Clomipramine

INTRODUCTION

Indications

Obsessive-Compulsive Disorder (OCD). Unlabeled Use: Depression, neuropathic pain/chronic pain.

Action

Potentiates the effect of serotonin (antiobsessional effect) and norepinephrine in the CNS. Has moderate anticholinergic effects. Therapeutic Effects: Diminished obsessive-compulsive behavior.

Adverse Reactions/Side Effects

CNS: SEIZURES, lethargy, sedation, weakness, aggressive behavior. EENT: blurred vision, dry eyes, dry mouth, vestibular disorder. CV: ARRHYTHMIAS, ECG changes, orthostatic hypotension. GI: constipation, nausea, vomiting, weight gain, eructation. GU: male sexual dysfunction, urinary retention. Derm: dry skin, photosensitivity. Endo: gynecomastia. Hemat: anemia. MS: muscle weakness. Neuro: extrapyramidal reactions. Misc: hyperthermia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising, and pale skin. Notify physician immediately if these signs occur.

• Be alert for sedation, lethargy, aggressive behavior, or other alterations in mental status. Notify physician or mental health professional if these side effects become problematic.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

• Assess motor function, and be alert for extrapyramidal reactions, including Parkinson-like symptoms, dyskinesias, dystonias, or other motor abnormalities. Report any motor problems that might affect gait, balance, and other functional activities.

• Monitor muscle strength and vestibular function. Report unexplained strength loss or balance problems, especially if these problems affect gait and functional activities.

• If used to treat chronic pain, assess pain levels periodically to help determine drug efficacy.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fallprevention strategies (See Appendix E).

• Because of the risk of cardiac arrhythmias and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess ...