A 26-year-old pregnant patient has been treated with clomipramine (Anafranil) 10 mg/day for several

Fråga: A 26-year-old pregnant patient has been treated with clomipramine (Anafranil) 10 mg/day for several weeks. Now it is necessary to increase the dose to 20-40 mg/day because of her anxiety. The patient is going to give birth in one and a half months (4/12). Would clomipramine 20-40 mg/day have any risk for the child?

Sammanfattning: Adaptation disturbances have not been seen in neonates whose mothers were treated with clomipramine at doses less than 75 mg/day before delivery. However, if it is possible to discontinue the therapy the drug should be stopped at least 10 days before partus.

Svar: Neonatal adaptation disturbances in relation to maternal clomipramine treatment during pregnancy have been discussed previously in Drugline (1-4). In summary: adaptation disturbances have been seen in neonates whose mothers were treated with clomipramine at doses higher than 75 mg/day before delivery. The concentrations of clomipramine and its major active metabolite, desmethylclomipramine, were determined in two mothers whose children developed adaptation disorders. The total concentration of the parent drug plus metabolite was 1900 nmol/l two days after delivery in one of the mothers and 1750 nmol/l 24 hours after delivery in the other (5). The biological half-life of clomipramine is about one day and the half-life of desmethylclomipramine is about two days. However, certain individuals metabolize the drug slowly and a longer half-life is expected in these patients. It has been recommended that if it is possible to discontinue the therapy, the drug should be stopped at least 10 days before partus in normal cases, but the required drug-free period is dependent on the individual´s variation in metabolism (2). 1 Drugline nr 05757 (year 1987)

2 Drugline nr 05928 (year 1987)
3 Drugline nr 06972 (year 1989)
4 Drugline nr 09083 (year 1991)

5 Hasselström J, Gustafsson LL, Hardell LI: Adaptationssvårigheter hos barn till mödrar behandlade med antidepressiva. Läkartidningen 1985; 82: 2312-2313