Reactions 840 - 24 Feb 2001

Clomipramine

Delirium: 2 case reportsTwo women, aged 61 and 67 years, with major depressive

disorder developed delirium after IV clomipramine was addedto their regimen of oral clomipramine, and the plasmaconcentration of the agent became acutely elevated.

Both women started oral clomipramine with the dosageincreased over 3 and 6 weeks, respectively, to 150 mg/day[duration of therapy not stated]. Their plasma clomipramineconcentrations were 150 and 148 ng/ml and their plasmadesmethylclomipramine concentrations were 151 and 103 ng/ml, respectively. Both patients subsequently started additionaltreatment with IV clomipramine 12.5mg [frequency ofadministration not stated] for worsening depressivesymptoms.

Both women developed symptoms of delirium 6 and 4 daysafter starting IV clomipramine, respectively. Both patientsexperienced disorientation, confusion and hallucinations.Their pupils were slightly dilated and they had mildlyhyperactive deep tendon reflexes. Their delirium rating scalescores were 20 and 16, respectively (> 10 is considereddelirious). Their plasma clomipramine concentrations were252 and 248 ng/ml, and their plasma desmethylclomipramineconcentrations were 295 and 194 ng/ml, respectively.

Intravenous administration of clomipramine wasdiscontinued in both of the patients, while their oral dosagewas 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 146and 144 ng/ml, respectively.Ueda N, et al. Delirious episodes induced by intravenous administration ofclomipramine associated with an acute increase in its plasma concentrations.Psychiatry and Clinical Neurosciences 54: 669-672, Dec 2000 - Japan 800857323

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Reactions 24 Feb 2001 No. 8400114-9954/10/0840-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved