Phenelzine Clomipramine

Tranylcypromine, phenelzine, clomipramine and imipramine appear to be high on the list of drugs that have interacted adversely. Combination of clomipramine with tranyleypromine is particularly dangerous. Amitriptyline, trimipramine and isocarboxazid are possibly safer. 

Panic disorder SSRIs Venlafaxine XR Alprazolam Clomipramine Clonazepam Imipramine Phenelzine... 

Unfortunately, some patients respond poorly to these first-line interventions. In particular, patients with a long duration of illness, extreme agoraphobic avoidance, and comorbid personality disorders are more likely to exhibit a poor treatment response. For such patients, TCAs such as imipramine or clomipramine and MAOIs such as phenelzine remain viable strategies. 

Monoamine Oxidase Inhibitors (MAOIs). Controlled trials comparing the M AOl phenelzine to clomipramine or fluoxetine have produced mixed results. Given the limited data regarding any efficacy of MAOIs in the treatment of OCD coupled with their potentially dangerous interactions, we cannot recommend MAOIs in the treatment of OCD until other approaches have been tried. 

Based on some intriguing case reports (Jenike et al. 1983), a trial with a monoamine oxidase inhibitor (MAOI) may be an option in OCD patients who have comorbid panic disorder. In a double-blind trial, both phenelzine and clomipramine were found to be effective in reducing symptoms in OCD, as reflected on two of four OC measures [Vallejo et al. 1992). None of the patients in this study had panic disorder. This study suggests that MAOIs may be helpful in some patients with OCD even in the absence of panic disorder. However, in an earlier comparison trial, clomipramine, but not the MAOI clorgiline, resulted in significant reduction in OC symptoms [Insel et al. 1983b). Additional studies are needed to evaluate the place of MAOIs (including the newer reversible inhibitors of monoamine oxidase A [RIMAs], such as moclobemide) in the pharmacotherapy of OCD. 

Vallejo J, Olivares J, Marcos T, et al Clomipramine versus phenelzine in obsessive-compulsive disorder a controlled clinical trial. Br J Psychiatry 161 665-670,... 

OFFICIAL NAMES Amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), fluoxetine (Prozac), imipramine (Norfranil, Tofranil), isocarboxazid (Marplan), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), phenelzine (Nardil), protriptyline (Vivactil), sertraline (Zoloft), thioridazine (Mellaril), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Sur-montil), venlafaxine (Effexor) the herb St. John s wort (Hypericum perforatum) is sold over-the-counter without prescription STREET NAMES Happy pills... 

Other options - a non-specific MAOI (e.g. phenelzine), RIMA (e.g. moclobemide), clomipramine. 

Hyperthermia and labile blood pressure, perhaps due to an interaction of clomipramine, phenelzine, and chlorpro-mazine has been described in one patient (SEDA-17,17). 

Hyperthermia and labile blood pressure occurred in a patient taking chlorpromazine, phenelzine, and clomipramine (56). 

Stern TA, Schwartz JH, Shuster JL. Catastrophic illness associated with the combination of clomipramine, phenelzine and chlorpromazine. Ann Clin Psychiatry 1992 4 81-5. 

Clinically important, potentially hazardous interactions with albuterol, alpha-blockers, amitriptyline, amoxapine, atenolol, beta-blockers, carteolol, chlorpromazine, clomipramine, cocaine, desipramine, doxepin, ephedra, ergotamine, furazolidone, halothane, imipramine, insulin detemir, MAO inhibitors, metoprolol, nadolol, nortriptyline, oxprenolol, penbutolol, phenelzine, phenoxybenzamine, phenylephrine, pindolol, prazosin, propranolol, protriptyline, sympathomimetics, terbutaline, thioridazine, timolol, tranylcypromine, tricyclic antidepressants, trimipramine, vasopressors... 

MAOIs phenelzine, tranylcypromine TCAs amitriptyline, imipramine, clomipramine... 

DA agonists levodopa, bromocriptine, ropinirole, pramipexole, selegiline AAAD inhibitor carbidopa M-blockers benztropine, trihexiphenidyl MAOIs phenelzine, tranylcypromine TCAs amitriptyline, imipramine, clomipramine SSRIs fluoxetine, paroxetine, sertraline Others bupropion, mirtazapine, nefazodone, trazodone... 

Antidepressants Amitriptyline Amoxapine Clomipramine Desipr amine Doxepin Imipramine Maprotiline Nortriptyline Phenelzine Protriptyline Trazodone Trimipramine... 

Augmentation is called for when there is partial or non-response to the above approaches. Combinations of SSRIs with buspirone, clonazepam, clonidine, inositol, lithium, pindolol, olanzapine, risperidone, trazodone, tryptophan, and venlafaxine have been reported, with limited benefit. To date, only two augmenting agents have been found to be effective in double-blind studies risperidone and pindolol. Augmentation of SSRIs with clomipramine (or vice versa) is a common practice in non-responders however, this combination may lead to a substantial increase in the level of tricyclics in the blood and/or increase the risk of serotonin syndrome. Phenelzine may be helpful in symmetry-related or other atypical obsessions. Electroconvulsive therapy (ECT) should be reserved for severely depressed and suicidal OCD patients. Neurosurgery is the last resort current operations include anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The outcome of such operations is questionable. 

Elevated blood pressure has been reported in four patients taking buspirone and either phenelzine or tranylcypromine. Buspirone may have contributed to a case of the serotonin syndrome in a patient who overdosed on moclobemide and clomipramine. 

The serotonin syndrome developed in one patient on iproniazid and tramadol, and delirium in another given tramadol shortly after stopping phenelzine. A fatal case of possible serotonin syndrome has been seen with tramadol, moclobemide and clomipramine. 

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