Clomipramine (oral)

Primarily used to treat obsessive-compulsive disorder, Clomipramine can also be prescribed to patients who have been diagnosed with depression.

Overview

Classified as a tricyclic antidepressant, Clomipramine can be given to patients who are diagnosed with major depressive disorder, chronic pain and/or panic disorder. It is most commonly used to treat patients who have been diagnosed with obsessive compulsive disorder (OCD).

As a serotonin-norepinephrine reuptake inhibitor, or SNRI, Clomipramine works by preventing serotonin and norepinephrine from reverting from neurotransmitters back to neurons. In doing so, neurotransmissions of norepinephrine and serotine are increased.

It is believed that norepinephrine is associated with energy, alertness, and interest in life, while a low level of serotonin is linked to anxiety, compulsions, and obsessions. By increasing neurotransmissions of norepinephrine and serotonin, Clomipramine helps to reduce feelings of anxiety and limits the strength of compulsions and obsessions, as well as boosting the patient's mood, energy, and motivation.

As an SNRI, Clomipramine is particularly useful in the treatment of obsessive-compulsive disorder. While selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression and anxiety, these types of medications don't have a direct impact on norepinephrine. By using an SNRI, such as Clomipramine, physicians can help to alleviate more of the patient's symptoms.

As Clomipramine also has an analgesic effect, it can be used to treat patients with chronic pain. Although it is not normally a first-line treatment for pain management, it can be particularly effective in treating neuropathic pain. As many other pain-relieving medications are ineffective at resolving this type of pain, Clomipramine may be prescribed to patients who are unable to obtain pain relief from other medications.

If patients have previously been prescribed SSRIs for a mental health condition but their symptoms have continued, treatment with an SNRI, such as Clomipramine, may be more effective. By increasing norepinephrine, as well as Serotonin, Clomipramine helps to reduce anxiety further and increases the patient's ability to focus. As anxiety, confusion, and distraction can cause or exacerbate compulsive behaviors, Clomipramine can provide relief from the symptoms of OCD.

Treating any type of panic disorder, depressive disorder or anxiety disorder can be complex. Obsessive compulsive disorder itself is categorized into various different types and patients can experience vastly different symptoms. Although medications, such as Clomipramine, can be effective in reducing the anxiety and stress associated with OCD, they can be even more effective if they are used in conjunction with other forms of treatment, such as cognitive behavioral therapy.

With large numbers of people suffering from mental health conditions, such as generalized anxiety, OCD or depression, it's vital that physicians are able to prescribe appropriate medications. For patients dealing with compulsive thoughts and behaviors, Clomipramine can be a safe and suitable treatment.

By enabling the patient to resist compulsive behaviors and rituals, Clomipramine can have a considerable effect on their emotional and physical health. Once patients are able to free themselves from ritualistic behaviors and obsessive thoughts by using Clomipramine, they often find that their anxiety diminishes. While this can lead to an improvement in mood, the increase in serotonin and norepinephrine also has a direct impact on the patient's outlook and motivation.

Conditions Treated:

  • Major Depressive Disorder
  • Obsessive Compulsive Disorder
  • Panic Disorder
  • Anxiety Disorder
  • Chronic Pain
  • Body Dysmorphic Disorder
  • Depersonalization Disorder
  • Premature Ejaculation
  • Trichotillomania
  • Sleep Paralysis
  • Enuresis
  • Cataplexy

Type of Medicine:

  • Tricyclic Antidepressant
  • Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)

Side Effects:

Although effective in treating OCD and similar disorders, tricyclic antidepressants are associated with a number of side-effects. When taking Clomipramine, patients may notice the following side-effects:

  • Sour or acid stomach
  • Changes in taste
  • Crusting, irritation, blistering, reddening or itching of the skin
  • Constipation
  • Dry, scaly or cracked skin
  • Change in interest in sexual intercourse
  • Heartburn
  • Diarrhea
  • Welts or hives
  • Dry skin
  • Inability to become aroused or keep an erection
  • Rash on the skin
  • Increased interest in sexual intercourse
  • Pimples
  • Joint pain
  • Redness of the neck, arms, face and upper chest
  • Shakiness in the arms, legs, feet or hands
  • Swelling
  • Stomach pain, upset and/or discomfort
  • Swollen joints
  • Shaking or trembling of the feet or hands
  • Irregular, missed and/or absent menstrual periods
  • White spots, sores or ulcers in the mouth or on the lips or tongue
  • Breast pain

Unless these side-effects are particularly serious, patients may not need to seek medical assistance. In most cases, side-effects will diminish as patient's get used to the medication.

