Risks/Side Effects

The clinically most common side effects from NAC include nausea, indigestion, headache and abdominal pain although it is generally well tolerated. Contraindications include current asthma and current pregnancy/lactation as the effects of NAC on fetal development have not been assessed.

Patients taking clomipramine should also be alerted to the increased risk of seizure associated with taking this medication. Other side effects associated with clomipramine include nausea, diarrhea, loss of appetite, dry mouth, increased anxiety, blurred vision, dizziness, constipation, trouble concentrating, insomnia, drowsiness, nightmares, increased sweating, decreased libido, impotence, and difficulties having an orgasm. Where available, plasma levels of clomipramine (and its metabolite desmethylclomipramine) should be recorded (draw levels 12 hours after last dose and after 7-14 days on the same dose). This can be useful to monitor for high levels that would predispose towards toxicity. Some studies suggest that plasma levels of 100-250ng/mL for clomipramine and 230-550ng/mL for the major metabolite are generally likely to be effective, but these recommendations stem from limited data.

The most commonly reported adverse events from antipsychotic medications include sedation, weight gain, elevated lipids/glucose, and constipation. Rarer but serious side effects of antipsychot- ics include extra-pyramidal side effects (including acute dystonic reactions), neuroleptic malignant syndrome (NMS), drug-induced Parkinsonism, dry mouth, blurred vision, elevated prolactin (which can lead to sexual dysfunction in men and women), urinary retention, and clinically significant EKG (ECG) changes.

All patients with Trichotillomania and co-occurring Major Depressive Disorder or symptoms of depression who are taking antidepressant medications should be alerted to the risk of clinical worsening of depressive symptoms and suicidal ideation which have been linked to the use of these medications. Parents or guardians of children who are prescribed antidepressants, regardless of depression history, should be alerted to this risk.

The most clinically significant side effects seen with cannabinoid antagonists such as dronabinol include nausea and psychomotor agitation and retardation. As such, extreme caution should be exercised in operating machinery and motor vehicles.

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