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Pulse-Loaded Intravenous Clomipramine in Treatment-Resistant Obsessive-Compulsive Disorder.

Author(s): Koran LM, Aboujaoude E, Ward H, Shapira NA, Sallee FR, Gamel N, Elliott M

Affiliation(s): *Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA daggerDepartment of Psychiatry, University of Florida Medical Center, Gainesville, FL and double daggerDepartment of Psychiatry, University of Cincinnati Medical Center, Cincinnati, OH.

Publication date & source: 2006-02, J Clin Psychopharmacol., 26(1):79-83.

INTRODUCTION:: Small studies have suggested that intravenous clomipramine (CMI) may be more effective and induce faster improvement in obsessive-compulsive disorder than do orally administered serotonin reuptake inhibitors. OBJECTIVE:: To test these hypotheses, we conducted a randomized, double-blind, double-dummy study of pulse-loaded intravenous versus oral CMI, followed by open-label oral CMI for 12 weeks. METHODS:: We enrolled a volunteer and referred group of 34 adults with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition obsessive-compulsive disorder of >/=1-year duration and Yale-Brown Obsessive Scale score of >/=20. Eligible subjects had failed >/=2 adequate serotonin reuptake inhibitor trials. Subjects received pulse loaded CMI 150 mg by vein or by mouth on day 1 and 200 mg on day 2. Oral CMI began on day 6 at 200 mg/d and was increased by 25 mg every 4 days to 250 mg/d, as tolerated, for 12 weeks. RESULTS:: Adverse events led to one withdrawal during oral pulse loading and 5 during open-label oral treatment. Intravenous pulse loading did not induce a more rapid or greater Yale-Brown Obsessive Scale score decrease than oral pulse loading at day 6 or by week 12. Day 6 and week 12 improvement were unrelated to plasma drug or metabolite concentrations. Pulse loading itself seemed to induce more rapid and greater improvement than expected in treatment-resistant obsessive-compulsive disorder. CONCLUSIONS:: Further investigation of oral pulse-loading regimens in treatment-resistant obsessive-compulsive disorder is warranted.

Page last updated: 2006-01-31

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