BMA Concise Guide to Medicine & Drugs

Clomipramine

Brand names Anafranil, Anafranil SR

Used in the following combined preparations None

QUICK REFERENCE

Drug group Tricyclic antidepressant drug

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Clomipramine belongs to the class of antidepressant drugs known as the tricyclics. It is used mainly in the long-term treatment of depression.

Clomipramine is particularly useful in the treatment of obsessive and phobic disorders. In this case, the drug has to be taken for many months to achieve its full effect. It is also used to treat cataplexy (sudden loss of muscle tone) and narcolepsy (attacks of sleepiness).

Clomipramine has similar adverse effects to other tricyclic drugs, such as drowsiness, dizziness, dry mouth, and constipation. In overdose, clomipramine may cause coma and dangerously abnormal heart rhythms.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used SR tablets, capsules.

Frequency and timing of doses 1–3 x daily.

Adult dosage range 10–250mg daily. (100mg is the usual minimum effective dose).

Onset of effect Some effects, a few days; full antidepressant effect, up to 6 weeks; phobic and obsessional disorders, full effect up to 12 weeks.

Duration of action During prolonged treatment antidepressant effect may last up to 2 weeks.

Diet advice Avoid grapefruit and cranberry juice because they may interact with clomipramine and increase the drug’s effects.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 3 hours, take a single dose now and skip the next.

Stopping the drug Stopping abruptly can cause withdrawal symptoms and a recurrence of the original trouble. Consult your doctor, who will supervise a gradual reduction in dosage.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if palpitations are noted or consciousness is lost.

POSSIBLE ADVERSE EFFECTS

The adverse effects of clomipramine are mainly the result of its anticholinergic action; they include drowsiness, dizziness, dry mouth, sweating, flushing, blurred vision, and constipation. Weight gain may also occur. If you experience difficulty in passing urine, stop taking the drug and talk to your doctor. If you have palpitations, stop taking the drug and consult your doctor urgently.

INTERACTIONS

Sedatives All drugs that have a sedative effect may intensify those of clomipramine.

Anticonvulsant drugs Clomipramine may reduce the effects of these drugs and vice versa.

Antihypertensives Clomipramine may enhance the effect of some of these drugs.

Monoamine oxidase inhibitors (MAOIs) A serious reaction may occur if these drugs are given with clomipramine.

Grapefruit and cranberry juice These may increase the effects of clomipramine.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have heart problems.

· You have had epileptic seizures.

· You have long-term liver or kidney problems.

· You have had glaucoma.

· You have had prostate problems.

· You have had mania or a psychotic illness.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid such activities until you have learned how clomipramine affects you because the drug may cause blurred vision, drowsiness, and dizziness.

Alcohol Avoid. Alcohol may increase the sedative effects of this drug.

Surgery and general anaesthetics Clomipramine treatment may need to be stopped before you have a general anaesthetic. Discuss this with your doctor or dentist before any operation.

PROLONGED USE

No problems expected.

Monitoring Regular checks on heart and liver function are recommended.