Clomipramine - Dosage

Dosage

For depression, the normal adult dose starts at 10 mg a day. This might be increased to 30-150 mg a day, and to no more than 250 mg. The normal elderly dose for depression also starts at 10 mg, which your doctor may increase to 30 - 75 mg a day.

For phobias and obsessive states, adults will usually be started on 25 mg a day, and the elderly on 10 mg a day. Both of these may be slowly increased if needed.

For cataplexy associated with narcolepsy, the usual starting does for adults (including the elderly) is 10 mg a day, which may be increased to up to 75 mg a day.

In hospitalized patients initial intramuscular injections and very slow intravenous infusions can be used, but the risk of hypotension and seizures may be increased with parenteral drug use. The advantage is that the onset of action may be faster.

Usually, clomipramine needs some weeks to reach its maximum effects and needs to be given as long-term treatment, sometimes for life (narcolepsy). In cases of narcolepsy, antidepressant compounds like clomipramine are used to manage symptoms of cataplexy, which usually manifests as sleep paralysis (the inability to move skeletal muscles upon waking from REM sleep). In most patients with narcolepsy, clomipramine monotherapy is not sufficient to control non-cataleptic symptoms, such as excessive daytime fatigue and sleep attacks. In these cases, a commonly used CNS stimulant medication (e.g. modafinil, dextroamphetamine or methylphenidate) is used in lieu of, or in addition to, a tricyclic antidepressant like clomipramine. Concomitant use of a psychostimulant medication and an antidepressant is common in narcolepsy. Other antidepressants used to help control cataplexy include desipramine, protriptyline and venlafaxine.

Clomipramine is not able to elevate the mood of non-depressive persons and any unindicated use may be dangerous.