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Clomipramine, Serum

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Serum clomipramine is used to monitor drug levels in the body during treatment, to monitor patients' compliance with treatment, and to evaluate any drug toxicity.

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Clomipramine (Clomipramine, Anafranil) belongs to tricyclic antidepressants. Clomipramine is absorbed orally but probably has significant first-pass metabolism. Drug metabolism may be dose related, which should be taken into account when using large doses (> 150 mg / day). Due to enzyme inhibition, co-administration with valproic acid may result in elevated blood clomipramine levels which may lead to seizures. The peak plasma concentration time is 2-6 hours with the drug bound to the protein at 95%. The major hepatic metabolite is norclomipramine, which has biological activity. The metabolites of clomipramine are excreted in the urine and faeces.

Tricyclic antidepressants are a group of drugs with similar cyclic chemical structures, often used to treat depression on a long-term basis. These drugs, such as amitriptyline (Amitriptyline, Saroten), act by inhibiting the re-uptake of norepinephrine and serotonin into the central nervous system and have anticholinergic properties. They are metabolized in the liver, with a variable half-life and a maximum therapeutic level of 4-8 hours after oral administration. As some of the medicines in this group are metabolized to other medicines belonging to the same tricyclic antidepressant group, the levels of all medicines should be measured and taken into account when evaluating clinical symptoms. Monitoring blood drug levels is important, both because the drugs have a narrow therapeutic efficacy window and because they have been shown to be insufficiently correlated with their clinical efficacy. Thus, the occurrence of drug toxicity is a real risk when doses are increased to improve clinical symptoms.

In order to achieve steady state levels, the drug needs to be taken for 7–21 days.

  • Taking certain medications may increase the levels of tricyclic antidepressants: barbiturates, bupropion, cimetidine, corticosteroids, methylphenidine, neuroleptin, oral contraceptives, selective reperfusion inhibitors (SAP), sertraline, venlafaxine, valproic acid.
  • Taking certain medications can cause levels of tricyclic antidepressants to decrease: barbiturates, chloral hydrate, glutethimide, nicotine (smoking), phenobarbital.

Toxicity from this group of drugs is more readily apparent in the elderly as a result of reduced metabolism as well as due to concomitant use of phenothiazine. Tricyclic antidepressants can cause an increase in serum glucose and a decrease in glucose tolerance. Patients with diabetes should be monitored for the occurrence of hyperglycaemia when using these medications. When tricyclic antidepressants are taken concomitantly with the herb Pausinystalia yohimbe, the risk of hypertension is increased.



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