Papp L A, Schneier F R, Fyer A J, Leibowitz M R, Gorman J M, Coplan J D, Campeas R, Fallon B A, Klein D F
New York State Psychiatric Institute, NY 10032, USA.
J Clin Psychiatry. 1997 Oct;58(10):423-5. doi: 10.4088/jcp.v58n1002.
Controlled trials suggest that clomipramine may be a highly effective antipanic drug. Lowering the starting dose may alleviate troublesome initial side effects and increase acceptability and compliance.
Fifty-eight patients with DSM-III-R panic disorder with or without agoraphobia underwent 13 weeks of clomipramine treatment. Starting at 10 mg/day, the dose was gradually increased to a mean dose of 97 mg/day.
While completers showed highly significant improvement, the benefits were severely limited by a high dropout rate due to adverse reactions occurring mostly during the first 2 weeks of treatment.
Given the alternatives, clomipramine should not be used as a first-line antipanic medication.
