Clomipramine
證據等級: L5 | 預測適應症: 10 個
## 藥師評估報告
Clomipramine 藥師筆記
一句話總結
Clomipramine 是經典的三環抗憂鬱劑，TxGNN 預測其對焦慮症有療效，這與其已知的藥理作用及豐富的臨床證據高度吻合，屬於證據充足的「老藥既有用途」。
快速總覽
| 項目 | 內容 |
|---|---|
| 藥物名稱 | Clomipramine (可洛米普明) |
| DrugBank ID | DB01242 |
| 台灣商品名 | 倍欣膜衣錠 25 公絲 等多種製劑 |
| 原核准適應症 | 憂鬱症、強迫症、恐懼症、驚懼發作 |
| 預測新適應症 | 焦慮症、obsessive-compulsive disorder、benign paroxysmal torticollis of infancy、schizotypal personality disorder、histrionic personality disorder (disease)、paranoid personality disorder、schizoid personality disorder、agoraphobia、major depressive disorder、endogenous depression |
| 最高預測分數 | 0.999 (anxiety disorder) |
| 證據等級 | L1-L2 (多個 RCT/系統性回顧) |
預測適應症詳細分析
1. anxiety disorder L1 99.93% 主要分析
為什麼這個預測合理？
Clomipramine 的藥理機轉完全支持其對焦慮症的療效：
- 血清素再吸收抑制：Clomipramine 是三環抗憂鬱劑中血清素選擇性最高者，其活性代謝物 desmethylclomipramine 則抑制正腎上腺素再吸收
- 抗焦慮機轉明確：血清素系統失調是焦慮症的核心病理機轉，增加血清素傳導可改善焦慮症狀
- 臨床經驗豐富：Clomipramine 已廣泛用於強迫症 (OCD)、恐慌症等焦慮相關疾患，療效確立
實際上，「焦慮症」的預測反映的是 clomipramine 已知的治療譜系，而非真正的新適應症發現。
臨床試驗
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT03299166 | PHASE2, PHASE3 | COMPLETED | 426 | A Randomized, Double-blind, Placebo-controlled Trial of Adjunctive Troriluzole i... |
| NCT04436952 | NA | WITHDRAWN | 0 | An Open Label Study to Compare and Evaluate the Efficacy of the Deep Transcrania... |
| NCT01404871 | NA | COMPLETED | 26 | Predicting Medication Response in Obsessive Compulsive Disorder |
| NCT02374567 | PHASE3 | TERMINATED | 407 | Pharmacovigilance in Gerontopsychiatric Patients |
| NCT06942494 | NA | RECRUITING | 88 | Effect of a Family-Based Cognitive Behavioral Therapy Self-Help Intervention for... |
| NCT04708834 | PHASE3 | ENROLLING_BY_INVITATION | 1200 | A Multicenter, Long-Term Open-Label Safety Study of Adjunctive Troriluzole in Su... |
| NCT00004310 | PHASE2 | UNKNOWN | 76 | Phase II Randomized Study of Intravenous Versus Oral Clomipramine in Patients Wi... |
| NCT05737511 | PHASE4 | NOT_YET_RECRUITING | 80 | Efficacy of Hydroxyzine Versus Treatment as Usual for Panic Disorder: An Eight-W... |
| NCT02431845 | NA | RECRUITING | 200 | Pharmaco(Epi)Genetic, Proteomic, and Microbiomic Study of Obsessive-Compulsive |
| NCT00466609 | PHASE4 | COMPLETED | 54 | Pharmacological Augmentation Strategies for Obsessive Compulsive Disorder Patien... |
| NCT01148316 | NA | COMPLETED | 144 | Adaptive Treatment Strategies for Children and Adolescents With Psychiatric Diso... |
| NCT02450695 | NA | WITHDRAWN | 0 | A Randomized Crossed-over Trial Examining Efficacy of Repetitive Transcranial Ma... |
| NCT06659094 | NA | COMPLETED | 95 | Step Down From Maximal Support: Efficacy of Stepped-care Internet-based Cognitiv... |
| NCT00564564 | PHASE4 | COMPLETED | 21 | Quetiapine Augmentation Versus Clomipramine Augmentation of Selective Serotonin ... |
| NCT04989413 | PHASE2, PHASE3 | TERMINATED | 110 | Randomized, Double Blind Clinical Trial to Study the Effect of Cannabidiol (CBD)... |
| NCT00074815 | PHASE3 | COMPLETED | 124 | Treatment of Pediatric OCD for SRI Partial Responders |
| NCT00254735 | PHASE3 | COMPLETED | 44 | Quetiapine Augmentation in Severe Obsessive Compulsive Disorder (OCD) - Pilot St... |
| NCT01944657 | NA | WITHDRAWN | 0 | Supplemental TMS vs. Standard Medication Monotherapy for Treating Major Depressi... |
