How to interpret clomipramine and desmethylclomipramine levels

The significance of the desmethylclomipramine level

In addition to potentially toxic levels, the levels of clomipramine and desmethylclomipramine are also related to response to the medication.

It has been suggested that improvement in OCD is related to serum levels of clomipramine (Mavissakalian et al., 1990; Stern et al., 1980), while improvement in depression may be related to serum levels of desmethylclomipramine (Stern et al., 1980).

Patients who responded to treatment of OCD with clomipramine had a trend toward lower desmethylclomipramine/clomipramine ratios (Mavissakalian et al., 1990).

This was also found in a more recent study. Patients who had a greater improvment in OCD with clomipramine treatment were found to have a lower desmethylclomipramine/clomipramine ratio (Marcourakis et al., 2015). The authors concluded that hese data suggest that a lower demethylation rate correlates with better clinical outcome.

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Related Pages

When and how to check the clomipramine level

Clomipramine metabolism and drug interactions

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References

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Grant JE. Clinical practice: Obsessive-compulsive disorder. N Engl J Med. 2014 Aug 14;371(7):646-53. Review. PubMed PMID: 25119610.

Marcourakis T, Bernik MA, Lotufo Neto F, Gedanke Shavitt R, Gorenstein C. Clomipramine demethylation rate is important on the outcome of obsessive-compulsive disorder treatment. Int Clin Psychopharmacol. 2015 Jan;30(1):43-8. PubMed PMID: 25279584.

Marcourakis T, Gorenstein C, Ramos RT, da Motta Singer J. Serum levels of clomipramine and desmethylclomipramine and clinical improvement in panic disorder. J Psychopharmacol. 1999;13(1):40-4. PubMed PMID: 10221358.

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Mavissakalian MR, Jones B, Olson S, Perel JM. Clomipramine in obsessive-compulsive disorder: clinical response and plasma levels. J Clin Psychopharmacol. 1990 Aug;10(4):261-8. PubMed PMID: 2286699.

Mavissakalian M, Jones B, Olson S, Perel JM. The relationship of plasma clomipramine and N-desmethylclomipramine to response in obsessive-compulsive disorder. Psychopharmacol Bull. 1990;26(1):119-22. PubMed PMID: 2371366.

Montgomery SA, McAuley R, Montgomery DB, Dawling S, Braithwaite RA. Plasma concentration of clomipramine and desmethylclomipramine and clinical response in depressed patients. Postgrad Med J. 1980;56 Suppl 1:130-3. PubMed PMID: 7393823.

Noguchi T, Shimoda K, Takahashi S. Clinical significance of plasma levels of clomipramine, its hydroxylated and desmethylated metabolites: prediction of clinical outcome in mood disorders using discriminant analysis of therapeutic drug monitoring data. J Affect Disord. 1993 Dec;29(4):267-79. PubMed PMID: 8126313.

Stern RS, Marks IM, Wright J, Luscombe DK. Clomipramine: plasma levels, side effects and outcome in obsessive-compulsive neurosis. Postgrad Med J. 1980;56 Suppl 1:134-9. PubMed PMID: 7393824.

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