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Influence of age, cigarette smoking and the oral contraceptive on plasma concentrations of clomipramine.

The influence of age, cigarette smoking and the oral contraceptive on the plasma profile and tolerability of clomipramine has been studied in depressed patients given the drug daily for four weeks. Older patients tend to have higher plasma concentrations of clomipramine than the younger and tolerate clomipramine less well; this latter is considered to be at least partly due to the increased plasma concentrations of the drug. Clearly elderly patients need a lower dose than the young if a high incidence of side effects is to be avoided. Patients smoking 15 or more cigarettes a day were found to tolerate daily doses of 75 mg clomipramine far better than non-smokers. Perhaps surprisingly, this was not reflected in lower plasma clomipramine concentrations in smokers, possibly owing to the high drop-out rate amongst non-smokers, which biased these data. Finally, no interaction was observed in females between clomipramine and oral contraceptives, the concomitant administration of which did not influence either plasma clomipramine concentrations or its tolerability.