Clomipramine

Brand names

• Anafranil
• Apo-Clomipramine
• Dom-Clomipramine
• Gen-Clomipramine
• Maronil
• Med-Clomipramine
• Novo-Clopamine
• Penta-Clomipramine

Usage

To treat obsessive-compulsive disorder and depression.

How it works

Clomipramine affects levels of a specific brain chemical (serotonin) that is thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Confusion, sexual dysfunction, heartbeat irregularities, hallucinations, seizures, extreme fatigue or drowsiness, vision problems, breathing difficulty, staring and absence of facial expression, impaired concentration, difficult urination, fever, extreme and persistent restlessness, loss of coordination and balance, difficulty swallowing or speaking, dilated pupils, eye pain, fainting. Also trembling, weakness, and stiffness in the extremities, shuffling gait. Seek medical help as soon as possible.

Common

Drowsiness or dizziness, headache, dry mouth or unpleasant taste, fatigue, heightened sensitivity to light, weight gain, nausea, increased appetite, constipation.

Less common

Heartburn, insomnia, diarrhea, sweating, vomiting.

Possible interactions

Other medicaments:

Clomipramine may increase the effects of:

• all medicaments with atropinelike effects.
• all sedating medicaments. Watch for excessive sedation.

Clomipramine may decrease the effects of:



• clonidine (Catapres).
• guanadrel (Hylorel).
• guanethidine (Ismelin, Esimil).

Clomipramine taken concurrently with:



• anticonvulsants such as carbamazepine (Tegretol) requires careful monitoring for changes in seizure patterns and the need to adjust anticonvulsant dosage.
• bepridil (Vascor) may lead to dangerous heart rhythms.
• cisapride (Propulsid) may lead to dangerous heart rhythms.
• dofetilide (Tikosyn) may lead to dangerous heart rhythms. Do not combine.
• gatifloxacin (Tequin, grepafloxacin (Raxar), moxifloxacin (Avelox) or sparfloxacin (Zagam) may lead to dangerous heart rhythms. Combination is not recommended.
• monoamine oxidase (MAO) type A inhibitor medicaments may cause high fever, seizures and hypertension. Avoid combining these medicaments - 14 days should separate doses of either.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) may lead to phenytoin or fosphenytoin toxicity.
• stimulant medicaments (amphetamine, cocaine, epinephrine, phenylpropanolamine, etc.) may cause severe high blood pressure and/or high fever.
• thyroid preparations may increase risk of heart rhythm disorders.
• tramadol (Ultram) may increase seizure risk.
• venlafaxine (Effexor) may lead to venlafaxine and clomipramine toxicity.
• warfarin (Coumadin) may cause an increased warfarin effect and bleeding. More frequent INR (prothrombin time) testing is needed.

The following medicaments may increase the effects of clomipramine:



• ACE inhibitors.
• birth control pills (oral contraceptives).
• cimetidine (Tagamet).
• enalapril (Vasotec, Vaseretic).
• estrogens (various).
• fluoxetine (Prozac).
• fluvoxamine (Luvox).
• haloperidol (Haldol).
• methylphenidate (Ritalin).
• paroxetine (Paxil).
• phenothiazines.
• propafenone (Rythmol).
• quinidine (Quinaglute).
• ranitidine (Zantac).
• ritonavir (Norvir) and perhaps other protease inhibitors.
• sertraline (Zoloft).
• verapamil (Calan, others).

The following medicaments may decrease the effects of clomipramine:



• barbiturates.
• carbamazepine (Tegretol).
• chloral hydrate (Noctec, Somnos, etc.).
• lithium (Lithobid, Lithotab, etc.).
• reserpine (Serpasil, Ser-Ap-Es, etc.).

Herbal medicines or minerals:

Since clomipramine and St. John's wort may act to increase serotonin, the combination is not advised. St. John's wort also increases sun sensitivity. Since part of the way ginseng works may be as a MAO inhibitor, do not combine with this medicine. Ma huang and yohimbe are best avoided while taking clomipramine. Indian snakeroot, kava kava and yohimbe are also best avoided while taking this medicine.

Alcohol:

Avoid completely. This medicament can markedly increase the intoxicating effects of alcohol; the combination can depress brain function significantly.

Tobacco smoking:

May delay the elimination of this medicament and require dosage adjustment.

Marijuana smoking:

Increased drowsiness and mouth dryness; reduced effectiveness.

Exposure to heat:

This medicament may impair the body's adaptation to hot environments, increasing the risk of heatstroke. Avoid saunas.

Exposure to environmental chemicals:

This medicament may mask the symptoms of poisoning due to handling certain insecticides (organophosphorous types).

Discontinuation:

It is best to slowly reduce the dose over 3 to 4 weeks. Abrupt withdrawal after prolonged use may cause nausea, vomiting, diarrhea, headache, dizziness, malaise, disturbed sleep and irritability. Obsessive-compulsive behavior may worsen if medicament is stopped. Other medicament doses may need to be changed to adjust.