Documentation concerning hypertension as a side-effect of clomipramine is requested./nBackground: A

Fråga: Documentation concerning hypertension as a side-effect of clomipramine is requested.

Background: A 35-year-old woman with panic disorder was successfully treated with clomipramine 125 mg daily. However, she experienced some form of dizziness, and high blood pressure of 210/137 was diagnosed. Therapeutic drug monitoring was not performed. The blood pressure promptly returned to normal when clomipramine treatment was stopped. The patient is now treated with a combination of citalopram and buspirone in high doses with no effect on her panic disorder.

Sammanfattning: There are a few case reports concerning hypertension as a side-effect of clomipramine. However, the documentation is scarce in relation to the vast use of the drug.

Svar: Hypertension is mentioned as a rare side-effect of clomipramine in FASS and in pharmacological handbooks (1). We have only found one reference; a letter published in 1971, in which three cases of hypertension (in a clomipramine trial involving 26 patients) is reported. The three patients were aged 54 to 63 years and they had all had a pre-treatment blood pressure at the upper limit of normal (2).

One case of hypertension possibly related to clomipramine has been reported to the Swedish Adverse Drug Reactions Advisory Comittee (SADRAC).

Hypertension also has been sporadically reported in connection with imipramine and desipramine (active metabolite to lofepramine) (1,3).

Neither the mechanism behind the hypertensive reaction, nor the possible relation to concentration are known. Hyper- as well as hypotension may be seen in intoxications with tricyclic antidepressants (TCA). On Drugline, we have previously discussed hypertension as a possible consequence of a pharmacodynamic interaction between TCAs and levodopa (4) or of a kinetic interaction with cimetidine (3). Central nervous system stimulants and even alpha-adrenoceptor agonists in nasal drops may also theoretically interact with clomipramine.

The clinical effect of serotonin reuptake inhibitors (SSRI) on panic disorder still remains to be proven (5).

In the present case, as the clinical indication for clomipramine seems strong and as both drug concentration and blood pressure can be easily monitored, a careful rechallenge may be tried.

With or without rechallenge, we recommend that this case be reported to the regional center of SADRAC. 1 Davies, Textbook of adverse drug reactions, 1991; 4th ed: 155 2 Hessov I: Hypertension during chlorimipramine therapy. Br Med J 1971; I: 406 3 Drugline nr 08844 (year 1992) 4 Drugline nr 06114 (year 1988) 5 Drugline nr 09985 (year 1993)