Clomipramine (Anafranil): OCD Drug Dosage & Side Effects

What is clomipramine? What is clomipramine used for?

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

What are the side effects of clomipramine?

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.

Panic attacks are repeated attacks of fear that can last for several minutes.
See Answer

What is the dosage for clomipramine?

: 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.

Which drugs or supplements interact with clomipramine?

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.

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Is clomipramine safe to take if I’m pregnant or breastfeeding?

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 else should I know about clomipramine?

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.