Clomipramine and Nalbuphine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clomipramine
Nalbuphine Injection
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
An increased risk of serotonin syndrome, an increased risk of CNS depression and an increased risk of paralytic ileus
Interaction Deep Dive
Exert caution with concomitant use of clomiPRAMINE with nalbuphine (CNS depressant) due to increased risk of additive CNS effects3. Concomitant use of nalbuphine, with serotonergic drugs, such as clomiPRAMINE may result in serotonin syndrome. Additionally, the concomitant use of nalbuphine with anticholinergic drugs, such as clomiPRAMINE may increase the risk of paralytic ileus. If concomitant use is necessary, observe the patient especially during treatment initiation and dose adjustment; discontinue nalbuphine if serotonin syndrome is suspected. Observe for signs of severe constipation, which can result in paralytic ileus 1.
Why it happens (mechanism)
Additive serotonergic effects; additive CNS depression; additive effects on gastric motility
Literature reports
1 report — tap to read
a) Serotonin syndrome symptoms such as neuromuscular abnormalities (including hyperreflexia, tremor, muscle rigidity, clonus, peripheral hypertonicity, and shivering), autonomic hyperactivity (including tachycardia, mydriasis, diaphoresis, the presence of bowel sounds, and diarrhea), and mental status changes (including agitation and delirium). Serotonin syndrome can be life-threatening. If serotonin syndrome develops, discontinue the offending agents and provide supportive care and other therapy as necessary 2.
Common questions
Can I take Clomipramine and Nalbuphine Injection together?
An increased risk of serotonin syndrome, an increased risk of CNS depression and an increased risk of paralytic ileus Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clomipramine and Nalbuphine Injection 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 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 Clomipramine or Nalbuphine Injection 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 (3)
- Product Information: NUBAIN(R) intramuscular, subcutaneous, intravenous injection, nalbuphine HCl intramuscular, subcutaneous, intravenous injection. Par Pharmaceutical (per FDA), Chestnut Ridge, NY, 2016.
- Boyer EW & Shannon M: The serotonin syndrome. N Eng J Med 2005; 352(11):1112-1120. PubMed
- 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 Nalbuphine Injection
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist