クロミプラミン

動物種別の用量

投与経路

禁忌

• Prior hypersensitivity to clomipramine or other tricyclic antidepressants
• Concomitant use with monoamine oxidase inhibitors (MAOIs) within 14 days
• Concurrent ingestion of aged cheeses (high tyramine content)
• Known sensitivity to tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs)
• Concurrent use of Monoamine Oxidase Inhibitors (MAOIs) or within 2 weeks of their use
• Male breeding animals (due to risk of testicular hypoplasia)

有害事象

• Emesis
• Diarrhea
• Sedation, lethargy, and depression
• Anticholinergic effects (dry mouth, tachycardia, urinary retention)
• Elevation of liver enzymes
• Pancreatitis (rarely reported in dogs)
• Birds: Ataxia, drowsiness, regurgitation
• Sporadic vomiting
• Changes in appetite
• Lethargy
• Urinary retention (especially in cats)
• Testicular hypoplasia (in male breeding animals)

薬物相互作用

• Anticholinergic agents · Additive anticholinergic effects; use cautiously
• Butyrophenone antipsychotics (e.g., haloperidol) · Risk of extrapyramidal side effects (reported in a macaw)
• Cimetidine · May inhibit tricyclic antidepressant metabolism and increase the risk of toxicity · moderate
• Cisapride · Increased risk for prolonged QT interval
• Clonidine · May cause increased blood pressure
• CNS Depressants · Additive CNS depression; use cautiously
• Meperidine, Pentazocine, Dextromethorphan · Increased risk for serotonin syndrome
• Quinidine · Increased risk for QTc interval prolongation and tricyclic adverse effects
• Rifampin · May decrease tricyclic blood levels
• SSRIs (e.g., fluoxetine, paroxetine, sertraline) · Increased risk for serotonin syndrome
• Sympathomimetic agents · May increase the risk of cardiac effects (arrhythmias, hypertension, hyperpyrexia)
• Monoamine Oxidase Inhibitors (MAOIs, e.g., amitraz, selegiline) · Concomitant use is generally contraindicated due to high risk of fatal serotonin syndrome
• Selegiline (MAOIs) · Risk of fatal serotonin syndrome; do not use concurrently or within 2 weeks of each other · major

モニタリング

• Clinical efficacy (behavioral improvement)
• Baseline and annual liver function tests
• EKG (especially in patients with cardiac risks or hyperthyroidism)
• Clinical efficacy (reduction in anxiety/compulsive behaviors)
• Signs of serotonin syndrome (agitation, tremors, hyperthermia, tachycardia) if used with other serotonergic drugs
• Urinary output and frequency, particularly in cats
• Appetite and gastrointestinal tolerance

過量投与

Clomipramine has a **narrow margin of safety**. Significant clinical signs can be seen at or slightly above the therapeutic range (2-3 mg/kg). * **Lethal Dose**: In dogs, lethal doses are approximately 50-100 mg/kg/day PO (12.5-25X recommended dose). * **Clinical Signs (Dogs)**: Lethargy, tachycardia, ataxia, depression, vocalization, and vomiting. * **Clinical Signs (Cats)**: Lethargy, mydriasis, tachypnea, ataxia, depression, and tachycardia. * **Severe Toxicity**: Overdosage with TCAs can be life-threatening, leading to severe arrhythmias, seizures, and cardiorespiratory collapse. > **Action**: Because toxicities and therapies are complicated and controversial, contact an animal poison control center immediately in any potential overdose situation.