Clora Uses

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What is Clora?

Clora is used to treat obsessive compulsive disorder (OCD). OCD is a nervous condition where a person has recurring thoughts or ideas, or does repetitive things because they are anxious.

Clora is a tricyclic antidepressant (TCA). It is thought to work in the brain by increasing the activity of the chemical serotonin.

Clora is available only with your doctor's prescription.

Clora indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Clora™ (Clora hydrochloride) Capsules USP is indicated for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD). The obsessions or compulsions must cause marked distress, be time-consuming, or significantly interfere with social or occupational functioning, in order to meet the DSM-III-R (circa 1989) diagnosis of OCD.

Obsessions are recurrent, persistent ideas, thoughts, images, or impulses that are ego-dystonic. Compulsions are repetitive, purposeful, and intentional behaviors performed in response to an obsession or in a stereotyped fashion, and are recognized by the person as excessive or unreasonable.

The effectiveness of Clora for the treatment of OCD was demonstrated in multicenter, placebo-controlled, parallel-group studies, including two 10-week studies in adults and one 8-week study in children and adolescents 10 to 17 years of age. Patients in all studies had moderate-to-severe OCD (DSM-III), with mean baseline ratings on the Yale-Brown Obsessive Compulsive Scale (YBOCS) ranging from 26 to 28 and a mean baseline rating of 10 on the NIMH Clinical Global Obsessive Compulsive Scale (NIMH-OC). Patients taking CMI experienced a mean reduction of approximately 10 on the YBOCS, representing an average improvement on this scale of 35% to 42% among adults and 37% among children and adolescents. CMI-treated patients experienced a 3.5 unit decrement on the NIMH-OC. Patients on placebo showed no important clinical response on either scale. The maximum dose was 250 mg/day for most adults and 3 mg/kg/day (up to 200 mg) for all children and adolescents.

The effectiveness of Clora for long-term use (i.e., for more than 10 weeks) has not been systematically evaluated in placebo-controlled trials. The physician who elects to use Clora for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

How should I use Clora?

Use Clora as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Clora.

Uses of Clora in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Obsessive-compulsive disorder: Treatment of obsessive-compulsive disorder

Off Label Uses

Major depressive disorder

Data from randomized, double-blind studies supports the use of Clora in the treatment of major depressive disorder. Additional trials may be necessary to further define the role of Clora in this condition.

According to the American Psychiatric Association treatment guidelines, Clora is effective and recommended for the management of major depressive disorder. Although the WFSBP treatment guidelines also recommend Clora, particularly for patients with severe depression or concomitant obsessive-compulsive disorder, the guidelines recommend prescribing a limited supply for severely depressed patients at risk of overdose.

Panic disorder

Data from randomized, double-blind, placebo-controlled studies supports the use of Clora in the management of panic disorder with or without agoraphobia to decrease severity of anxiety and phobias, as well as severity and frequency of panic attacks. Additional trials may be necessary to further define the role of Clora in this condition.

Based on the American Psychiatric Association guidelines for the treatment of panic disorder, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines all have roughly comparable efficacy in the treatment of panic disorder, but SSRIs are likely to have the most favorable balance of efficacy and adverse effects for most patients. Based on the Canadian Psychiatric Association guidelines for the management of anxiety disorders, TCAs like Clora are second-line choices for panic disorder. Based on the World Federation of the Societies of Biological Psychiatry guidelines for the management of anxiety disorders, TCAs are recommended in panic disorder in patients who have not responded to SSRIs or SNRIs.

