| DRUG | SUPPLIED | DOSE | COMMENTS |
|---|---|---|---|
| CLOMIPRAMINE (Paeds) (Anafranil) Mechanism of action: Tricyclic antedepressant (not an SSRI) with the greatest serotonergic re-uptake blockade. A serotonin - norepinephrine reuptake inhibitor (SNRI). Ref: 32, 83, 101, 233 Last update: 2021-08-02 |
tablet: 10 mg, 25 mg, 50 mg | Antiobsessional Agent: Children < 10 years old: Dose not established. Children >= 10 years old: Initial: 10-25 mg PO QHS initially. Dose may be increased by 25 mg increments at weekly intervals as needed and tolerated up to 100 mg/24 hr or 3 mg/kg/24 hr in divided doses, whichever is less. Maintenance: Dose may be further increased to a maximum of 200 mg/24 hr or 3 mg/kg/24 hr, whichever is less. |
Tricyclics have limited efficacy for treatment of depression in children and adolescents. SSRIs are safer and should be used as first-line treatment for obsessive compulsive disorder in children and adolescents. Dosage must be individualized; increase gradually. Increased risk of seizures with large/ abrupt dosage increase. May take several weeks to see therapeutic effects Anticholinergic and sedative side effects. A discontinuation syndrome is documented for Tricyclics (flu-like symptoms, dizziness, mood changes). Do not suddenly stop long-term treatment. Recommend tapering down dose by ~25%/week. ECG recommended at baseline, and once effective dose reached. Many CYP drug interactions. Contraindicated if MAO inhibitors used within 14 days. Steady state serum level monitoring recommended (draw ≥14 days after dose change). Serum level (clomipramine plus active metabolite desmethylclomipramine) not to exceed 1400 nmol/L in adults and children. Assess patient carefully and limit prescribed quantities if necessary – potential for significant toxicity of Tricyclics in overdose. Prescribers must be aware of warnings issued by Health Canada regarding the use of antidepressants in pediatric patients. Refer to the Health Canada website. Standard Prescription: clomipramine__mg PO__(frequency) |