Clomipramine Hyperprolactinaemia and galactorrhoea

A 20-year-old woman had received clomipramine 10mg bid for anxiety for 4 years, and an increased dose of SOmg at night for 6 months. The patient had a normal menstrual cycle and had taken an oral contraceptive for 3 years. Several weeks after receiving clomipramine 50mg the patient had galactorrhoea, uncomfortable breast engorgement, loss of libido, and sneezing. Thyroid function tests and a pituitary fossa x­ray were normal and a pregnancy test was negative. Plasma prolactin concentration was 988 IU/ml. Withdrawal of the oral contraceptive had no effect after 12 weeks

Within 2 weeks of discontinuing clomipramine treatment, galactorrhoea reduced. Three months later Ille patient's breasts were normal, no galactorrhoea was evident, libido was normal and sneezing had stopped. Plasma prolactin concentration was 140 IU/ml. Propranolol was used to treat continued anxiety.

The persistence of symptoms after withdrawing oral contraceptive treatment suggests that ' ... thl. patient's symptoms and hyperprolactlnaemla were caused by clomipramine'. Fowlie 5 and Burton J. Scottish Medical Journal 32: 52, Apr 1987

Pancytopenia: first report * A 54-year-old man with a depressive episode had received oral clomipramine 50 mg/day, oxazepam 45 mg/day and triazolam 0.5 mg/day for about 25 days without improvement in depressive symptoms. A major depressive episode with mood-congruent psychotic features (OSM-III) was diagnosed on admission and there were no abnormalities in clinical examination, blood or urine analysis. IV clomipramine 50mg was started with oral clomipramine 50 mg/ day, diazepam 18 mg/day, triazolam 0.5 mg/day, tolbutamide 1 mg/day and an ipoglucidic diet and the patient developed fatigue, pallor, drowsiness, slope oedemas, and ecchymoses on his arms. Complete haematochimic and urine analyses showed that only haemachromometry and Quick time were altered. A progressive decrease in all haemachromometry values, especially platelets and white blood cells, was noted in the following days and 20 days after admission clomipramine was withdrawn because of a possible toxic action. Haemachromometry values and the patient's physical condition immediately improved. Ten days after

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stopping clomipramine treatment a reticulocyte count showed 18/1000 elements. 1M sulpiride 200 mg/day was begun and the patient was discharged 49 days after admission with good mood tone, no delirious ideas and had an almost complete resolution of his depressive episode. Blood cell count continued to improve but had not reached premorbid levels 1 week after discharge. The data presented, including the temporal relationship and the absence of ' ... other coexisting medical illness responsible for the pancytopenia . .. ' indicates that this is ' •.. the first case in which clomipramine caused pancytopenia' .

Magni G, Urbani A, Sllveslro A. Grassetto M Journal of Nervous and Mental Disease 175: 309· 310, No.5, 1987

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