Clora description

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Clora, the 3-chloro analog of imipramine, is a dibenzazepine-derivative tricyclic antidepressant (TCA). TCAs are structurally similar to phenothiazines. They contain a tricyclic ring system with an alkyl amine substituent on the central ring. In non-depressed individuals, Clora does not affect mood or arousal, but may cause sedation. In depressed individuals, Clora exerts a positive effect on mood. TCAs are potent inhibitors of serotonin and norepinephrine reuptake. Tertiary amine TCAs, such as Clora, are more potent inhibitors of serotonin reuptake than secondary amine TCAs, such as nortriptyline and desipramine. TCAs also down-regulate cerebral cortical β-adrenergic receptors and sensitize post-synaptic serotonergic receptors with chronic use. The antidepressant effects of TCAs are thought to be due to an overall increase in serotonergic neurotransmission. TCAs also block histamine-H1 receptors, α1-adrenergic receptors and muscarinic receptors, which accounts for their sedative, hypotensive and anticholinergic effects (e.g. blurred vision, dry mouth, constipation, urinary retention), respectively. See toxicity section below for a complete listing of side effects. Clora may be used to treat obsessive-compulsive disorder and disorders with an obsessive-compulsive component (e.g. depression, schizophrenia, Tourette’s disorder). Unlabeled indications include panic disorder, chronic pain (e.g. central pain, idiopathic pain disorder, tension headache, diabetic peripheral neuropathy, neuropathic pain), cataplexy and associated narcolepsy, autistic disorder, trichotillomania, onchophagia, stuttering, premature ejaculation, and premenstrual syndrome. Clora is rapidly absorbed from the gastrointestinal tract and demethylated in the liver to its primary active metabolite, desmethylclomipramine.

Clora dosage

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Clora Dosage

Generic name: Clora HYDROCHLORIDE 25mg

Dosage form: capsule

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

The treatment regimens described below are based on those used in controlled clinical trials of Clora in 520 adults, and 91 children and adolescents with OCD. During initial titration, Clora should be given in divided doses with meals to reduce gastrointestinal side effects. The goal of this initial titration phase is to minimize side effects by permitting tolerance to side effects to develop or allowing the patient time to adapt if tolerance does not develop.

Because both CMI and its active metabolite, DMI, have long elimination half-lives, the prescriber should take into consideration the fact that steady-state plasma levels may not be achieved until 2 to 3 weeks after dosage change. Therefore, after initial titration, it may be appropriate to wait 2 to 3 weeks between further dosage adjustments.

Initial Treatment/Dose Adjustment (Adults)

Treatment with Clora should be initiated at a dosage of 25 mg daily and gradually increased, as tolerated, to approximately 100 mg during the first 2 weeks. During initial titration, Clora should be given in divided doses with meals to reduce gastrointestinal side effects. Thereafter, the dosage may be increased gradually over the next several weeks, up to a maximum of 250 mg daily. After titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation.

Initial Treatment/Dose Adjustment (Children and Adolescents)

As with adults, the starting dose is 25 mg daily and should be gradually increased (also given in divided doses with meals to reduce gastrointestinal side effects) during the first 2 weeks, as tolerated, up to a daily maximum of 3 mg/kg or 100 mg, whichever is smaller. Thereafter, the dosage may be increased gradually over the next several weeks up to a daily maximum of 3 mg/kg or 200 mg, whichever is smaller. As with adults, after titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation.

Maintenance/Continuation Treatment (Adults, Children, and Adolescents)

While there are no systematic studies that answer the question of how long to continue Clora, OCD is a chronic condition and it is reasonable to consider continuation for a responding patient. Although the efficacy of Clora after 10 weeks has not been documented in controlled trials, patients have been continued in therapy under double-blind conditions for up to 1 year without loss of benefit. However, dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for treatment. During maintenance, the total daily dose may be given once daily at bedtime.

Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders

At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Clora. Conversely, at least 14 days should be allowed after stopping Clora before starting an MAOI intended to treat psychiatric disorders.

Use of Clora With Other MAOIs, Such as Linezolid or Methylene Blue

Do not start Clora in a patient who is being treated with linezolid or intravenous methylene blue because there is increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered.

In some cases, a patient already receiving Clora therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Clora should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for two weeks or until

24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Clora may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.

The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Clora is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use.

More about Clora (Clora)

Consumer resources

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Related treatment guides

Clora interactions

See also:
What other drugs will affect Clora?

The risks of using Clora in combination with other drugs have not been systematically evaluated. Given the primary CNS effects of Clora, caution is advised in using it concomitantly with other CNS-active drugs. Clora should not be used with MAO inhibitors.

Close supervision and careful adjustment of dosage are required when Clora is administered with anticholinergic or sympathomimetic drugs.

Several tricyclic antidepressants have been reported to block the pharmacologic effects of guanethidine, clonidine, or similar agents, and such an effect may be anticipated with CMI because of its structural similarity to other tricyclic antidepressants.

The plasma concentration of CMI has been reported to be increased by the concomitant administration of haloperidol; plasma levels of several closely related tricyclic antidepressants have been reported to be increased by the concomitant administration of methylphenidate or hepatic enzyme inhibitors (e.g., cimetidine, fluoxetine) and decreased by the concomitant administration of hepatic enzyme inducers (e.g., barbiturates, phenytoin), and such an effect may be anticipated with CMI as well. Administration of CMI has been reported to increase the plasma levels of phenobarbital, if given concomitantly.

Drugs Metabolized By P450 2D6

The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the Caucasian population (about 7% to 10% of Caucasians are so-called “poor metabolizers”); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8 fold increase in plasma AUC of the TCA). In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, paroxetine, and fluvoxamine, inhibit P450 2D6, they may vary in the extent of inhibition. Fluvoxamine has also been shown to inhibit P450 1A2, an isoform also involved in TCA metabolism. The extent to which SSRI-TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved. Nevertheless, caution is indicated in the co-administration of TCAs with any of the SSRIs and also in switching from one class to the other. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary). Concomitant use of agents in the tricyclic antidepressant class (which includes Clora) with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant agent or the other drug. Furthermore, whenever one of these drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant agent may be required. It is desirable to monitor TCA plasma levels whenever an agent of the tricyclic antidepressant class including Clora is going to be co-administered with another drug known to be an inhibitor of P450 2D6 (and/or P450 1A2).

Because Clora is highly bound to serum protein, the administration of Clora to patients taking other drugs that are highly bound to protein (e.g., warfarin, digoxin) may cause an increase in plasma concentrations of these drugs, potentially resulting in adverse effects. Conversely, adverse effects may result from displacement of protein-bound Clora by other highly bound drugs.

Monoamine Oxidase Inhibitors (MAOIs )

Serotonergic Drugs

Clora side effects

See also:
What are the possible side effects of Clora?

Applies to Clora: oral capsule, oral tablet

In addition to its needed effects, some unwanted effects may be caused by Clora (the active ingredient contained in Clora). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Clora:

More common:

Less common:

Minor Side Effects

Some of the side effects that can occur with Clora may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

Less common:

Clora contraindications

See also:
What is the most important information I should know about Clora?

Clora is contraindicated in patients with a history of hypersensitivity to Clora or other tricyclic antidepressants.

Monoamine Oxidase Inhibitors (MAOIs)

The use of MAOIs intended to treat psychiatric disorders with Clora or within 14 days of stopping treatment with Clora is contraindicated because of an increased risk of serotonin syndrome. The use of Clora within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated.

Starting Clora in a patient who is being treated with linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome.

Myocardial Infarction

Clora is contraindicated during the acute recovery period after a myocardial infarction.

