What is the dose range of clomipramine (a tricyclic antidepressant) for Obsessive-Compulsive Disorder (OCD)?

From the Guidelines

Clomipramine for OCD is typically dosed in the range of 25-250 mg per day, with most patients requiring at least 100 mg daily to see therapeutic benefits. The dosing of clomipramine is crucial in managing OCD symptoms, and it's essential to start with a low dose and gradually increase it to minimize side effects. Although the provided evidence is focused on premature ejaculation, it mentions clomipramine's dosing range as 25-50 mg/day or 25 mg 4-24 hours pre-intercourse 1. However, for OCD treatment, higher doses are often necessary. The dose should be increased by 25 mg every few days as tolerated, with the goal of reaching an effective dose. It's also important to note that clomipramine works by inhibiting the reuptake of serotonin and norepinephrine, with its strong serotonergic effects being particularly important for OCD treatment. Common side effects include dry mouth, constipation, blurred vision, sedation, and sexual dysfunction.

Some key points to consider when dosing clomipramine for OCD include:

• Starting with a low dose of 25 mg daily to minimize side effects
• Gradually increasing the dose by 25 mg every few days as tolerated
• Reaching an effective dose of at least 100 mg daily for most patients
• Monitoring blood levels in some cases to ensure optimal dosing while minimizing adverse effects
• Tapering the dose gradually when discontinuation is desired to avoid withdrawal symptoms.

It's essential to prioritize the patient's response to the medication and adjust the dose accordingly, while also being mindful of potential side effects and interactions with other medications 1.

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 for OCD is not explicitly stated in the provided text, but the maximum recommended daily dose is 250 mg in adults and 3 mg/kg (or 200 mg) in children and adolescents 2.

From the Research

Dose Range of Clomipramine for OCD

• The dose range of clomipramine for the treatment of obsessive-compulsive disorder (OCD) is typically between 25-250 mg/day 3, 4, 5.
• Response to clomipramine is most often associated with doses greater than 75 mg/d, with 250 mg being the maximum recommended daily dose 3.
• The usual initial adult dosage is 25-50 mg/day, titrated gradually to 250 mg/day if necessary 4.
• Some studies suggest that clomipramine may be effective in treating OCD at doses as low as 150 mg/day, with peak plasma concentrations occurring three to four hours after oral administration 4.

Titration and Monitoring

• Clomipramine should be titrated gradually to minimize side effects and maximize efficacy 4, 5.
• Clinical response to clomipramine should be monitored regularly, with evaluation of target symptoms and use of clinical rating instruments such as the Children's Yale-Brown Obsessive Compulsive Scales 6.
• Drug plasma levels may also be used to aid in the evaluation of clinical response, although this is limited 6.

Side Effects and Precautions

• Clomipramine has a range of potential side effects, including anticholinergic, cardiovascular, sexual, and central nervous system effects 3, 4, 7, 5, 6.
• The incidence of seizures is dose-related, occurring in 0.48% of patients receiving clomipramine at doses less than or equal to 250 mg/day, and 2.1% of patients receiving doses greater than or equal to 300 mg/day 7.
• Clomipramine exhibits a potential for cardiotoxicity, especially by impairing conduction and/or orthostasis, and has a risk of overdose 5.