相關文獻
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 38014714 | 2023 | Article | The Cochrane database of syste | Pharmacological treatments in panic disorder in adults: a network meta-analysis. |
| 3887336 | 1985 | Article | The Psychiatric clinics of Nor | Obsessive-compulsive disorder. |
| 34582562 | 2021 | Article | The Cochrane database of syste | Pharmacotherapy for trichotillomania. |
| 11450830 | 2001 | Article | Journal of the American Animal | Clomipramine--beyond separation anxiety. |
| 24214100 | 2013 | Article | The Cochrane database of syste | Pharmacotherapy for trichotillomania. |
| 19398818 | 2008 | Article | The Israel journal of psychiat | Obsessive-compulsive disorder. |
| 22204483 | 2012 | Article | Current topics in medicinal ch | Treatment strategies of obsessive-compulsive disorder and panic disorder/agoraph... |
| 1933762 | 1991 | Article | Canadian journal of psychiatry | Intravenous clomipramine and obsessive-compulsive disorder. |
| 1474179 | 1992 | Article | Journal of clinical psychophar | Clomipramine, clonazepam, and clonidine treatment of obsessive-compulsive disord... |
| 3887445 | 1985 | Article | Psychiatry research | Clomipramine and imipramine in obsessive-compulsive disorder. |
| 25681005 | 2015 | Article | Psychiatry research | Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological an... |
| 28470111 | 2017 | Article | Pharmacogenomics | Serum clomipramine and desmethylclomipramine levels in a CYP2C19 and CYP2D6 inte... |
| 36740347 | 2023 | Article | The Psychiatric clinics of Nor | The Pharmacological Treatment of Obsessive-Compulsive Disorder. |
| 9631696 | 1998 | Article | Australian veterinary journal | Use of clomipramine in the treatment of anxiety-related and obsessive-compulsive... |
| 12063477 | 2002 | Article | Journal of the American Academ | Trichotillomania. |
| 8263222 | 1993 | Article | Journal of behavior therapy an | Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-com... |
| 11349411 | 2001 | Article | Australian veterinary journal | Use of clomipramine in treatment of obsessive-compulsive disorder, separation an... |
| 2178909 | 1990 | Article | Drugs | Clomipramine. An overview of its pharmacological properties and a review of its ... |
| 10665629 | 1999 | Article | The Journal of clinical psychi | Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disord... |
| 27663940 | 2016 | Article | Journal of the American Academ | Systematic Review and Meta-Analysis: Early Treatment Responses of Selective Sero... |
2. benign paroxysmal torticollis of infancy L5 99.90%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
3. schizotypal personality disorder L4 99.90%
相關文獻（5 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 11893994 | 2002 | Article | Comprehensive psychiatry | Obsessive-compulsive disorder with poor insight. |
| 2265532 | 1990 | Article | Comprehensive psychiatry | Correlates of DSM-III personality disorder in obsessive-compulsive disorder. |
| 1444723 | 1992 | Article | Archives of general psychiatry | Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patient... |
| 7635854 | 1995 | Article | The Journal of clinical psychi | Predictors of drug treatment response in obsessive-compulsive disorder. |
