Clomipramine and Enalapril: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clomipramine
Enalapril
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.
What happens
ClomiPRAMINE toxicity (confusion, insomnia, irritability)
Interaction Deep Dive
The addition of clomiPRAMINE to long-standing enalapril therapy resulted in high blood levels of clomiPRAMINE and signs of toxicity (confusion, insomnia, irritability, and mood changes) in 2 cases. Reduction of the clomiPRAMINE dose resulted in lower blood levels1.
Why it happens (mechanism)
Unknown
Common questions
Can I take Clomipramine and Enalapril together?
ClomiPRAMINE toxicity (confusion, insomnia, irritability) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clomipramine and Enalapril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Clomipramine or Enalapril 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 anything you'd monitor while I'm on both?
References (1)
- Toutoungi M: Potential effect of enalapril on clomipramine metabolism. Human Psycopharmacol Clin Exper 1992; 7:347-349. DOI
Keep reading about Clomipramine
Keep reading about Enalapril
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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