A 62 year old woman presented with a long history of obsessive-compulsive disorder, the symptoms of which were not adequately controlled by oral clomipramine. The patient was started on intravenous clomipramine. Drug levels of both clomipramine and its active metabolite desmethylclomipramine were measured. Symptoms were controlled during her hospital stay. A three year follow-up report indicated the patient is doing well with no evidence of obsessive-compulsive or depressive symptoms. A discussion of the blood levels obtained and the caution to be exercised during intravenous administration is presented.
References
1.
AnanthJ.Clomipramine: an antiobsessive drug.Can J Psychiatry1986; 31(3): 253–258.
2.
PriceL.H., GoodmanW.K., CharneyD.S.Treatment of severe obsessive-compulsive disorder with fluvoxamine.Am J Psychiatry1987; 144: 1059–1061.
3.
JenikeM.A.Approaches to the patient with treatment-refractory obsessive-compulsive disorder.J Clin Psychiatry1990 (Suppl 2); 51: 15–21.
4.
MurphyD.L., ZoharJ., BenkelfatC.Obsessive-compulsive disorder as a 5-HT subsystem-related behavioural disorder.Br J Psychiatry1989 (Suppl 8); 155: 15–24.
5.
WarnekeL.B.Intravenous chlorimipramine therapy in obsessive-compulsive disorder.Can J Psychiatry1989; 34(9): 853–859.
6.
LiebowitzM.R., HollanderE., SchneierF.Fluoxetine treatment of obsessive-compulsive disorder: an open clinical trial.J Clin Psychopharmacol1989; 9: 423–427.
7.
WarnekeL.B.The use of intravenous chlorimipramine in the treatment of obsessive-compulsive disorder.Can J Psychiatry1984; 29(3): 135–141.
8.
WestenbergH.G.M., DrenthB.F.H., De ZeeuwR.A.Determination of clomipramine and desmethylclomipramine in plasma by means of liquid chromatography.J Chromatogr1977; 142: 725–733.
9.
WestenbergH.G.M., De ZeeuwR.A., De CuyperH.Bioanalysis and pharmacokinetics of clomipramine and desmethylclomipramine in man by means of liquid chromatography.Postgrad Med J1977 (Suppl 4); 53: 124–130.
10.
CorteL.D., BroadhurstA.D., SgaragliG.P.Clinical response and tricyclic plasma levels during treatment with clomipramine.Br J Psychiatry1979; 134: 390–400.
11.
LuscombeD.K., WrightJ., SternR.S.Plasma concentrations of clomipramine and desmethylclomipramine in obsessive-compulsive neurosis.Postgrad Med J1980 (Suppl 1); 56: 140–143.
12.
SternR.S., MarksI.M., WrightJ.Clomipramine: plasma levels, side effects and outcome in obsessive-compulsive neurosis.Postgrad Med J1980 (Suppl 1); 56: 134–139.
13.
VandelB., VandelS., JounetI.M.Relationship between the plasma concentration of clomipramine and desmethylclomipramine in depressive patients and the clinical response.Eur J Clin Pharmacol1982; 22: 15–20.
14.
FlamentM.F., RapoportJ.L., MurphyD.L.Biochemical changes during clomipramine treatment of childhood obsessive-compulsive disorder.Arch Gen Psychiatry1987; 44: 219–225.
PetitJ.M., SpikerD.G., RutwitchJ.F.Tricyclic antidepressant plasma levels and adverse effects after overdose.Clin Pharmacol Ther1977; 21: 47–51.
17.
EllenhornM.J., BarcelouxD.G.Antidepressants. In: EllenhornM.J., BarcelouxD.G., eds. Medical toxicology — diagnosis and treatment of human poisoning.New York: Elsevier, 1988: 401–420.
18.
BoehnertM.T., LovejoyF.H.Value of the QRS duration vs the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants.N Engl J Med1985; 313: 474–479.