| 10897982 | 1999 | Article | MMW Fortschritte der Medizin | [Drug treatment of obsessive-compulsive disorder. With proper drugs and some pat... |
4. histrionic personality disorder (disease) L5 99.90%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
5. paranoid personality disorder L4 99.90%
6. schizoid personality disorder L4 99.90%
相關文獻（1 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 9316681 | 1994 | Article | Clinical neuropharmacology | Clomipramine-induced tourettism in obsessive-compulsive disorder: clinical and t... |
7. agoraphobia L4 99.87%
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 38014714 | 2023 | Article | The Cochrane database of syste | Pharmacological treatments in panic disorder in adults: a network meta-analysis. |
| 6373161 | 1984 | Article | Current medical research and o | Clomipramine and diazepam in the treatment of agoraphobia and social phobia in g... |
| 22204483 | 2012 | Article | Current topics in medicinal ch | Treatment strategies of obsessive-compulsive disorder and panic disorder/agoraph... |
| 22290995 | 1993 | Article | Journal of psychopharmacology | Clomipramine, a better reference drug for panic/agoraphobia. II. Psychomotor and... |
| 10221358 | 1999 | Article | Journal of psychopharmacology | Serum levels of clomipramine and desmethylclomipramine and clinical improvement ... |
| 2651491 | 1989 | Article | Journal of clinical psychophar | Panic attacks and agoraphobia: low dose clomipramine treatment. |
| 10665629 | 1999 | Article | The Journal of clinical psychi | Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disord... |
| 2178909 | 1990 | Article | Drugs | Clomipramine. An overview of its pharmacological properties and a review of its ... |
| 6347516 | 1983 | Article | Comprehensive psychiatry | Antidepressants in the treatment of agoraphobia and obsessive-compulsive disorde... |
| 8575719 | 1995 | Article | Fortschritte der Neurologie-Ps | [Panic disorder and agoraphobia: what is effective?]. |
| 40946318 | 2025 | Article | Psychotherapy and psychosomati | Integrative Systematic Review on Pharmacological, Psychotherapeutic, and Neurost... |
| 9585709 | 1998 | Article | The American journal of psychi | Comparison of aerobic exercise, clomipramine, and placebo in the treatment of pa... |
| 11277602 | 2001 | Article | Journal of psychopharmacology | A dose-finding and discontinuation study of clomipramine in panic disorder. |
| 19698677 | 1998 | Article | European psychiatry : the jour | New treatments for panic. |
| 7621388 | 1995 | Article | Canadian journal of psychiatry | Clomipramine treatment and behaviour therapy with agoraphobic women. |
| 11071019 | 2000 | Article | Pharmacopsychiatry | The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical tria... |
| 10066007 | 1999 | Article | Acta psychiatrica Scandinavica | Comparative effects of low and high doses of clomipramine and placebo in panic d... |
| 3312397 | 1987 | Article | International clinical psychop | Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; a dou... |
| 12729940 | 2003 | Article | European neuropsychopharmacolo | 5-HT1A responsivity in patients with panic disorder before and after treatment w... |
