Major Adverse Reactions During Desipramine Treatment

Delirious episodes induced by intravenous administration of clomipramine associated with an acute increase in its plasma concentrations

“…They concluded that delirium could be avoided by monitoring plasma amitriptyline levels. However, some reports have described the monitoring of plasma levels of tricyclic antidepressants as useless in preventing the delirium 6,7 …”

“…However, some reports have described the monitoring of plasma levels of tricyclic antidepressants as useless in preventing the delirium. 6,7 Koran et al reported that intravenous pulse loading of clomipramine might be effective and its effect emerged rapidly for obsessive-compulsive disorder for patients who have failed oral treatment trials, and there was no difference in side-effects between oral and intravenous administration of clomipramine. 10 Therefore, we tried the therapeutic method of the intravenous injection of clomipramine in addition to the oral medication.…”

“…However, Godwin reported a case of tricyclic antidepressant‐induced delirium within documented therapeutic plasma concentrations 6 . Furthermore, Nelson et al suggested that tricyclic antidepressant plasma levels are of little use in preventing delirium 7 …”

“…6 Furthermore, Nelson et al suggested that tricyclic antidepressant plasma levels are of little use in preventing delirium. 7 We encountered two cases of delirious patients with acute increases in the levels of plasma clomipramine and its active metabolite, desmethylclomipramine, which were rather high plasma concentrations in Japanese. 8…”

Snipping the Thread of Life

“…Urinary retention may occur as an undesired result of use of these medications67"70 or of other drugs with atropine-like effects. 10,28,32,71,72 In elderly men with prostatic hypertrophy, the use of even small doses of over-the-counter antihistamines may lead to increased urinary obstructive symptoms.…”