IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

22 November 2021
Medically reviewed by
Sumayya Salam
Pharm D
What are the Dangers of Mixing Clomipramine And Alcohol?
Table of Contents

Clomipramine is a member of the tricyclic antidepressant drug class (TCA). It works by raising serotonin levels in the brain, which are necessary for maintaining mental balance. FDA-approved Clomipramine for the treatment of obsessive-compulsive disorder (OCD) in people ten years of age and older. In a meta-analysis, clomipramine outperformed sertraline, fluoxetine, and fluvoxamine in treating OCD.

The effects of alcohol and clomipramine vary depending on the dose. Many people experience a feeling of vigor and strength at modest doses of alcohol and clomipramine. And even combining a small amount of clomipramine and alcohol is not advised.

If you take clomipramine and alcohol together, some adverse effects may worsen, or the drug may stop working as it should. Let's find out the outcomes of mixing clomipramine and alcohol in more depth.

What Is Clomipramine?

Clomipramine is a tricyclic dibenzazepine antidepressant. In 1989, it became the first OCD drug to receive FDA approval. Clomipramine was found to be more effective than sertraline, fluoxetine, and fluvoxamine in treating OCD. 

Off-label, clomipramine aids in the treatment of depression, anxiety, cataplexy syndrome, insomnia, neuropathic pain, body dysmorphic disorder, panic disorder, premature ejaculation, pediatric nocturnal enuresis, and many other conditions.

How Does Clomipramine Work?

A tertiary amine known as clomipramine is a member of the tricyclic antidepressant. Compared to other TCAs and S-RIs, clomipramine is a serotonin reuptake inhibitor with a greater affinity for the serotonin transporter (SERT).

Clomipramine's resultant action enhances noradrenergic and serotonergic transmission. By restoring the brain's serotonin balance, Clompiramine aids in reducing persistent or unwanted thoughts.

Dosage

The dosage instructions describe how much medicine a patient should take at one time. Patients must adhere to the recommended dosage guidelines once the drug has been prescribed at the proper dosage to provide the intended clinical effect.

For Depression

Initial dose of 10mg; may be increased as needed.  Typically, this is 30 to 150 mg daily, or up to 250 mg daily for severe conditions.

Obsessions and phobias

25mg, with a daily maximum of 100–150 mg.

For cataplexy,

A starting dose of 10mg; can be escalated to a daily maximum of 75 mg.

 

What Is Alcohol?

Alcohol is categorized as a depressant. It slows down vital processes, causing slurred speech, unsteady movement, foggy perceptions, and delayed response time. Alcohol is obtained by the process of fermentation.

The 2020–2025 Dietary Guidelines for Americans encourage adults of legal drinking age to choose not to drink or to drink in moderation by keeping their intake to 2 drinks or less for men and 1 drink or less for women on days when they choose to consume alcohol.

How Does Alcohol Work In The Body?

Alcohol affects the brain in a variety of ways. It raises the inhibitory neurotransmitter GABA while suppressing the excitatory neurotransmitter glutamate. As one's consumption levels rise, this translates to a worsening impairment of one's thoughts, movements, and speech. 
Dopamine is released more frequently when alcohol is consumed. 

One who is dependent on the benefits of dopamine at this point keeps drinking to experience the ‘high.’ Low blood alcohol levels will affect the brain's inhibitory regions, causing the user to become more lively and friendly. 

Alcohol can still impair judgment and coordination at low doses. Higher levels of alcohol will start to impair judgment, memory, and coordination. Alcohol also impairs the ability to control emotion, which is why drunk people act emotionally or violently.

Users will become dizzy and may pass if there are high enough levels of alcohol in their blood. A potentially lethal level of alcohol in the blood will depress respiration-related brain regions, causing breathing to become significantly slower and eventually stop.

It is best to wait until all traces of Clomipramine have left your system before consuming any alcohol, even in modest amounts, to prevent any lingering toxicity
Patients who get long-term treatment with the tricyclic antidepressant Clomipramine experience increased appetites and weight gain.
Take this medicine with food. To prevent daytime sleepiness, use this medication before bed.

Can You Take Clomipramine And Alcohol Together?

Patients on clomipramine have experienced stomach trouble, dry mouth, and increased drowsiness and weariness, among other side effects. Mixing the drug with alcohol may cause patients to be less awake than usual due to these potential side effects. Therefore, it is not advisable to mix clomipramine with alcohol.

What Happens When You Mix Clomipramine With Alcohol?

Alcohol increases the concentration of the inhibitory neurotransmitter GABA, which is present in the spinal cord and brain stem, and its impact on excitatory neuronal transmitters.  This fundamental effect is exacerbated when alcohol and clomipramine are taken together, increasing greater demand on the body.

