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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Clomipramine Hydrochloride
Generic Name
Clomipramine Hydrochloride
Active Ingredient
ClomipramineCategory
Other
Salt Form
Hydrochloride
Variants
48
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Clomipramine Hydrochloride, you must consult a qualified healthcare professional.
| 50 mg/1 | CAPSULE | ORAL | 62332-408 |
| 75 mg/1 | CAPSULE | ORAL | 63629-1111 |
| 50 mg/1 | CAPSULE | ORAL | 70756-406 |
| 75 mg/1 | CAPSULE | ORAL | 71205-912 |
| 25 mg/1 | CAPSULE | ORAL | 27241-210 |
| 75 mg/1 | CAPSULE | ORAL | 27241-212 |
| 75 mg/1 | CAPSULE | ORAL | 51672-4013 |
| 50 mg/1 | CAPSULE | ORAL | 46708-408 |
| 50 mg/1 | CAPSULE | ORAL | 59651-382 |
+ 36 more variants
Detailed information about Clomipramine Hydrochloride
Clomipramine is a potent tricyclic antidepressant (TCA) primarily utilized for the treatment of obsessive-compulsive disorder (OCD). It functions by modulating neurotransmitters in the brain, particularly serotonin, to reduce repetitive thoughts and behaviors.
The dosing of Clomipramine must be highly individualized and managed by a qualified healthcare professional. The goal is to find the lowest effective dose that manages symptoms while minimizing side effects.
Clomipramine is one of the few TCAs with specific FDA approval for use in children and adolescents for the treatment of OCD.
Certain patient populations require special considerations when determining the appropriate dose of Clomipramine.
While Clomipramine is primarily metabolized by the liver, its metabolites are excreted by the kidneys. Patients with significant kidney disease should be monitored closely. Although specific dose adjustment formulas based on GFR are not always standardized for TCAs, a 'start low and go slow' approach is generally recommended to prevent the accumulation of metabolites.
Since the liver is the primary site of Clomipramine metabolism, patients with liver cirrhosis or hepatic insufficiency are at high risk for drug toxicity. Lower starting doses and slower titration are mandatory. Periodic liver function tests (LFTs) may be required to ensure the drug is being processed safely.
Older adults are more sensitive to the anticholinergic effects (e.g., confusion, urinary retention) and cardiovascular effects (e.g., orthostatic hypotension) of Clomipramine. Clinical guidelines suggest starting at very low doses (e.g., 10-25 mg) and monitoring for fall risks and cognitive changes. The Beers Criteria often lists TCAs as potentially inappropriate medications for the elderly.
To get the most benefit from your medication and stay safe, follow these specific instructions:
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and return to your regular schedule. Do not 'double up' or take two doses at once to make up for a missed one, as this increases the risk of toxicity.
A Clomipramine overdose is a life-threatening medical emergency. Because TCAs affect the heart's electrical conduction and the central nervous system, an overdose can lead to rapid heart rate, severe low blood pressure, seizures, and coma. If an overdose is suspected, call 911 or your local emergency services immediately. Signs of overdose include extreme drowsiness, dilated pupils, irregular heartbeat, muscle rigidity, and fainting.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking the medication without medical guidance, as sudden discontinuation can cause withdrawal symptoms.
Because Clomipramine affects multiple receptor systems, side effects are very common, especially when starting the medication or increasing the dose. Most patients will experience at least one of the following:
Clomipramine is a powerful medication that affects several major organ systems. Patients must be aware that the full therapeutic benefit for OCD may not be realized for 4 to 10 weeks. During this time, it is vital to continue the medication as prescribed. Patients should also be aware that Clomipramine can significantly impair physical and mental abilities required for performing hazardous tasks.
Suicidality and Antidepressant Drugs:
According to the FDA, Clomipramine increases the risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18-24) with psychiatric disorders. This risk was not seen in studies of patients over age 24. Patients of all ages who are started on Clomipramine should be monitored closely for worsening of symptoms, irritability, agitation, or any emergence of suicidal thoughts. This is particularly critical during the initial titration phase and whenever the dosage is adjusted up or down.
Certain drugs must NEVER be used with Clomipramine due to the risk of life-threatening reactions:
There are specific circumstances where Clomipramine must NEVER be used because the risks far outweigh any potential benefits:
Clomipramine is classified by the FDA as Pregnancy Category C. This means that animal reproduction studies have shown an adverse effect on the fetus, and there are no adequate and well-controlled studies in humans. However, the potential benefits may warrant use of the drug in pregnant women despite potential risks.
