Serum clomipramine is used to monitor drug levels in the body during treatment, to monitor patients' compliance with treatment, and to evaluate any drug toxicity.
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Clomipramine (Clomipramine, Anafranil) belongs to tricyclic antidepressants. Clomipramine is absorbed orally but probably has significant first-pass metabolism. Drug metabolism may be dose-related, which should be taken into account when using large doses (> 150 mg/day). Due to enzyme inhibition, co-administration with valproic acid may result in elevated blood clomipramine levels which may lead to seizures. The time to reach max plasma concentration is 2-6 hours while the drug is circulated bound to proteins by 95%. The major hepatic metabolite is nor-clomipramine, which has biological activity. The metabolites of clomipramine are excreted in the urine and feces.
Tricyclic antidepressants are a group of drugs with similar cyclic chemical structures, often used to treat depression on a long-term basis. These drugs, such as amitriptyline (Amitriptyline, Saroten), act by inhibiting the reuptake of norepinephrine and serotonin in the central nervous system and have anticholinergic properties. They are metabolized in the liver, with a variable half-life and a maximum therapeutic level of 4-8 hours after oral administration. As some of the drugs in this group are metabolized to other drugs belonging to the same tricyclic antidepressant group, the levels of all drugs should be measured and considered when evaluating clinical symptoms. Monitoring levels of drugs in blood is important, as they have a narrow therapeutic efficacy window and also because they are poorly correlated with their clinical efficacy. Thus, the development of drug toxicity is a real risk when doses are increased to improve clinical symptoms.
To achieve steady-state levels, the drug needs to be taken for 7–21 days.
- Taking certain medications may increase the levels of tricyclic antidepressants: barbiturates, bupropion, cimetidine, corticosteroids, methylphenidate, neuroleptics, oral contraceptives, selective serotonin reuptake inhibitors (SSRIs) (citalopram, fluoxetine, milnacipran, norfluoxetine, paroxetine, sertraline, venlafaxine), valproic acid.
- Taking certain medications may decrease the levels of tricyclic antidepressants: barbiturates, chloral hydrate, glutethimide, nicotine (smoking), and phenobarbital.
Toxicity from this group of drugs is more readily apparent in the elderly as a result of reduced metabolism as well as due to concomitant use of phenothiazine. Tricyclic antidepressants can cause an increase in serum glucose and a decrease in glucose tolerance. Patients with diabetes mellitus should be monitored for the occurrence of hyperglycemia when using these medications. When tricyclic antidepressants are taken concomitantly with the herb Pausinystalia yohimbe, the risk of hypertension is increased.
Important Note
Laboratory test results are the most important parameter for the diagnosis and monitoring of all pathological conditions. 70%-80% of diagnostic decisions are based on laboratory tests. The correct interpretation of laboratory results allows a doctor to distinguish "healthy" from "diseased".
Laboratory test results should not be interpreted from the numerical result of a single analysis. Test results should be interpreted in relation to each individual case and family history, clinical findings, and the results of other laboratory tests and information. Your personal physician should explain the importance of your test results.
At Diagnostiki Athinon we answer any questions you may have about the test you perform in our laboratory and we contact your doctor to get the best possible medical care.