| 10361962 | 1999 | Article | European archives of psychiatr | The efficacy and safety of moclobemide compared to clomipramine in the treatment... |
8. major depressive disorder L1 99.77%
臨床試驗（10 項）
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT00944996 | NA | COMPLETED | 100 | Assessment of PACAP-BDNF Signaling System Involvement in Etiology and Treatment ... |
| NCT00704860 | PHASE4 | COMPLETED | 27 | Treatment-Resistant Depression, Hippocampus Atrophy and Serotonin Genetic Polymo... |
| NCT06942494 | NA | RECRUITING | 88 | Effect of a Family-Based Cognitive Behavioral Therapy Self-Help Intervention for... |
| NCT01305707 | PHASE4 | TERMINATED | 104 | Continuation Electroconvulsive Therapy Associated With Pharmacotherapy Versus Ph... |
| NCT05931965 | NA | COMPLETED | 88 | Comparative Efficacy of Antidepressants With L-methylfolate, B12, and Magnesium ... |
| NCT05952713 | N/A | COMPLETED | 73336 | Comparative Responses to 15 Different Antidepressants in Major Depressive Disord... |
| NCT06659094 | NA | COMPLETED | 95 | Step Down From Maximal Support: Efficacy of Stepped-care Internet-based Cognitiv... |
| NCT04989413 | PHASE2, PHASE3 | TERMINATED | 110 | Randomized, Double Blind Clinical Trial to Study the Effect of Cannabidiol (CBD)... |
| NCT03548675 | PHASE4 | COMPLETED | 125 | Pharmacogenetics to Improve Personalized Antidepressant Dosing in Patients With ... |
| NCT01944657 | NA | WITHDRAWN | 0 | Supplemental TMS vs. Standard Medication Monotherapy for Treating Major Depressi... |
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 29477251 | 2018 | Article | Lancet (London, England) | Comparative efficacy and acceptability of 21 antidepressant drugs for the acute ... |
| 27289172 | 2016 | Article | Lancet (London, England) | Comparative efficacy and tolerability of antidepressants for major depressive di... |
| 25911132 | 2015 | Article | Journal of affective disorders | Dose equivalents of antidepressants: Evidence-based recommendations from randomi... |
| 28850959 | 2018 | Article | Pharmacopsychiatry | Epileptic Seizures Under Antidepressive Drug Treatment: Systematic Review. |
| 30611836 | 2019 | Article | Progress in neuro-psychopharma | Pharmacological interventions targeting anhedonia in patients with major depress... |
| 32982805 | 2020 | Article | Frontiers in psychiatry | Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerabili... |
| 39341084 | 2024 | Article | European neuropsychopharmacolo | A higher desmethylclomipramine to clomipramine ratio predicts more effectiveness... |
| 37155164 | 2023 | Article | JAMA network open | Effectiveness of Genotype-Specific Tricyclic Antidepressant Dosing in Patients W... |
| 3572384 | 1987 | Article | The Journal of nervous and men | Clomipramine-induced pancytopenia. |
| 38379028 | 2024 | Article | Acta psychiatrica Scandinavica | Comparative responses to 17 different antidepressants in major depressive disord... |
| 34598683 | 2021 | Article | BMC psychiatry | Tricyclic antidepressants for major depressive disorder: a comprehensive evaluat... |
| 11986508 | 2002 | Article | Psychiatric services (Washingt | Psychodynamic psychotherapy and clomipramine in the treatment of major depressio... |
