Changes

:*Some narcoleptic disorders

:*Some narcoleptic disorders

Onset of action is 4 or more weeks. The dose of Clomipramine may need to be increased from an initial dose rate once daily, to a higher dose rate if initial response is insufficient after 6-8 weeks. Higher doses are associated with increased adverse effects such as sedation and it is important that genuine response to therapy is not confused with undesirable profound sedative effects which will suppress all sorts of behaviour.

Onset of action is 4 or more weeks. The dose of Clomipramine may need to be increased from an initial dose rate once daily, to a higher dose rate if initial response is insufficient after 6-8 weeks. Higher doses are associated with increased adverse effects such as sedation and it is important that genuine response to therapy is not confused with undesirable profound sedative effects which will suppress all sorts of behaviour. Sensitivity of cats to TCAs is generally higher than in dogs as they use glucuronidation to metabolise them<ref>Overall, K.L., 2004. Paradigms for pharmacologic use as a treatment component in feline behavioral medicine. Journal of Feline Medicine and Surgery 6, 29-42.</ref>.  

Once the condition being treated is deemed under control drug therapy should be gradually phased out over approximately 4-8 weeks. This is preferable to stopping administration of a drug all at once and reduces potential central withdrawal signs, as well as allowing establishment of the lowest dose that is still effective if problem behaviour is resumed during the weaning process. Although treatments are long term, maintenance doses are generally significantly lower than doses used at the beginning of the treatment regime. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

Once the condition being treated is deemed under control drug therapy should be gradually phased out over approximately 4-8 weeks. This is preferable to stopping administration of a drug all at once and reduces potential central withdrawal signs, as well as allowing establishment of the lowest dose that is still effective if problem behaviour is resumed during the weaning process. Although treatments are long term, maintenance doses are generally significantly lower than doses used at the beginning of the treatment regime. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

*Impaired liver function (TCAs metabolised by liver)

*Impaired liver function (TCAs metabolised by liver)

*Hyperthyroidism (enhanced response to TCAs)

*Hyperthyroidism (enhanced response to TCAs)

*Urinary retention <ref name="Overall2">Overall, K.L. 2001. Pharmacological Treatment in Behavioural Medicine: The Importance of Neurochemistry, Molecular Biology and Mechanistic Hypotheses. The Veterinary Journal, 162, 9-23</ref>.

*Urinary retention <ref>Overall, K.L. 2001. Pharmacological Treatment in Behavioural Medicine: The Importance of Neurochemistry, Molecular Biology and Mechanistic Hypotheses. The Veterinary Journal, 162, 9-23</ref>.

'''Care should be taken if used in conjunction with any of the following drugs, which may interact and cause adverse effects:'''

'''Care should be taken if used in conjunction with any of the following drugs, which may interact and cause adverse effects:'''

*SSRIs: Fluoxetine inhibits Cytochrome p450, leading to toxic levels of TCA. Cimetidine also has this effect.

*SSRIs: Fluoxetine inhibits Cytochrome p450, leading to toxic levels of TCA. Cimetidine also has this effect.

*Fibre rich diets reduce availability of TCAs.

*Fibre rich diets reduce availability of TCAs.

*Thyroid medications: can interfere, therefore if simultaneously used must be carefully monitored <ref name="Overall2"/>

*Thyroid medications: can interfere, therefore if simultaneously used must be carefully monitored <ref>Gullikers, K.P., Panciera, D.L., 2002. Influence of various medications on canine thyroid function. Compendium of Continuing Education for the Practicing Veterinarian 24, 511-521</ref>

If the drug is overdosed/combined with an inappropriate drug (see above) an increased sedation and degree of adverse effects as listed will be seen. If the drug dose is persistently high or the drug is combined with an MAOI, serotonin syndrome is a possible consequence:

If the drug is overdosed/combined with an inappropriate drug (see above) an increased sedation and degree of adverse effects as listed will be seen. If the drug dose is persistently high or the drug is combined with an MAOI, serotonin syndrome is a possible consequence: