Clomipramine

Generic Name: Clomipramine Hydrochloride

Brand Names: Clomicalm, Anafranil

Drug Class: TCA

Similar Class Drugs: Amitriptyline, Nortriptyline

Available Dosage Form: IV, oral capsule

What is Chlomipramine?

Clomipramine is primarily used to treat obsessive-compulsive disorder (OCD) in children aged 10 or more and other mental illnesses (depression, schizophrenia) with an OCD component.¹

It affects the activity of multiple neurotransmitters, although it has a potent affinity for serotonergic modulation due to its chemical nature. Action on muscarinic receptors in non-depressed individuals causes sedation and hypnosis. In depressed individuals, Clomipramine inhibits the reuptake of serotonin and norepinephrine to upregulate the mood-enhancing effects of these neurotransmitters. A meta-analysis established that Clomipramine had therapeutic efficacy superior to that of Fluoxetine, Sertraline, Fluvoxamine in the treatment of OCD.¹

Exposure Response Prevention (ERP) is a behavioral therapy aimed at improving OCD with behavioral exercises. Comparative studies evaluated the efficacy of Clomipramine alone and combination therapy with ERP. Groups exposed to combination therapy produced better treatment outcomes than those given treatment with Clomipramine alone.²

Non-FDA approved indications of Clomipramine:

– Depression

– Anxiety

– Trichotillomania

– Refractory depression

– Cataplexy

– Body dysmorphia

– Insomnia

– Neuropathic pain

– Nocturnal enuresis

How to use Clomipramine?

– Initial starting dosage for adults is 25mg

– Your doctor will start your treatment in a set of split dosages

– The highest approved dosage for children and adults is 250mg

– Dosages will be increased or decreased based on the stage of treatment

– Always take the capsules with food to avoid gastrointestinal upset

– If a single dose is prescribed, take it just before bedtime

What are the side effects of Clomipramine?

Following side effects are related to the action of Clomipramine on muscarinic receptors:

– Blurred vision

– Dry mouth

– Constipation

– Urinary retention

– Drowsiness

Adverse effects with Clomipramine:

– Teratogenic potential (category C drug)

– Cardiac arrhythmias

– Suicidal ideation

– Manic behavior

– Liver failure

– Hyperthermia

– Sexual impairment (mostly men)

Who should not use Clomipramine?

– Those with a history of hypersensitivity to TCAs

– Those taking MAOIs

– Myocardial infarction

– The medication has an increased risk of causing seizures

– Do not drive, lift heavy machinery, do tasks that involve vigilance

– Tell your doctor if you are pregnant or planning to become pregnant

– The drug has the risk of inducing suicidal behavior in patients, especially children

– Report your doctor if you see any signs of agitation, irritability, unexplained behavior.

References

1. Wilson M, Tripp J. Clomipramine. [Updated 2021 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541006/
2. Liebowitz MR, et al. Randomized, placebo-controlled trial of exposure and Ritual Prevention, Clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.1.151. Published January 1, 2005. Accessed August 3, 2021.