Clomipramine

Antidepressant · Tricyclic antidepressant (TCAD)

Indications

Depression, obsessional and phobic states. Cataplexy accompanying narcolepsy. Panic attacks, phobia, chronic painful conditions, nocturnal enuresis.

Dosage

Adults: 10 mg increasing gradually to 30-150 mg daily in divided doses or as a single dose at night. Elderly: Initially 10 mg daily; max 75 mg daily. Children: > 10 yr: Initial: 25 mg/day. Increase to 3 mg/kg/day or 100 mg/day within 1st 2 wk. Titrate: Increase over several wk. Max: 3 mg/kg/day or 200 mg/day. May be given every night.

Adverse Effects

Anticholinergic effects (e.g. dry mouth, blurred vision), drowsiness, fatigue, neurological effects, GI upset, weight gain, disturbances of libido and potency, hot flushes, psychiatric effects, postural hypotension, tachycardia, ECG changes, allergic skin reactions, taste disturbance, tinnitus. Rarely, glaucoma, SIADH, hepatitis, blood dyscrasias, conduction disorders.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Recent MI, heart block, arrhythmias, mania, severe hepatic impairments, glaucoma, urinary retention. Porphyria. Precautions: Epilepsy, pheochromocytoma, concomitant ECT, hyperthyroidism, history of increased intraocular pressure, glaucoma or urinary retention, chronic constipation, psychosis. Monitor BP before initiating therapy and blood cell counts periodically. Monitor cardiac and hepatic function. Risk of QT interval prolongation. Monitor for suicidal ideation. Contact lenses. Anaesthesia. Elderly. Withdraw gradually.

Interactions

With or within 3 weeks of MAOIs, other antidepressants, CNS depressants, antipsychotics, anticoagulants, anticholinergics, antihypertensives, sympathomimetics, drugs prolonging QT interval (e.g. antiarrhythmics), anticonvulsants, diuretics.

Advice to Patient

Take with meals. Take single daily dose at bedtime. Take missed dose as soon as you remember unless it is almost time for the next scheduled dose. Do not take double dose. Contact prescriber if you experience hallucinations, confusion, abnormal thoughts or behaviour, unrelieved constipation, stomach upset, palpitations, unusual muscle weakness, change in gait, lack of sleep, difficulty in urination, dry mouth. Avoid alcohol and caffeine intake during therapy. Change position slowly from sitting or lying to standing. Avoid direct sunlight. Use sunscreen, wear proper clothing and eyewear to prevent photosensitivity.

Pharmacokinetics

Onset of action: 1 to 2 weeks; maximum effect: 8 to 12 weeks. Duration of action: 1 to 2 days. Absorption: Rapid. Metabolism: Hepatic to desmethylclomipramine (DMI; active). Half-life elimination: Adults (following a 150 mg dose): Clomipramine 19 to 37 hours (mean:32 hours); DMI: 54 to 77 hours (mean: 69 hours). Time to peak, plasma: 2 to 6 hours. Excretion: Urine (50% to 60%; 0.8% to 1.3% as parent drug and active metabolite combined amount); feces (24% to 32%).

Brands with this active ingredient

• Anafril
• Clomfranil
• Clomipril
• Clomixet
• Clopra
• Cloril
• Depramine

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.