Clomipramine is a tertiary amine tricyclic antidepressant. Its primary molecular target is the Serotonin Transporter (SERT), where it acts as a potent reuptake inhibitor. By binding to SERT, it prevents the recycling of serotonin back into the presynaptic neuron, thereby increasing the dwell-time of serotonin in the synapse. This enhances serotonergic neurotransmission. Its active metabolite, desmethylclomipramine, acts similarly on the Norepinephrine Transporter (NET). Furthermore, Clomipramine has antagonistic effects at the following receptors:
Common questions about Clomipramine Hydrochloride
Clomipramine is primarily FDA-approved for the treatment of Obsessive-Compulsive Disorder (OCD) in both adults and children aged 10 and older. It helps reduce the frequency and intensity of intrusive thoughts and the urge to perform repetitive compulsive behaviors. Beyond OCD, healthcare providers may use it off-label to treat conditions like treatment-resistant depression, panic disorder, and cataplexy associated with narcolepsy. Because it is a very potent medication, it is often reserved for cases where other treatments, such as SSRIs, have not been fully effective. Always consult your doctor to see if this specific medication is appropriate for your diagnosis.
The most common side effects of Clomipramine include dry mouth, extreme drowsiness, constipation, and increased sweating. Many patients also experience sexual dysfunction, such as a decreased sex drive or difficulty reaching orgasm. Because it affects the nervous system, you might also notice tremors, blurred vision, or feeling dizzy when you stand up too quickly. Most of these side effects are most noticeable during the first few weeks of treatment and may lessen as your body adjusts. However, if these symptoms become bothersome or persistent, you should discuss them with your healthcare provider.
No, you should strictly avoid drinking alcohol while taking Clomipramine. Alcohol can dangerously increase the sedative effects of the medication, leading to extreme drowsiness, impaired coordination, and slowed breathing. This combination significantly increases the risk of accidents and can also lower your seizure threshold, making a seizure more likely. Furthermore, alcohol can interfere with the medication's ability to manage your OCD symptoms effectively. For your safety, it is best to eliminate alcohol consumption entirely during your course of treatment.
Clomipramine is generally not recommended during pregnancy unless the benefits clearly outweigh the potential risks to the fetus. It is classified as Category C, meaning there is evidence of potential harm in animal studies but insufficient data in humans. Taking this medication late in pregnancy can cause the newborn to experience withdrawal symptoms like jitteriness, breathing problems, or muscle weakness. If you are pregnant or planning to become pregnant, it is crucial to have a detailed discussion with your doctor. They will help you weigh the risks of the medication against the risks of untreated OCD during pregnancy.
Clomipramine does not work immediately; it typically takes several weeks to feel the full therapeutic effects. While some patients may notice a slight improvement in anxiety within the first week or two, the significant reduction in OCD symptoms usually takes between 4 and 10 weeks of consistent use. It is important not to get discouraged and stop the medication too early if you don't see immediate results. Your doctor will likely start you on a low dose and gradually increase it to find the most effective level for you. Always follow the prescribed schedule even if you do not feel better right away.
You should never stop taking Clomipramine suddenly, as this can cause uncomfortable withdrawal symptoms known as discontinuation syndrome. Symptoms of stopping too quickly include nausea, headache, dizziness, irritability, and vivid dreams or sleep disturbances. To stop the medication safely, your healthcare provider will create a tapering schedule to gradually lower your dose over several weeks or months. This allows your brain chemistry to slowly readjust to the absence of the drug. Always consult your doctor before making any changes to how you take your medication.
If you miss a dose of Clomipramine, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed one and continue with your regular dosing schedule. Do not take two doses at the same time to make up for the one you missed, as this can increase your risk of experiencing serious side effects or toxicity. If you find yourself frequently forgetting doses, consider using a pill organizer or setting a daily alarm on your phone. Consistency is key to the effectiveness of this medication.
Weight gain is a known and relatively common side effect of Clomipramine. This occurs because the medication can increase your appetite and may cause changes in your metabolism. Some patients find that they crave sweets or high-carbohydrate foods more frequently while on this drug. To manage this, healthcare providers often recommend monitoring your weight regularly and maintaining a balanced diet and exercise routine. If you notice significant or rapid weight gain, discuss it with your doctor, as they may want to check your blood sugar or lipid levels.
Clomipramine has many potential drug interactions, some of which can be very serious. It should never be taken with MAO inhibitors, and it must be used with extreme caution alongside other serotonergic drugs like SSRIs or certain pain medications. It can also interact with heart medications, blood pressure drugs, and even common over-the-counter supplements like St. John's Wort. Because of these risks, it is vital that you provide your doctor and pharmacist with a complete list of everything you are taking. They will check for 'contraindications' to ensure your treatment plan is safe.
Yes, Clomipramine is available as a generic medication, which is typically more affordable than the brand-name version, Anafranil. Generic Clomipramine Hydrochloride capsules are produced by several different manufacturers and are required by the FDA to be bioequivalent to the brand-name drug. This means they contain the same active ingredient and work in the same way in the body. If you have concerns about the cost of your medication, ask your pharmacist or doctor if the generic version is an option for you. Most insurance plans cover the generic form of this medication.
Other drugs with the same active ingredient (Clomipramine)
> Warning: Stop taking Clomipramine and call your doctor immediately or seek emergency care if you experience any of the following serious symptoms:
Prolonged use of Clomipramine may lead to persistent weight gain, which can increase the risk of metabolic issues like type 2 diabetes. Long-term anticholinergic exposure has also been studied for its potential links to cognitive decline in older populations. Dental issues may also arise due to chronic dry mouth, as saliva is necessary to protect teeth from decay. Regular dental check-ups are advised for those on long-term therapy.
