Posted by ed_uk2010 on August 6, 2010, at 14:59:29
In reply to Clomipramine plasma levels and clinical outcome » ed_uk2010, posted by Brainbeard on August 6, 2010, at 4:28:03
Hi BB,
Thanks for the links.
Due to its potential toxicity, prudent psychiatrists always initiate clomipramine treatment at a low dose and increase gradually (in small steps) according to response. Adjustments to the dose (either up or down) are normally guided by clinical efficacy, subjective adverse effects such as dry mouth and sometimes by objective adverse effects such as hypotension, increased pulse rate and ECG (EKG) changes.
If a particular dosage of clomipramine was not effective, the dose would generally be increased - unless adverse effects were a problem (or the dose was already high). If a particular dosage of clomipramine caused unpleasant adverse effects, the dose would need to be decreased.
Although it may be necessary to measure blood levels in some cases, I am still not sure that it is needed for everyone. Just as an example, if 30mg per day caused severe anticholinergic adverse effects, the prescriber would have no option but to reduce the dose. Measuring the blood level wouldn't change this.
Similarly, if an OCD patient's dose was gradually increased from 10mg to 100mg over a period of two weeks, subjective response could be used to guide further adjustments. If 100mg/day was ineffective after several weeks and there were no troublesome side effects, an increased dose would be suitable.
Requirements for bloodwork vary from patient to patient. For example, in an elderly patient on diuretic treatment for hypertension, pre-treatment assessment of serum potassium would be essential. For a young person with no medical problems who was on no other medication, this would not be necessary.
poster:ed_uk2010
thread:956845
URL: http://www.dr-bob.org/babble/20100731/msgs/957525.html