METABOLISME VAN CLOMIPRAMINE

Data from 180 patients who were treated with clomipramine are analysed in order to quantify the influence of age, gender and comedication on the oxidative metabolism of clomipramine. The sum of the serum concentration of clomipramine and desmethylclomipramine was corrected for the daily dose by dividing the sum of the concentration of clomipramine and desmethylclomipramine by the daily dose. There was no difference in corrected sum of serum concentrations according to gender but there was a small but statistically insignificant difference according to age. When a neuroleptic, a benzodiazepine, or both were used by the patient, a 40% increase in corrected serum concentration of clomipramine and desmethylclomipramine was observed. This suggested a reduction of the oxidative metabolism of clomipramine and desmethylclomipramine. The implications of these findings are that when a benzodiazepine, a neuroleptic or both are prescribed when a patient is already using clomipramine, a 30% dose reduction of clomipramine must be considered. Consequently, a 40% increase of the dose of clomipramine must be considered when administration of benzodiazepines and neuroleptics is discontinued.