Posted by ed_uk2010 on August 5, 2010, at 18:00:18
In reply to 'Bloody' Clomipramine, posted by Brainbeard on August 5, 2010, at 15:24:23
>Clomipramine blood levels should always be taken.....
Perhaps you could post a link to a study which demonstrates that measuring clomipramine blood levels improves clinical outcome.
>(high blood levels) which could occur even with low doses in a slow metabolizer and/or a rapid absorber...
It is certainly true that blood levels can vary greatly between individuals, mainly due to differences in metabolism. I am not aware of the phenomenon of a 'rapid absorber'.
>......to avoid toxicity, which could occur even with low doses in a slow metabolizer.
In general, the most appropriate way to avoid toxicity is to start at a low dose (eg. 10mg/day) and to increase the dose gradually whilst carefully monitoring for adverse effects.
>blood work is imperative for any responsible doctor prescribing TCAs
In that case, I can only assume that the majority of doctors are irresponsible.
>Clomipramine doesn't have numerous active metabolites; it has only one active metabolite (just like the other tertiaty amine TCA's), which is desmethylclomipramine, a potent NRI.
Thank you Brainbeard, I am well aware that desmethylclomipramine is a potent NRI. Clomipramine does, however, have numerous metabolites. I would not like to presume that desmethylclomipramine is its only active metabolite. Not enough research has been done in this area.
Thank you for your comments.
poster:ed_uk2010
thread:956845
URL: http://www.dr-bob.org/babble/20100731/msgs/957357.html