A female patient has been taking Anafranil (clomipramine) for a long period of time at a relatively

Fråga: A female patient has been taking Anafranil (clomipramine) for a long period of time at a relatively low dose. The exact dose is unknown. The patient has now troubles with tinnitus. The patient history is poor because the questioner has not yet seen the patient. It is known to the questioner that tinnitus, a less common side-effect, is mentioned in Fass (pharmaceuticals registered in Sweden). Is there any antidepressive drug available which does not give rise to tinnitus?

Sammanfattning: Tinnitus have been reported to occur during treatment with many of the tricyclic antidepressive drugs. It is not possible to say whether one is better than the other regarding development of tinnitus.

Svar: Tinnitus, a less common side-effect, can be seen during treatment with tricyclic antidepressive drugs (1). The mechanism is unknown. In some cases the tinnitus has disappeared or decreased after dose-reduction (1). SADRAC (Swedish Adverse Drug Reactions Advisory Committee) has received a total of 14 reports concerning tinnitus during treatment with antidepressive drugs. In these reports different antidepressive drugs such as amitriptyline, clomipramine, maprotiline, lofepramine, paroxetin and mianserin are represented.

It cannot be excluded that tinnitus can appear occur treatment with any of the tricyclic antidepressive drugs. In the present case, a dose reduction and measuring of the plasma concentration might be considered. If the symptoms still persist we recommend that this case be reported to SADRAC.