| 23810143 | 2013 | Article | Asian journal of psychiatry | Psychotic versus non-psychotic major depressive disorder: a comparative naturali... |
| 31247926 | 2019 | Article | International journal of envir | Indices of Change, Expectations, and Popularity of Biological Treatments for Maj... |
| 12492769 | 2002 | Article | Acta psychiatrica Scandinavica | Treatment strategies in achieving remission in major depressive disorder. |
| 14978779 | 2004 | Article | Depression and anxiety | Intravenous antidepressants: a review. |
| 34389045 | 2021 | Article | Systematic reviews | Tricyclic antidepressants versus 'active placebo', placebo or no intervention fo... |
| 31312426 | 2019 | Article | Therapeutic advances in psycho | What combinations of agomelatine with other antidepressants could be successful ... |
| 34034811 | 2021 | Article | Systematic reviews | Beneficial and harmful effects of antidepressants versus placebo, 'active placeb... |
| 41290573 | 2025 | Article | Translational psychiatry | Comparative gastrointestinal effects of antidepressants for the acute treatment ... |
9. endogenous depression L4 99.71%
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 27289172 | 2016 | Article | Lancet (London, England) | Comparative efficacy and tolerability of antidepressants for major depressive di... |
| 2669440 | 1989 | Article | Acta psychiatrica Scandinavica | Moclobemide and clomipramine in endogenous depression. A randomized clinical tri... |
| 2694201 | 1989 | Article | Psychiatry research | Clomipramine and EEG sleep in depression. |
| 2005057 | 1991 | Article | Journal of the American Academ | Trichotillomania and depression. |
| 15994726 | 2005 | Article | The American journal of psychi | Dysbetalipoproteinemia and clomipramine. |
| 10446735 | 1999 | Article | The Journal of clinical psychi | Mirtazapine: clinical overview. |
| 3887336 | 1985 | Article | The Psychiatric clinics of Nor | Obsessive-compulsive disorder. |
| 6215443 | 1982 | Article | Journal of affective disorders | Fluvoxamine and chlorimipramine in endogenous depression. |
| 11986508 | 2002 | Article | Psychiatric services (Washingt | Psychodynamic psychotherapy and clomipramine in the treatment of major depressio... |
| 2644338 | 1989 | Article | International clinical psychop | Fluoxetine in endogenous depression and melancholia versus clomipramine. |
| 22516018 | 2012 | Article | Neuroscience | Sleep homeostasis and depression: studies with the rat clomipramine model of dep... |
| 28470111 | 2017 | Article | Pharmacogenomics | Serum clomipramine and desmethylclomipramine levels in a CYP2C19 and CYP2D6 inte... |
| 62147 | 1976 | Article | Lancet (London, England) | Sleep deprivation and clomipramine in endogenous depression. |
| 2199435 | 1990 | Article | The Journal of clinical psychi | Worldwide use of clomipramine. |
| 14532855 | 2003 | Article | The Journal of urology | Alterations in voiding frequency and cystometry in the clomipramine induced mode... |
| 10460069 | 1999 | Article | Clinical pharmacology and ther | Clomipramine dose-effect study in patients with depression: clinical end points ... |
| 16195134 | 2005 | Article | Nordic journal of psychiatry | Orthostatic side effects of clomipramine and moclobemide during treatment for de... |
| 3929308 | 1985 | Article | Psychopharmacology | Orthostatic side effects of clomipramine and citalopram during treatment for dep... |
| 31376442 | 2019 | Article | Behavioural brain research | Zinc improves clomipramine effects on depressive and locomotor behavior and reve... |
| 8382710 | 1993 | Article | Journal of affective disorders | Noradrenergic and serotoninergic depression? |
10. attention deficit-hyperactivity disorder L4 99.58%
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 25238582 | 2014 | Article | The Cochrane database of syste | Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in... |
| 32982805 | 2020 | Article | Frontiers in psychiatry | Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerabili... |
| 10418807 | 1999 | Article | The Journal of clinical psychi | Aggressive behavior in patients with attention-deficit/hyperactivity disorder, c... |
| 12185806 | 2002 | Article | Neurologia i neurochirurgia po | [Tic syndrome]. |
| 17207050 | 2007 | Article | Journal of paediatrics and chi | Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autis... |
| 22583957 | 2012 | Article | Journal of medical case report | High dose methylphenidate treatment in adult attention deficit hyperactivity dis... |
| 39372877 | 2024 | Article | Neuropsychiatric disease and t | Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials: Ant... |
| 6875128 | 1983 | Article | Journal of the American Academ | Tricyclic antidepressant and methylphenidate treatment of attention deficit diso... |
| 1429426 | 1992 | Article | Journal of the American Academ | Clomipramine side effects. |
| 8496110 | 1993 | Article | Journal of the American Academ | Antidepressant treatments in children and adolescents: II. Anxiety, physical, an... |
| 1537774 | 1992 | Article | Journal of the American Academ | Clomipramine for comorbid conditions. |
| 1549543 | 1992 | Article | The Psychiatric clinics of Nor | Pharmacotherapy of Tourette's syndrome and associated disorders. |
| 8861545 | 1996 | Article | Drugs | Pharmacological treatment of psychiatric disorders in children and adolescents: ... |
| 9547477 | 1998 | Article | The Journal of neuropsychiatry | When fluvoxamine treats only depression and clomipramine treats only obsessive-c... |
| 7717094 | 1995 | Article | Acta psychiatrica Scandinavica | Reversible and selective inhibitors of monoamine oxidase A in mental and other d... |
| 9242899 | 1997 | Article | Annals of clinical psychiatry | Three years on clomipramine: before and after brain SPECT study. |
| 9288426 | 1997 | Article | Canadian journal of psychiatry | Bipolar disorder in children and adolescents: current challenges. |
| 26529542 | 2017 | Article | The world journal of biologica | Interaction between methylphenidate, methadone and different antidepressant drug... |
| 11725521 | 2001 | Article | No to hattatsu = Brain and dev | [Narcolepsy in a prepubertal boy]. |
| 19393386 | 2009 | Article | L'Encephale | [Treatment of a serious autistic disorder in a child with Naltrexone in an oral ... |
台灣上市資訊
| 許可證字號 | 商品名 | 適應症 | 劑型 | 狀態 |
|---|---|---|---|---|
| 多項許可證 | 倍欣膜衣錠等 | 憂鬱病、強迫症、恐懼症、驚懼發作 | 錠劑/膠囊 | 有效 |