In some cases, however, patients may experience side-effects which do require medical attention. If patients experience any of the following when taking Clomipramine, they should seek medical advice:

  • Difficulty in controlling anger
  • Increase in breast size
  • Burning while urinating
  • Chills
  • Changes to vision
  • Decreased urination
  • Difficulty urinating (dribbling)
  • Difficulty speaking
  • Irregular, fast, racing and/or pounding pulse or heartbeat
  • Dry mouth
  • Headache
  • Irritability
  • Hyperventilation
  • Vomiting or nausea
  • Weakness, numbness or tingling in the feet or hands
  • Panic attacks
  • Pain or discomfort during sexual intercourse
  • Paranoia
  • Change in moods
  • Restlessness
  • Swelling of the fingers, lower legs, feet and/or face
  • Shaking
  • Bladder pain
  • Cloudy or bloody urine
  • Blurry vision
  • Pain or body aches
  • Crawling, burning, itching, tingling or feelings of "pins and needles"
  • Confusion
  • Faintness, dizziness or lightheadedness when getting up from a sitting or lying position
  • Increase in muscle tone
  • Nervousness or fear
  • Feeling empty or sad
  • Changes to hearing
  • Fever
  • Pain in side or lower back
  • Rhythmic movement of muscles
  • Tightness, tension or stiffness of the muscles
  • Poor concentration
  • Sneezing
  • Shortness of breath
  • Wheezing and/or chest tightness
  • Weakness or tiredness
  • Changes to voice

Although the presence of side-effects does not automatically mean that Clomipramine is an unsuitable treatment, the above adverse effects should be investigated by a medical professional.

If patients experience any side-effects which are not listed, they should contact their doctor or physician. In addition to this, patients can report additional side-effects to the Food and Drug Administration by calling 1-800-FDA-1088.

Dosage:

When patients are first prescribed Clomipramine, they are normally given a relatively low starting dose. Depending on how they respond to this initial dose, their physician may increase the amount of medication the patient takes over time.

Typically, a starting dose of 25mg per day is given to adults when they are first prescribed Clomipramine. If required, this dose will be increased up to a maximum of 250mg per day. In most cases, patients on higher doses will be advised to take two or more doses of medication throughout the day.

If younger patients or teenagers are prescribed Clomipramine, they are usually given a starting dose of 25mg per day as well. If the dose needs to be increased, they may be prescribed Clomipramine up to a maximum of 200mg per day.

Patients over the age of 10 can be prescribed Clomipramine if their physician feels it is appropriate. As studies have yet to be carried out on the effects of Clomipramine on children under the age of 10, it is not normally prescribed to patients in this age range. However, if doctors feel that the benefits of taking Clomipramine outweigh the risks, they may prescribe a relatively low dose of medication for patients who are under the age of ten years old.

When taking Clomipramine, most patients are advised to take their medication with food. This can help to reduce the incidence of side-effects, particularly those which are stomach-related.

Although a starting dose of 25mg per day is a standard treatment regimen, patients will be given individual instructions by their physician. When taking Clomipramine, patients should always follow their doctor's advice.

If patients miss a dose Clomipramine, they should take the medication as soon as they are able to do so. If the next dose is due soon, however, they will need to skip the missed dose and continue with their normal dosing schedule. Patients should not take a double dose of Clomipramine.

If patients are unsure how to take their medication or are unsure how to proceed after missing a dose of Clomipramine, they should seek advice from their physician or pharmacist.

