Clomipramine is considered highly effective for OCD. What limits its first-line use compared to SSRIs?
- A Risk of QT prolongation and anticholinergic side effects ✓
- B Lower efficacy in severe OCD
- C Need for therapeutic drug monitoring
- D High risk of serotonin syndrome when used alone
Correct answer: A. Risk of QT prolongation and anticholinergic side effects
Explanation
Clomipramine carries cardiac risks including QT prolongation and has significant anticholinergic, antihistaminic, and alpha-blocking side effects, making SSRIs better tolerated first-line agents. Clomipramine has comparable or superior efficacy to SSRIs in some studies. Therapeutic drug monitoring is not routinely required. Serotonin syndrome risk is not unique to clomipramine.
Reference: Stahl's Essential Psychopharmacology, 5th ed.
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