備註：台灣核准適應症已包含「恐懼症」及「驚懼發作」，實質上涵蓋了焦慮症的主要類型。
安全性考量
重要警語
- 心臟毒性：可能延長 QT 間期，心臟病患者需謹慎使用
- 抗膽鹼副作用：口乾、便秘、尿滯留、視力模糊
- 鎮靜作用：可能影響駕駛及操作機械能力
- 過量中毒風險：三環抗憂鬱劑過量可能致命
- 年輕人自殺風險：18-24 歲患者初期治療需密切監測
藥物交互作用注意事項
- MAO 抑制劑：禁止併用，可能導致血清素症候群
- CYP2D6 抑制劑：可能增加 clomipramine 血中濃度
- 中樞神經抑制劑：加強鎮靜作用
- 抗膽鹼藥物：加重抗膽鹼副作用
CYP450 代謝考量
Clomipramine 經由 CYP2C19 及 CYP2D6 代謝。文獻報告 (PMID: 28470111) 顯示，CYP2C19 及 CYP2D6 中間代謝者可能出現顯著升高的藥物血中濃度，建議考慮藥物基因檢測。
藥物-食物交互作用 (DFI)
資料來源：DDInter 2.0（原文內容請參閱該網站）
酒精 🟡 Moderate
- 影響：產生協同作用。
- 建議：需監測療效或不良反應。
葡萄柚汁 🟡 Moderate
- 影響：影響藥物代謝。可能增加藥物血中濃度。
- 建議：需監測療效或不良反應。避免食用葡萄柚或葡萄柚汁。
蔓越莓汁 🟡 Moderate
- 影響：影響藥物代謝。可能增加藥物血中濃度。
- 建議：需監測療效或不良反應。
藥物-草藥交互作用 (DHI)
聖約翰草（貫葉連翹） 🔴 Major
- 影響：併用可能導致血清素症候群
- 建議：禁止併用
卡瓦 🔴 Major
- 影響：卡瓦增強中樞神經抑制作用
- 建議：避免併用
纈草 🟡 Moderate
- 影響：纈草可能增強鎮靜作用
- 建議：謹慎使用
藥物-疾病注意事項 (DDSI)
資料來源：DDInter 2.0（原文內容請參閱該網站）
Adrenal Gland Neoplasms 🟡 Moderate
- 應謹慎使用本藥物。
Mania 🟡 Moderate
- 注意事項：Premarketing studies reported activation of mania/hypomania in patients with affective disorders treated with clomipramine…
Bone Marrow Failure Disorders 🟡 Moderate
- 需密切監測。風險包括：骨髓抑制、血栓、貧血。
糖尿病 🟡 Moderate
- 需定期監測。
肝臟疾病 🟡 Moderate
- 可能需要調整劑量。
Schizophrenia 🟡 Moderate
- 注意事項：Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology…
Tardive Dyskinesia 🟡 Moderate
- 需定期監測。特別注意族群：老年人。
Alcoholic Intoxication 🟡 Moderate
- 注意事項：Tricyclic antidepressants can enhance the response to alcohol…
躁鬱症 🟡 Moderate
- 注意事項：A major depressive episode can be the initial presentation of bipolar disorder…
青光眼 🟡 Moderate
- 本藥物在此情況下禁用。
糖尿病 🟡 Moderate
- 應謹慎使用本藥物。需定期監測。風險包括：低血糖、高血糖。
肝臟疾病 🟡 Moderate
- 應謹慎使用本藥物。需定期監測。可能有嚴重不良反應。特別注意族群：老年人。
Neutropenia 🟡 Moderate
- 必要時應停止治療。
Schizophrenia 🟡 Moderate
- 注意事項：Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients…
Thyroid Diseases 🟡 Moderate
- 應謹慎使用本藥物。風險包括：心律不整。
尿滯留 🟡 Moderate
- 本藥物在此情況下禁用。
Anticholinergic Syndrome 🟢 Minor
- 需定期監測。風險包括：血壓控制不良。特別注意族群：老年人。
心血管疾病 🟢 Minor
- 應避免使用本藥物。需定期監測。風險包括：低血壓、心律不整、血栓。可能有致命風險。
Pheochromocytoma 🟢 Minor
- 注意事項：Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines…
Acute Myocardial Infarction Recovery 🟢 Minor
- 本藥物在此情況下禁用。
Depressive Disorder 🟢 Minor
- 需密切監測。特別注意族群：兒童。
癲癇 🟢 Minor
- 應謹慎使用本藥物。風險包括：癲癇發作。
結論與下一步
預測評估
| 評估項目 | 結果 |
|---|---|
| 機轉合理性 | 高 - 血清素/正腎上腺素再吸收抑制對焦慮症有明確療效 |
| 臨床證據 | 充足 - 多項 RCT 及 meta-analysis 支持 |
| 文獻支持 | 強 - 國際指引推薦 |
| 整體證據等級 | L1-L2 (多個 RCT/系統性回顧) |
臨床建議
- 已可臨床使用：Clomipramine 對焦慮相關疾患（特別是 OCD、恐慌症）的療效已獲確認
- 適應症考量：台灣核准適應症已涵蓋多種焦慮疾患，符合仿單適應症使用
- 處方注意事項：
- 起始劑量宜低，緩慢調升
- 監測心電圖，特別是有心臟病史者
- 注意年輕患者的自殺風險
- 避免突然停藥
結語
此預測驗證了 TxGNN 知識圖譜方法能準確識別藥物的已知治療潛力。Clomipramine 對焦慮症的療效已有堅實的證據基礎，屬於「再發現」而非「新發現」。
本筆記僅供研究參考，不構成醫療建議。任何用藥決策應諮詢專業醫療人員。
最後更新：2026-02-11
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引用本報告
如需引用本報告，請使用以下格式：
APA 格式：
TwTxGNN. (2026). Clomipramine老藥新用驗證報告. https://twtxgnn.yao.care/drugs/clomipramine/
BibTeX 格式：
@misc{twtxgnn_clomipramine,
title = {Clomipramine老藥新用驗證報告},
author = {TwTxGNN Team},
year = {2026},
url = {https://twtxgnn.yao.care/drugs/clomipramine/}
}
免責聲明
本報告僅供學術研究參考，不構成醫療建議。藥物使用請遵循醫師指示，切勿自行調整用藥。任何老藥新用決策需經過完整的臨床驗證與法規審查。
最後審核：2026-02-20 | 審核者：TwTxGNN Research Team
本報告僅供學術研究參考，不構成醫療建議。藥物使用請遵循醫師指示，切勿自行調整用藥。任何老藥新用決策需經過完整的臨床驗證與法規審查。
最後審核：2026-02-20 | 審核者：TwTxGNN Research Team
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