Potential Drug Interactions:

If patients are taking prescription medication for any other conditions, the use of Clomipramine may not be appropriate. When more than one medicine is used, there is a risk that they can interact with each other. In some cases, this could cause potentially harmful effects. If patients are taking the following medications, they will not usually be prescribed Clomipramine as well:

  • Amifampridine
  • Ziprasidone
  • Bepridil
  • Safinamide
  • Bromopride
  • Isocarboxazid
  • Cisapride
  • Methylene Blue
  • Dronedarone
  • Thioridazine
  • Furazolidone
  • Piperaquine
  • Grepafloxacin
  • Ranolazine
  • Iproniazid
  • Procarbazine
  • Linezolid
  • Mesoridazine
  • Sparfloxacin
  • Metoclopramide
  • Terfenadine
  • Moclobemide
  • Rasagiline
  • Pargyline
  • Selegiline
  • Phenelzine
  • Toloxatone
  • Pimozide
  • Tranylcypromine

Although Clomipramine is not usually prescribed with the following medications, doctors may feel that prescribing Clomipramine is justified in some situations. Modifying the patient's dose or providing specific instructions regarding when the medications should be taken may help to reduce the risk of drug interactions occurring. These medications include:

  • Aceclofenac
  • Choline Salicylate
  • Acemetacin
  • Bromfenac
  • Albuterol
  • Chlorpromazine
  • Alfuzosin
  • Celecoxib
  • Almotriptan
  • Chloroquine
  • Amiodarone
  • Clarithromycin
  • Amisulpride
  • Clonidine
  • Amitriptyline
  • Citalopram
  • Amoxapine
  • Ciprofloxacin
  • Amtolmetin Guacil
  • Buprenorphine
  • Anagrelide
  • Bupropion
  • Apomorphine
  • Bufexamac
  • Aripiprazole
  • Buserelin
  • Arsenic Trioxide
  • Bromocriptine
  • Artemether
  • Cyclobenzaprine
  • Asenapine
  • Darunavir
  • Aspirin
  • Clonixin
  • Astemizole
  • Crizotinib
  • Atazanavir
  • Dextromethorphan
  • Azithromycin
  • Dexketoprofen
  • Dabrafenib
  • Droxicam
  • Dasatinib
  • Dexibuprofen
  • Degarelix
  • Domperidone
  • Delamanid
  • Donepezil
  • Desipramine
  • Droperidol
  • Deslorelin
  • Dofetilide
  • Desvenlafaxine
  • Dolasetron
  • Diclofenac
  • Disopyramide
  • Fingolimod
  • Diflunisal
  • Flufenamic Acid
  • Dipyrone
  • Iloperidone
  • Efavirenz
  • Etoricoxib
  • Epinephrine
  • Fenoprofen
  • Erythromycin
  • Gonadorelin
  • Escitalopram
  • Hydroxychloroquine
  • Eslicarbazepine Acetate
  • Hydroxytryptophan
  • Etilefrine
  • Frovatriptan
  • Floctafenine
  • Etodolac
  • Felbinac
  • Etofenamate
  • Fepradinol
  • Histrelin
  • Flecainide
  • Ibuprofen
  • Fluconazole
  • Gatifloxacin
  • Fluoxetine
  • Haloperidol
  • Flurbiprofen
  • Gemifloxacin
  • Halofantrine
  • Goserelin
  • Ibutilide
  • Granisetron
  • Hydroxyzine
  • Imipramine
  • Loxoprofen
  • Indomethacin
  • Levomilnacipran
  • Iobenguane I 123
  • Leuprolide
  • Ketoprofen
  • Ivabradine
  • Ketoconazole
  • Ketorolac
  • Levofloxacin
  • Lapatinib
  • Lornoxicam
  • Levalbuterol
  • Lumefantrine
  • Levothyroxine
  • Lopinavir
  • Meclofenamate
  • Lorcaserin
  • Midodrine
  • Lumiracoxib
  • Mefenamic Acid
  • Niflumic Acid
  • Mefloquine
  • Norepinephrine
  • Meloxicam
  • Nabumetone
  • Meperidine
  • Nepafenac
  • Methadone
  • Nilotinib
  • Methoxamine
  • Nimesulide
  • Metronidazole
  • Naproxen
  • Mifepristone
  • Naratriptan
  • Mirtazapine
  • Norfloxacin
  • Moricizine
  • Ofloxacin
  • Morniflumate
  • Octreotide
  • Moxifloxacin
  • Nafarelin
  • Oxymetazoline
  • Nefopam
  • Parecoxib
  • Nimesulide Beta Cyclodextrin
  • Panobinostat
  • Nortriptyline
  • Paliperidone
  • Olanzapine
  • Paroxetine
  • Ondansetron
  • Pasireotide
  • Palonosetron
  • Oxaprozin
  • Oxymorphone
  • Pranoprofen
  • Oxilofrine
  • Procainamide
  • Oxycodone
  • Salicylic Acid
  • Oxyphenbutazone
  • Pazopanib
  • Salsalate
  • Peginterferon Alfa-2b
  • Quinidine
  • Perflutren Lipid Microsphere
  • Rofecoxib
  • Phenylbutazone
  • Phenylephrine
  • Sumatriptan
  • Piketoprofen
  • Solifenacin
  • Pimavanserin
  • Saquinavir
  • Piroxicam
  • Sertraline
  • Pitolisant
  • Sorafenib
  • Pixantrone
  • Sulindac
  • Posaconazole
  • Sotalol
  • Prochlorperazine
  • Sulpiride
  • Proglumetacin
  • Quinine
  • Promethazine
  • Sevoflurane
  • Propafenone
  • Quetiapine
  • Propyphenazone
  • Sodium Salicylate
  • Proquazone
  • Tiaprofenic Acid
  • Protriptyline
  • Telithromycin
  • Sodium Phosphate
  • Tenoxicam
  • Sodium Phosphate, Dibasic
  • Tetrabenazine
  • Sodium Phosphate, Monobasic
  • Telavancin
  • Sunitinib
  • Tacrolimus
  • Venlafaxine
  • Tapentadol
  • Vasopressin
  • Tiotropium
  • Valdecoxib
  • Tolfenamic Acid
  • Vardenafil
  • Tolmetin
  • Vemurafenib
  • Toremifene
  • Vandetanib
  • Tramadol
  • Vortioxetine
  • Trazodone
  • Voriconazole
  • Trifluoperazine
  • Vilanterol
  • Trimipramine
  • Vinflunine
  • Triptorelin
  • Vilazodone
  • Zuclopenthixol

