Clomipramine in Combination with Fluvoxamine: A Potent Medication Combination for Severe or Refractory Pediatric OCD

Nathan E. Hardy, John T. Walkup*

*Corresponding author for this work

Research output: Contribution to journalComment/debatepeer-review

1 Scopus citations

Abstract

Clomipramine (CMI) and fluvoxamine (FLV) combination therapy has been shown in adults to be a potent medication strategy for obsessive compulsive disorder (OCD). Fung et al. (2021) is the first to show similar benefit in pediatric OCD. The addition of FLV to CMI inhibits the metabolism of clomipramine to desmethylclomipramine (DCMI) and enhances the serotonergic potency of CMI by shifting the routine ratio of CMI<DCMI to CMI>DCMI via inhibition of the CYP450 system. The approach to CMI+FLV combination therapy outlined by Fung et al. requires close monitoring. This commentary reviews the benefits and challenges of the approach of Fung et al. (2021) and provides other strategies to take advantage of this combination. Clinicians may consider starting with CMI and adding FLV for patients with refractory OCD to offer a faster pathway to potentially more effective treatment. If a clinician prefers starting with SSRI monotherapy, choosing FLV initially allows for a simpler transition to CMI+FLV in the event that SSRI monotherapy fails.

Original languageEnglish (US)
Pages (from-to)273-277
Number of pages5
JournalJournal of the Canadian Academy of Child and Adolescent Psychiatry
Volume30
Issue number4
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • Clomipramine
  • Fluvoxamine
  • Obsessive compulsive disorder
  • Psychopharmacology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health

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