clomipramine (Anafranil)

Clomipramine (Anafranil) is a psychotropic agent used to treat obsessive-compulsive disorder (OCD). Clomipramine shares structural similarities with a class of antidepressants known as tricyclic antidepressants (TCAs).

The exact mechanism by which clomipramine exerts its therapeutic benefits is not fully understood. However, similar to other TCAs, clomipramine is thought to enhance the actions of norepinephrine and serotonin (chemical neurotransmitters in the brain that nerves use to communicate with one another) by blocking their reuptake and prolonging their activity. Clomipramine also has anticholinergic properties which means it blocks the action of another neurotransmitter, acetylcholine. This increases the risk for certain side effects. It also has weak antihistamine properties which appear to play a role in the mild sedative effects observed with use. Clomipramine was approved by the US FDA for the treatment of OCD in 1991.

What brand names are available for clomipramine?

Anafranil

Is clomipramine available as a generic drug?

Yes

Do I need a prescription for clomipramine?

Yes

The most common side effects associated with the use of clomipramine include:

• upset stomach,
• dry mouth,
• constipation,
• nausea,
• heartburn,
• anorexia,
• tremor,
• dizziness,
• tiredness,
• nervousness,
• sexual dysfunction,
• weight gain,
• low blood pressure,
• sweating,
• respiratory problems, and
• visual changes.

Less common but serious side effects include:

• hypersensitivity type reactions,
• suicidal ideation,
• serotonin syndrome, and
• others.

: Treatment with clomipramine should be started at the lowest recommended dose and increased slowly based on patient response to minimize the risk for side effects. Clomipramine tablets are better tolerated when administered with meals.

Patients starting treatment with clomipramine should consult with their doctor or pharmacist to find out if any of their current medications or supplements have any drug interactions with clomipramine. Also, patients receiving treatment with clomipramine should always consult with their doctor before starting treatment with any new medications.

Clomipramine generally is not recommended to be used with other tricyclic antidepressants or related cyclic antidepressants. Co-administration with medications that share similar properties increases the risk for side effects. Examples of similar antidepressants are amoxapine, imipramine (Tofranil), and desipramine (Norpramin).

Clomipramine shares pharmacological properties with Class IA and Class III antiarrhythmic medications. Co-administration increases the risk for QT prolongation and life-threatening arrhythmias. For this reason, use of clomipramine should be avoided with bretylium, dofetilide (Tikosyn), dronedarone (Multaq), flecainide (Tambocor), sotalol (Betapace), quinidine (Quinidex), procainamide (Pronestyl), propafenone (Rythmol), ranolazine (Ranexa), ibutilide (Corvert), and others.

Clomipramine should be avoided when possible or used cautiously with medications known to prolong the QTc interval. Examples of such medication are thioridazine (Mellaril), ziprasidone (Geodon), pimozide (Orap), and others.

Clomipramine increases the levels of serotonin in the brain. Co-administration with other medications that also increase serotonin levels increases the risk of serotonin syndrome. Symptoms of serotonin syndrome include rapid development of hyperthermia (high body temperature), high blood pressure, muscle rigidity, confusion, and delirium. Some medications that increase serotonin levels are monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and linezolid (Zyvox). For a complete list, please ask your doctor or pharmacist.

Clomipramine has not been adequately evaluated in pregnant women. Due to the lack of conclusive safety data, clomipramine should be used in pregnancy only if the benefit justifies the potential risk to the fetus. Clomipramine is classified as FDA pregnancy risk category C.

Clomipramine is excreted into breast milk. Due to the lack of safety data, clomipramine is not recommended for use in females who are breastfeeding.

What preparations of clomipramine are available?

Oral tablets: 25, 50, and 75 mg.

How should I keep clomipramine stored?

Tablets should be stored at room temperature, between 15 C to 30 C (59 F to 86 F). As with all medications, clomipramine tablets should be kept out of the reach of children and pets.