Abrocitinib and Clomipramine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clomipramine
Abrocitinib
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on. Clomipramine (Anafranil) is broken down in your body by a liver enzyme called CYP1A2. Abrocitinib (Cibinqo) can slow that enzyme down. When the enzyme is slowed, your body clears clomipramine more slowly, so the level can build up.
Higher clomipramine levels can mean stronger side effects like drowsiness, dry mouth, constipation, dizziness, or a faster heartbeat. This is based on how the drugs are expected to behave, not on lots of real-world reports, so it may not affect everyone. The good news: your care team can manage this easily by tailoring your dose and watching how you feel. Don't change anything on your own, just keep the conversation open with your pharmacist or doctor.
Mechanism: Abrocitinib inhibits CYP1A2, the primary enzyme metabolizing clomipramine (a tertiary amine TCA). Reduced clearance is expected to increase clomipramine exposure (AUC/Cmax).
- Direction: increased clomipramine effect and toxicity risk (anticholinergic, sedation, QT/conduction, seizure threshold).
- Evidence: theoretical; magnitude not quantified.
- Onset: unspecified.
- Management: lower clomipramine doses than usual may be needed; monitor clinical response, tolerability, and consider TDM. On discontinuation of abrocitinib, an increased clomipramine dose may be required to maintain effect.
What happens
Increased clomiPRAMINE exposure
Interaction Deep Dive
When clomiPRAMINE is taken together with inhibitors of CYP1A2, clomiPRAMINE exposure may rise, and doses lower than those typically prescribed for clomiPRAMINE or for the co-administered drug may be needed. In addition, if either agent is discontinued from the combined regimen, a higher dose of clomiPRAMINE may become necessary. Monitoring clomiPRAMINE exposure is advisable any time it is given alongside another agent recognized as a CYP1A2 inhibitor1.
Why it happens (mechanism)
Inhibition of CYP1A2-mediated metabolism of clomiPRAMINE
How to manage this interaction
Keep taking both medications as prescribed unless your prescriber tells you otherwise. Here is how a care team typically handles this combination:
- Your clomipramine dose may need to be adjusted and individualized by your care team, sometimes to a lower dose while you are on abrocitinib.
- Your team may monitor you more closely, including watching for side effects and possibly checking clomipramine levels.
- If abrocitinib is later stopped, your clomipramine dose may need to be increased again.
What to raise: tell your pharmacist or doctor if you notice increased drowsiness, dry mouth, constipation, dizziness, or a racing heartbeat.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abrocitinib and Clomipramine together?
Abrocitinib can raise clomipramine levels by slowing its breakdown, which may increase side effects; your care team can manage this by adjusting the clomipramine dose and monitoring you, so keep taking both as prescribed and report new symptoms. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abrocitinib and Clomipramine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abrocitinib and Clomipramine interaction managed?
Keep taking both medications as prescribed unless your prescriber tells you otherwise. Here is how a care team typically handles this combination: Your clomipramine dose may need to be adjusted and individualized by your care team, sometimes to a lower dose while you are on abrocitinib. Your team may monitor you more closely, including watching for side effects and possibly checking clomipramine l… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abrocitinib or Clomipramine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: ANAFRANIL(TM) oral capsules, clomipramine hydrochloride oral capsules. SpecGx LLC (per Dailymed), Webster Groves, MO, 2024. DailyMed
Keep reading about Clomipramine
Keep reading about Abrocitinib
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