If patients are given Clomipramine alongside the following medication or substances, they may notice an increase in the amount of side-effects they experience. Often, physicians will provide additional medication to help relieve any unpleasant side-effects which occur. If side-effects are particularly severe or troublesome, physicians may alter the patient's treatment plan. These medications include:

  • Acenocoumarol
  • Yohimbine
  • Arbutamine
  • Valproic Acid
  • AtomS-Adenosylmethionine
  • Cannabis
  • Phenprocoumon
  • Dicumarol
  • Enalaprilat
  • Modafinil
  • Fluvoxamine
  • Enalapril Maleate

When considering the possibility of drug interactions occurring, it's important to remember that Clomipramine can interact with more than just prescription medications. Clomipramine may also interact with over-the-counter medicines, supplements and/or vitamins. In addition to this, Clomipramine may interact with tobacco and some food items, such as grapefruit.

Patients should inform their physician if they regularly purchase medications, vitamins or supplements and tell their doctor if they smoke cigarettes or use recreational drugs. Similarly, patients should seek medical advice before they take over-the-counter medicines, supplements and/or vitamins whilst also taking Clomipramine.

Warnings:

Patients should not suddenly stop taking Clomipramine unless their physician advises them to do so. Stopping this medication suddenly can cause unpleasant withdrawal symptoms. In most cases, doctors will instruct the patient to lower their dose gradually if treatment is to be discontinued.

Patients should not consume grapefruits, grapefruit juice or any grapefruit derivatives when taking Clomipramine or other SNRIs.

If patients have experienced any of the following medical conditions, treatment with Clomipramine may not be suitable for them:

  • Recent heart attack
  • Overactive thyroid (Hyperthyroidism)
  • Difficulty urinating (Urinary Retention)
  • Mood or behavior changes
  • Seizures
  • Schizophrenia
  • Bipolar Disorder
  • Psychosis
  • Glaucoma
  • Hypomania or mania
  • Liver Disease
  • Kidney Disease
  • Tumors of the adrenal glands (Pheochromocytoma, Neuroblastoma etc.)
  • Depression

Before taking Clomipramine, patients should discuss their medical history with their doctor. Although the conditions listed above may not prevent Clomipramine from being prescribed, patients may require additional monitoring if they have experienced these conditions. By informing their physician of any existing conditions they have, patients can ensure that they receive the most suitable treatment for their current health problems.

