Augmenting Clomipramine With Fluvoxamine
Clomipramine is typically metabolized to desmethyl-clomipramine by CYP450 1A2. Desmethyl-clomipramine is an NRI. While combining SSRIs and tricyclic antidepressants is risky, fluvoxamine, an inhibitor of CYP450 1A2, could be added to clomipramine to preserve more of the molecule in the original state, which is more serotonergic, thus creating a powerful synergy.
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