Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
J Clin Psychiatry. 2013 Dec;74(12):e1128-33. doi: 10.4088/JCP.13f08883.
A small body of literature suggests that clomipramine may usefully augment selective serotonin reuptake inhibitor (SSRI) treatment in obsessive-compulsive disorder (OCD) patients who do not respond to SSRI monotherapy. The combination, however, is associated with the risk of clinically significant drug interactions. Clomipramine can raise the blood levels and hence the adverse effects of most SSRIs, and many SSRIs can raise the blood levels and hence the adverse effects of clomipramine. The latter situation is more important because certain dose-dependent adverse effects of clomipramine, such as seizures, can be life-threatening. This article presents an evidence-based discussion of the pharmacodynamic and pharmacokinetic adverse effects of the SSRI-clomipramine combination along with suggestions for dosing and monitoring when the combination is used in OCD.
有少量文献表明，对于那些不能单药治疗有效的强迫症（OCD）患者，氯米帕明可能有助于增强选择性 5-羟色胺再摄取抑制剂（SSRI）的治疗效果。然而，这种联合用药会带来临床显著的药物相互作用风险。氯米帕明会提高大多数 SSRIs 的血药浓度，从而增加其不良反应，同时许多 SSRIs 也会提高氯米帕明的血药浓度，从而增加其不良反应。后一种情况更为重要，因为氯米帕明的某些剂量相关不良反应，如癫痫发作，可能危及生命。本文基于循证医学，对 SSRI-氯米帕明联合用药的药效学和药代动力学不良反应进行了讨论，并就 OCD 患者联合用药时的剂量和监测提出了建议。