Clomipramine carries the FDA's most serious warning, the Black Box Warning, regarding suicidality.
Report any unusual symptoms or persistent side effects to your healthcare provider immediately. They may adjust your dose or provide strategies to manage these effects.
To ensure safety, your healthcare provider may require the following monitoring:
Clomipramine frequently causes significant sedation, blurred vision, and impaired coordination. Do not drive a car, operate heavy machinery, or engage in dangerous activities until you know how this medication affects you. The sedative effects are often most pronounced during the first few weeks of treatment.
Patients must strictly avoid alcohol while taking Clomipramine. Alcohol significantly increases the sedative effects of the drug and can dangerously impair motor skills and judgment. Furthermore, the combination can increase the risk of respiratory depression and lower the seizure threshold.
Never stop taking Clomipramine abruptly. Doing so can lead to 'discontinuation syndrome,' which includes symptoms like nausea, headache, dizziness, irritability, and sleep disturbances (vivid dreams). Your doctor will provide a tapering schedule to slowly reduce the dose over several weeks to allow your brain chemistry to adjust.
> Important: Discuss all your medical conditions, including any history of heart, liver, or kidney problems, with your healthcare provider before starting Clomipramine.
Clomipramine may interfere with certain medical tests, potentially causing false-positive results for amphetamines on urine drug screens. Always inform the laboratory staff and your doctor that you are taking a tricyclic antidepressant before undergoing drug testing.
For each major interaction, the mechanism usually involves either 'Pharmacodynamic' synergy (two drugs doing the same thing to the body) or 'Pharmacokinetic' interference (one drug changing how the liver processes the other). The consequence is almost always either increased toxicity or reduced effectiveness of one of the medications.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. A complete list is the only way to prevent dangerous drug-drug interactions.
These are conditions where the drug should be used only with extreme caution and frequent monitoring:
Patients who are allergic to other dibenzazepine compounds (such as carbamazepine or certain other antidepressants) should be monitored for cross-allergic reactions. Symptoms of cross-sensitivity can range from mild skin rashes to systemic anaphylaxis.
> Important: Your healthcare provider will evaluate your complete medical history, including your heart health and any history of eye problems, before prescribing Clomipramine. Ensure you disclose all past medical events.
Clomipramine and its active metabolite, desmethylclomipramine, are excreted into human breast milk. While the amounts are generally low, there is a risk of the drug accumulating in the infant's system. Some studies have reported no adverse effects on nursing infants, while others suggest monitoring for sedation or poor feeding. The decision to breastfeed while taking Clomipramine should involve a careful risk-benefit analysis. In many cases, if the mother requires Clomipramine for stability, bottle-feeding may be considered to eliminate infant exposure.
Clomipramine is FDA-approved for the treatment of OCD in children and adolescents aged 10 and older. It has not been established as safe or effective for children under 10.
Older patients (65+) are at significantly higher risk for complications from Clomipramine.
In patients with kidney failure, the excretion of the water-soluble metabolites of Clomipramine is impaired. While the parent drug is mostly cleared by the liver, the buildup of metabolites can lead to increased side effects. Patients with a GFR below 30 mL/min should be monitored with extreme caution.
Liver disease significantly impacts the body's ability to metabolize Clomipramine. In patients with Child-Pugh Class B or C impairment, the drug's half-life can be doubled or tripled. These patients require very low starting doses and may not be able to tolerate the medication at all if liver failure is advanced.
> Important: Special populations require individualized medical assessment. Never share your medication with others, especially those in these sensitive groups.
The dose-response relationship for Clomipramine is well-established for OCD. Onset of therapeutic effect is slow, typically taking 2 to 4 weeks for initial changes and up to 10 weeks for maximum benefit. This delay suggests that the therapeutic effect is not just due to immediate reuptake inhibition, but rather downstream changes in receptor sensitivity (neuroplasticity). Tolerance to the sedative and anticholinergic side effects often develops within the first few weeks, but the therapeutic effect remains stable over long-term use.
| Parameter | Value |
|---|---|
| Bioavailability | ~50% (due to first-pass metabolism) |
| Protein Binding | 97% - 98% |
| Half-life (Parent) | 17 - 37 hours |
| Half-life (Metabolite) | 54 - 77 hours |
| Tmax (Time to peak) | 2 - 6 hours |
| Metabolism | Hepatic (CYP2D6, CYP2C19, CYP1A2, CYP3A4) |
| Excretion | Renal 60%, Fecal 32% |
Clomipramine is classified as a Tricyclic Antidepressant (TCA). Within this class, it is a tertiary amine. It is related to other TCAs like imipramine and amitriptyline but is distinguished by its specific chlorine substitution, which confers its high selectivity for the serotonin transporter compared to other members of the TCA family.