Clomipramine

Abstract

Clomipramine Delirium: 2 case reportsTwo women, aged 61 and 67 years, with major depressive disorder developed delirium after IV clomipramine was added to their regimen of oral clomipramine, and the plasma concentration of the agent became acutely elevated.Both women started oral clomipramine with the dosage increased over 3 and 6 weeks, respectively, to 150 mg/day [duration of therapy not stated]. Their plasma clomipramine concentrations were 150 and 148 ng/ml and their plasma desmethylclomipramine concentrations were 151 and 103 ng/ ml, respectively. Both patients subsequently started additional treatment with IV clomipramine 12.5mg [frequency of administration not stated] for worsening depressive symptoms.Both women developed symptoms of delirium 6 and 4 days after starting IV clomipramine, respectively. Both patients experienced disorientation, confusion and hallucinations. Their pupils were slightly dilated and they had mildly hyperactive deep tendon reflexes. Their delirium rating scale scores were 20 and 16, respectively (> 10 is considered delirious). Their plasma clomipramine concentrations were 252 and 248 ng/ml, and their plasma desmethylclomipramine concentrations were 295 and 194 ng/ml, respectively.Intravenous administration of clomipramine was discontinued in both of the patients, while their oral dosage was maintained. Their delirium improved 7 and 3 days later, respectively. After recovery from their delirium, the patients' plasma clomipramine concentrations were 110 and 176 ng/ml, and their desmethylclomipramine concentrations were 146 and 144 ng/ml, respectively.Ueda N, et al. Delirious episodes induced by intravenous administration of clomipramine associated with an acute increase in its plasma concentrations.