Meds and you

Updated 11 February 2013

Clomipramine

Clomipramine is an antidepressant prescribed for the treatment of depression and associated anxiety/panic disorders.

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Clomipramine is the active ingredient of Anafranil, Clomidep, Equinorm and Micro Clomipramine.

General information

Clomipramine is an antidepressant prescribed for the treatment of depression and associated anxiety/panic disorders. It is of particular use in patients with ongoing feelings of sadness, despair, worthlessness, hopelessness, fatigue, pessimism and difficulty dealing with normal daily life.

Clomipramine elevates mood, increase physical activity, improves appetite and restores interest in everyday activities.

It is also useful in treating obsessive compulsive disorder, a disorder in which individuals are plagued by persistent, recurring thoughts (obsessions) and associated ritualised behaviours intended to alleviate these thoughts and anxiety.

It may take several weeks for the full benefit of clomipramine to be achieved. During this period it is important to continue taking this medication.

Because of its effect on appetite, patients taking clomipramine may experience unwelcome weight gain.

The drug has significant sedative effects and may be useful in the treatment of insomnia.

How does it work?

Clomipramine has an effect on serotonin, noradrenaline and acethylcholine. These brain chemicals play an important role in mood, emotion, mental state and anxiety, and by elevating these brain chemicals, the conditions for which clomipramine is indicated, are greatly improved.

Fast facts

Drug schedule: Schedule 5

Available as : Tablets and injection

What does it do? Clomipramine is an antidepressant

Overdose risk: High

Dependence risk: Low

Available as a generic? Yes

Available on prescription only? Yes

User information

Onset of effect: Antidepressant effect is only evident after 3-6 weeks; to induce sedation, the drug is effective within a couple of hours.

Duration of action: As an antidepressant the effects may continue for as long as 6 weeks after discontinuing.

Dietary advice: Take with food to reduce gastrointestinal side effects.

Stopping this medicine: Stopping too soon may cause a recurrence of the original symptoms. Always consult your doctor before discontinuing.

Prolonged use: No problem is foreseen; tolerance to many side effects may occur over time.

Special precautions

Alert your doctor before using this drug if:

  • you have epilepsy
  • you have impaired liver or kidney function
  • you had a recent heart attack
  • you have a thyroid condition
  • you have an enlarged prostate or have difficulty passing urine
  • you have glaucoma
  • you are taking other medication

Pregnancy: Avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.

Breastfeeding: Avoid. It is unknown how this medication may affect your baby. Consult your doctor before use.

Porphyria: Avoid. This medication may cause serious adverse effects. Consult your doctor before use.

Infants and children: Safety and efficacy of this medication has not been established for children under the age of 18, and use in these patients is not recommended.

Elderly: Caution is advised in the elderly as side effects may be more severe.

Driving and hazardous work: Caution is advised as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how it affects you.

Alcohol: Avoid concomitant use as alcohol may potentiate sedative effects.

Possible side effects

Side effect

Frequency

Consult your doctor

Common

Rare

Only if severe

In all cases

Drowsiness, dizziness

x

x

Dry mouth

x

x

Headache

x

x

Nausea / vomiting

x

x

Sweating

x

x

Heartburn

x

x

Constipation

x

x

Difficulty urinating

x

x

Hallucinations

x

x

Fatigue

x

x

Blurred vision

x

x

Impaired concentration

x

x

Difficulty breathing

x

x

Seizures

x

x

Palpitations

x

x

Fever/ sore throat

x

x

Interactions

Drug interactions

Warfarin

Blood clotting time may be affected

Antihistamines

Increased risk of heart rhythm disturbance

Barbiturates

Reduced clomipramine efficacy

Benzodiazepines

Possible increase in sedative effects

Cimetidine

Possible clomipramine toxicity

Fluoxetine

Increased risk of serotonin toxicity

Fluvoxamine

Increased risk of clomipramine toxicity

Monoamine oxidase-inhibitors

Serious interactions may occur. Wait at least after stopping MAOI before starting clomipramine

Nitrates

Possible reduced effect on sublingual (under tongue) nitrates

Oral contraceptives

Increased risk of clomipramine toxicity

Rifampicin

Reduced clomipramine effect

Sertraline

Increased risk of serotonin toxicity

Tobacco

Possible reduced effect of clomipramine

Disease interactions

Consult your doctor before using this drug if you have epilepsy, glaucoma, abnormal heart rhythms, impaired liver or kidney function, had a recent heart attack, have a thyroid condition, or if you have an enlarged prostate.

Overdose action

A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage

Adults: 50-150 mg daily given as either a single dose at night, or as 2-3 divided doses.

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.

 

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