Both alcohol and clomipramine affect dopamine levels in the brain, causing mental and physical suffering. There is no way to predict how clomipramine plus alcohol will impact a person before they take it. While larger doses have a higher negative effect, mainstream medical advice is that smaller amounts can be just as detrimental.

Some individuals have reported increased anxiety symptoms while taking clomipramine and drinking alcohol, especially when they first start taking medicine. Furthermore, some patients had said that when they first started taking the medication or mixed it with alcohol, their initial OCD symptoms worsened.

If the symptoms or side effects become unbearable, talk to your doctor or pharmacist about whether the medicine is good for you. Though scientifically not confirmed, some people have reported more blackouts after taking antidepressants and drinking alcohol.

If this happens, book an appointment with a healthcare professional to discuss the appropriate medication and dosage for treating OCD symptoms.

Side-Effects Of Mixing Alcohol And Clomipramine

People who take both clomipramine and alcohol will experience the side effects of both drugs simultaneously. Technically,  the precise effects and reactions will result from repeated usage of clomipramine with alcohol.

Sedation and lethargy, as well as the synergistic effects of combining the two drugs, will ensue from using more clomipramine with alcohol. Moreover, some individuals may feel more depression, euphoria, irritation, or all three at once.

Contrary to popular belief, each person's genetic makeup and tolerance levels make it impossible to predict how clomipramine and alcohol will affect them. Due to the possibility of mild, moderate, or severe adverse effects, it is not safe to combine clomipramine and alcohol.

The side effects include-

  • Dizziness
  • Sluggishness
  • Itching
  • Hives
  • Drowsiness
  • Shortness of breath
  • Palpitations
  • Respiratory Depression
  • Cardiac Arrest
  • Coma
  • Seizures
  • Death 

Scientific Study On The Comparison Of The Interaction Between Alcohol And Clomipramine Or Moclobemide In Healthy Subjects

In a double-blind parallel-group experiment with 24 healthy adults, the effects of clomipramine and moclobemide on alcohol were studied. Alcohol doses were pre-determined for each subject to create a blood alcohol content of 0.6 g/1 1 hour after consumption, and this individual alcohol dose was administered on test days.

Alcohol increased body sway, reduced crucial flicker fusion frequency, lengthened choice reaction time, hindered copying skills, degraded memory, and raised subjective sensations of satisfaction and tension. Clomipramine, in particular, exacerbated the effect of drugs on body sway caused by alcohol.

Clomipramine enhanced body sway and lengthened choice reaction time more than moclobemide, both with and without alcohol. In one of the memory tests, clomipramine appeared to reduce alcohol-induced memory impairment.

The clomipramine group experienced considerably more negative effects after consuming alcohol than the moclobemide group. Clomipramine, unlike moclobemide, caused a moderate but considerable decline in standing systolic blood pressure and a noticeable suppression of salivary secretion.

Regarding their interactions with alcohol, there were no appreciable psychometric differences between moclobemide and clomipramine. However, moclobemide lacked anticholinergic qualities and had fewer side effects than clomipramine.(Dwyer, S.M. and Rosenwasser, A.M., 1998) 

Precautions Before Consuming Clomipramine

These are measures taken to prevent any unwanted side effects from occurring before you take these medications. Remember that side effects are possible when you take clomipramine or alcohol. 

Precautions you should follow before taking Clomipramine

1. Always take Clomipramine as your doctor or pharmacist has directed.
2. Do NOT take clomipramine if you have any of the following conditions:

  • an allergy to clomipramine;
  • a rash or adverse reaction to antidepressants;
  • a history of heart attack;
  • a liver problem;
  • mental health condition.

3. Avoid taking an MAOI within two weeks after stopping clomipramine.
4. If you are pregnant, you shouldn't take clomipramine unless your doctor has specifically instructed you to. Clomipramine could be harmful to the unborn child.
5. Clomipramine may pass into the breast milk. Therefore, if you are breastfeeding, you shouldn't take clomipramine.
6. Do not operate machinery or drive while taking clomipramine until the side effects have passed.
7. Avoid alcohol when taking this drug since it may make the side effects worse.
8. If you forget to take a dose, take it as soon as you remember, or skip it if it's too near to the next planned dose. If you miss a dose, don't double it up, and don't stop taking clomipramine without first consulting your doctor. 

Bottom Line From Practical Anxiety Solutions 

When taking clomipramine, adverse effects are possible. Before starting the prescription, talk to your doctor to determine how other medications or alcohol may interact with the ones you've been prescribed.

If you get a dry mouth as a side effect, eat ice chips or hard candies and drink plenty of water. Increase your fiber intake and exercise to help with side effects like constipation. Mixing Clomipramine with alcohol may sometimes cause serious side effects. Seek immediate medical care in case of any symptoms.

Furthermore, do not share Clomipramine with anyone else. You can also purchase Clomipramine online from a certified online pharmacy; it is recommended to take a doctor's advice first. 

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