NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Clomipramine supply (PostScript 81, May 2014)

Clomipramine capsule supply problem

 

Clomipramine is a tricyclic antidepressant most often used in the treatment of severe obsessional compulsive disorder (OCD). It is generally a second line option after SSRIs prove ineffective or are not tolerated. Consequently there is a small but important group of patients who rely on this drug. There is a supply problem with all versions of clomipramine 25mg and 50mg capsules. The Prescribing Management Group – Mental Health, recommend clinicians review ongoing need for treatment and take the following action for patients affected.

 Clomipramine dose modification

  • Where ongoing clomipramine treatment is required, change to an equivalent dose using clomipramine 75mg MR tablets.
  • If an exact equivalent dose is not possible, consider switching to the nearest equivalent dose that can be given using 75mg MR tablets:
  • total daily dose 50mg or 100mg: switch to 75mg daily
  • total daily dose 125mg or  175mg: switch to 150mg daily
  • total daily dose 200mg: switch to 225mg daily
  • Once the stock situation resolves, patients may return to their original dose and preparation where clinically appropriate.

 

Switching from clomipramine

The following drugs are licensed alternatives to clomipramine in OCD & panic disorder.

 

Drug

OCD dose

Panic Disorder dose

Fluoxetine

20mg initially increased gradually to 60mg daily

n/a

Paroxetine

20mg increased gradually in 10mg steps to 40mg daily

10mg increased gradually in 10mg steps to 40mg daily

Sertraline

50mg increased if necessary in weekly steps of 50mg to 200mg daily

25mg increased to 50mg after one week then if necessary in weekly steps of 50mg to 200mg daily

 

  • Stop the clomipramine
  • 24 hours later add fluoxetine, paroxetine or sertraline, taking care to increase dose gradually. 
  • Be aware of the risk of serotonin syndrome, cholinergic rebound and tricyclic withdrawal.

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