Active ingredient matches for Clora:

Clomipramine


Unit description / dosage (Manufacturer)Price, USD
CLORA 25MG TABLET 1 strip / 10 tablets each (Sigmund Promedica)$ 0.68
CLORA 50MG TABLET 1 strip / 10 tablets each (Sigmund Promedica)$ 1.07
CLORA 75MG TABLET SR 1 strip / 10 tablet srs each (Sigmund Promedica)$ 2.03
Clora 50mg Tablet (Sigmund Promedica)$ 0.11
Clora 75mg Tablet SR (Sigmund Promedica)$ 0.20

List of Clora substitutes (brand and generic names):

CLOTECH tab 25 mg x 10's (Alpic Biotech)$ 0.51
CLOTECH tab 50 mg x 10's (Alpic Biotech)$ 1.02
Clowin 50mg TAB / 100 (Arrowin)$ 11.08
Clowin 25 mg (Arrowin)
50 mg x 100's (Arrowin)$ 11.08
CLOWIN tab 50 mg x 10's (Arrowin)$ 1.11
Tablet; Oral; Clomipramine Hydrochloride 10 mg
Tablet; Oral; Clomipramine Hydrochloride 25 mg
Tablet; Oral; Clomipramine Hydrochloride 50 mg
Cosinic 25 mg
D.D.PRAMINE 10MG TABLET 1 strip / 10 tablets each (D D Pharmaceuticals)$ 0.30
D.D.PRAMINE 25MG TABLET 1 strip / 10 tablets each (D D Pharmaceuticals)$ 0.56
D.D.PRAMINE 50MG TABLET 1 strip / 10 tablets each (D D Pharmaceuticals)$ 1.06
D.D.PRAMINE 75MG TABLET 1 strip / 10 tablets each (D D Pharmaceuticals)$ 1.53
D.D.Pramine 25mg Tablet (D D Pharmaceuticals)$ 0.06
D.D.Pramine 50mg Tablet (D D Pharmaceuticals)$ 0.11
D.D.Pramine 75mg Tablet (D D Pharmaceuticals)$ 0.15
25 mg x 10's (Tas Med (I) Pvt. Ltd.)$ 0.49
Depnil 25mg TAB / 10 (Tas Med (I) Pvt. Ltd.)$ 0.49
Depnil 25 mg Tablet (Tas Med (I) Pvt. Ltd.)$ 0.01
Depnil 75 mg Tablet (Tas Med (I) Pvt. Ltd.)$ 0.02
Depnil 25 mg Cipla Tablet (Tas Med (I) Pvt. Ltd.)$ 0.05
DEPNIL 25MG TABLET 1 strip / 10 tablets each (Tas Med (I) Pvt. Ltd.)$ 0.22
DEPNIL 75MG TABLET 1 strip / 10 tablets each (Tas Med (I) Pvt. Ltd.)$ 4.92
DEPNIL tab 25 mg x 10's (Tas Med (I) Pvt. Ltd.)$ 0.49
Depnil 25mg Tablet (Tas Med (I) Pvt. Ltd.)$ 0.02
Depnil 75mg Tablet (Tas Med (I) Pvt. Ltd.)$ 0.49
DEPRAMINE 2MG TABLET 1 strip / 10 tablets each (RKG Pharma)$ 0.14
DEPRAMINE 5MG TABLET 1 strip / 10 tablets each (RKG Pharma)$ 0.14
DEPRAMINE 75MG TABLET 1 strip / 10 tablets each (RKG Pharma)$ 0.56
Depramine 5mg Tablet (RKG Pharma)$ 0.01
Depramine 75mg Tablet (RKG Pharma)$ 0.06
Tablet; Oral; Clomipramine Hydrochloride 25 mg
Tablet; Oral; Clomipramine Hydrochloride 50 mg
Dom-clomipramine tablet 25 mg (Dominion Pharmacal (Canada))

References

  1. PubChem. "clomipramine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "clomipramine". http://www.drugbank.ca/drugs/DB01242 (accessed September 17, 2018).
  3. DTP/NCI. "clomipramine: The NCI Development Therapeutics Program (DTP) provides services and resources to the academic and private-sector research communities worldwide to facilitate the discovery and development of new cancer therapeutic agents.". https://dtp.cancer.gov/dtpstandard/s... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Clora are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Clora. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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