witiidrawal may be especially difficult with alprazolam) rebound insomnia or excitement Rare Hypotension blood dyscrasias jaundice allergic reactions paradoxical rage reactions stuttering with alprazolam BUPROPION, Anxiety agitation insomnia tremor anorexia BUSPIRONE, Dizziness headache nausea paresthesias diarrhea CHLORDIAZEPOXIDE, see Benzodiazepines CHLORPROMAZINE, see Phenothiazines, aliphatic CHLORPROTHIXENE, similar to Phenothiazines CLOMIPRAMINE, see Tricyclic antidepressants CLORAZEPATE, see Benzodiazepines CLOZAPINE... 

Frequent Anticholinergic effects hypotension O ss with nortriptyline) drowsiness weight gain tachycardia Occasional Mania psychosis tremor first-degree heart block other ECG abnormalities rash sweating confusion insomnia sexual disturbances, especially with clomipramine increase in dental caries gingivitis... 

Tricyclic antidepressant (TCA) blocks reuptake of norepinephrine and serotonin. Tox atropine-like, postural hypotension, sedation, cardiac arrhythmias in overdose, additive effects with other CNS depressants. Other TCAs imipramine, clomipramine, doxepin. 

Fluvoxamine maleate is the most recent of the serotonin-specific antidepressants to reach the muket. fo vitro cuid in vivo animal experiments have shown fluvoxamine to have a marked effect on 5-HT mediated processes and little effect on norepinephrine. Clinical trials suggest similar efficacy to imipramine and clomipramine with a somewhat lower incidence of side effects, especially anticholinergic effects. Fluvoxamine, in contrast to the tricyclic antidepressants, does not appear to produce heMt rate increase, postural hypotension or prolongation of the intraventriculau conduction time auid QT intervcil. 

The tricyclic antidepressants, clomipramine, desipramine and imipramine, reduce or abolish the antihypertensive effects of clonidine. Other tricyclics are expected to behave similarly. A hypertensive crisis developed in a woman taking clonidine who was also given imipramine, and severe pain ocenrred in a man taking amitriptyline and diamorphine when he was given intrathecal clonidine. Conversely, the tetracyclics, maprotiline and mianserin do not appear to alter the antihypertensive effects of clonidine. An isolated case report describes a hypertensive crisis in a patient taking mirtazapine and clonidine. Hypotension ocenrred in a boy taking clonidine and trazodone. 

The interaction between clonidine and the trieyelics is established and clinically important. The incidence is uncertain but it is not seen in all patients. Avoid concurrent use unless the effects can be monitored. Increasing the dosage of clonidine may possibly be effective. The clonidine dosage was apparently successfully titrated in 10 out of 11 hypertensive patients already on amitriptyline or imipramine. Only clomipramine, desipramine and imipramine have been implieated so far, but other tricyclics would be expected to behave similarly (amitriptyline, nortriptyline and protriptyline have been shown to interact in animals ). The tetracyclic antidepressants maprotiline and mianserin do not generally appear to interact with clonidine. The isolated case of hypotension with trazodone is of unknown general importance. 

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