Clomipramine shares pharmacological properties with Class IA and Class III antiarrhythmic medications. Co-administration increases the risk for QT prolongation and life-threatening arrhythmias. For this reason, use of clomipramine should be avoided with bretylium, dofetilide (Tikosyn), dronedarone (Multaq), flecainide (Tambocor), sotalol (Betapace), quinidine (Quinidex), procainamide (Pronestyl), propafenone (Rythmol), ranolazine (Ranexa), ibutilide (Corvert), and others.
Clomipramine should be avoided when possible or used cautiously with medications known to prolong the QTc interval. Examples of such medication are thioridazine (Mellaril), ziprasidone (Geodon), pimozide (Orap), and others.
Clomipramine increases the levels of serotonin in the brain. Co-administration with other medications that also increase serotonin levels increases the risk of serotonin syndrome. Symptoms of serotonin syndrome include rapid development of hyperthermia (high body temperature), high blood pressure, muscle rigidity, confusion, and delirium. Some medications that increase serotonin levels are monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and linezolid (Zyvox). For a complete list, please ask your doctor or pharmacist.
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