If Clomipramine is prescribed to patients who are pregnant, it may put the unborn fetus at risk. Babies born to mothers who were taking Clomipramine throughout their pregnancy have shown signs of colic, irritability, hypotension, lethargy, hypertension, spasms, tremors and dyspnea.

Due to this, Clomipramine is not recommended for patients who are pregnant. In addition to this, women of childbearing age are often advised to take birth control measures when taking Clomipramine.

If patients become pregnant whilst using Clomipramine, they should contact their physician for medical advice as quickly as possible.

Generally, it is not considered safe for patients to breastfeed if they are taking Clomipramine. As the medication can be passed to an infant via breastmilk, patients should be given an alternative medication or stop breastfeed whilst they are taking Clomipramine. It is important to remember, however, that Clomipramine may stay in the patient's body for some time after the last dose has been taken. Patients should discuss breastfeeding and/or discontinuing treatment with their doctor before making any decisions regarding their use of Clomipramine.

If patients find that Clomipramine makes them drowsy or sleepy, they should not drive, operate heavy machinery or carry out tasks which require close attention. Similarly, if the medication affects their mood, behavior and/or impulse control, they should not be in charge of a vehicle or machinery.

Clomipramine can be prescribed to older patients and is often effective in treating them for the relevant disorders. However, geriatric patients may also suffer from age-related conditions which can make it difficult for their bodies to metabolize the drug. Due to this, geriatric patients may be given a relatively low starting dose of Clomipramine.

When taking Clomipramine, patients should have regular consultations with their physician. This will enable their doctor to monitor their symptoms, adjust their dose of Clomipramine and note any adverse effects which may be occurring.

In some patients, treatment with Clomipramine can increase the risk of suicidal thoughts and suicidal ideation. This can be particularly applicable to young adults, teenagers, and children who are treated with Clomipramine.

If patients feel more depressed when taking Clomipramine or if they have thoughts of harming themselves or others, they should seek medical help immediately. Their next-of-kin or caregiver should also make a note of any mood or behavioral changes and seek medical help on behalf of the patient if they feel it is necessary to do so.

If the patient has difficulty sleeping, exhibits sudden bursts of energy, gets upset easily, acts in a reckless manner or suddenly becomes nervous, violent, scared, anxious or aggressive, these changes should be reported to their doctor straight away.

If patients consume alcohol or take additional central nervous system depressants, Clomipramine will add to the effect of these substances. Central nervous system depressants can include medications for colds and flu, antihistamines, tranquilizers, relaxants, seizure medications and/or anesthetics.

Before undergoing any type of medical procedure, including dental treatment, patients should inform the relevant medical practitioners that they are taking Clomipramine. As the medication could interact with the treatment given, it's vital that the relevant healthcare professionals are aware that the patient is taking Clomipramine.

When taking Clomipramine, patients may experience weight changes. Although this is not an uncommon side-effect of the drug, patients should discuss this with their doctor if it is of particular concern.

Patients may also experience sexual dysfunction whilst taking Clomipramine. If applicable, patients should seek medical advice from their physician. Often, a change in dose or additional medication can be used to help minimize this type of side-effect.

Storage:

When patients are prescribed Clomipramine, they usually need to take the medication on a daily basis. Due to this, they will need to keep their medication at home. When keeping medicines in the home, it's vital that they are kept somewhere secure.

If children and/or pets are present in the home, for example, they should not be able to access any type of medication.

Usually, patients will need to store Clomipramine at room temperature. In addition to this, the medication should be kept out of direct sunlight and away from moisture and heat.

Once patients are advised to stop taking Clomipramine, they will need to dispose of the medication. Similarly, if medication becomes out-of-date, patients should dispose of it. When disposing of medication, patients should seek help from their pharmacist or physician's office so that Clomipramine can be disposed of safely and without presenting a risk to others.

Summary

Although Clomipramine can be used to treat a wide variety of conditions, it has been shown to be particularly effective in treating obsessive compulsive disorder. By enabling patients to reduce the number of obsessive thoughts they have and compulsions they carry out, Clomipramine can make a significant difference to the lives of patients.

As OCD and similar disorders can have a devastating effect on patients, it's vital that they have access to suitable treatments. Often prescribed in conjunction with other therapies, Clomipramine can reduce the symptoms of OCD, major depressive disorders, and anxiety significantly and can enable patients to manage their condition effectively.