From the Guidelines
The recommended dose range of clomipramine is 25-50 mg/day or 25 mg 4-24 hours prior to intercourse. This dosing is based on the most recent and highest quality study available, which suggests that clomipramine can improve ejaculatory latency and other measures of premature ejaculation when prescribed at these doses 1. The study also notes that adverse event rates and the beneficial effects of clomipramine appear to be dose-related, suggesting that lower doses may be associated with fewer side effects.
Some key points to consider when prescribing clomipramine include:
- The dose can be taken daily or situationally, depending on the patient's needs and preferences
- The optimal interval for situational dosing before intercourse has not been established, but 4-24 hours prior to intercourse is a commonly recommended range
- Therapy for premature ejaculation will likely be needed on a continuing basis, and the medication should not be discontinued abruptly due to the risk of withdrawal symptoms
- Patients should be monitored for potential side effects, including nausea, dry mouth, drowsiness, and reduced libido, and the dose should be adjusted accordingly.
It's also important to note that clomipramine is a tricyclic antidepressant with serotonin reuptake inhibitor effects, and its use should be carefully considered in patients with a history of depression or other mental health conditions. Overall, the recommended dose range of 25-50 mg/day or 25 mg 4-24 hours prior to intercourse is a reasonable starting point for patients with premature ejaculation, and the dose can be adjusted based on the patient's response and tolerance.
From the FDA Drug Label
The observed cumulative incidence of seizures among patients exposed to clomipramine hydrochloride at doses up to 300 mg/day was 0.64% at 90 days, 1.12% at 180 days, and 1.45% at 365 days. Nevertheless, prescribers are advised to limit the daily dose to a maximum of 250 mg in adults and 3 mg/kg (or 200 mg) in children and adolescents (see DOSAGE AND ADMINISTRATION).
The dose range of clomipramine is up to 250 mg in adults and 3 mg/kg (or 200 mg) in children and adolescents 2.
From the Research
Dose Range of Clomipramine
The dose range of clomipramine varies depending on the condition being treated and the patient's response to the medication.
- The usual initial adult dosage is 25-50 mg/day, titrated gradually to 250 mg/day if necessary 3.
- In clinical trials, doses of clomipramine hydrochloride ranged from 25 to 200 mg/day, with some patients receiving up to 250 mg/day 4.
- A study comparing various clomipramine dosage regimes found that doses of 10 mg t.d.s., 30 mg o.n., 25 mg t.d.s., and 75 mg o.n. were effective in treating depression, with the best response obtained in the group receiving 25 mg t.d.s. 5.
- When augmenting selective serotonin reuptake inhibitors (SSRIs) with clomipramine in obsessive-compulsive disorder (OCD), the dose of clomipramine should be carefully considered due to the risk of clinically significant drug interactions 6.
Factors Affecting Dose Range
Several factors can affect the dose range of clomipramine, including:
- Patient response to the medication: the dose may need to be adjusted based on the patient's response to treatment 3.
- Side effects: the dose may need to be reduced if the patient experiences significant side effects 3, 5.
- Drug interactions: the dose of clomipramine may need to be adjusted when used in combination with other medications, such as SSRIs 6.
- Condition being treated: the dose range of clomipramine may vary depending on the condition being treated, such as OCD or depression 3, 4.