Clomipramine (Oral route)

Pronunciation:

kloe-MIP-ra-meen

Brand Names:

Anafranil

Dosage Forms:

Capsule

Warnings:

Oral route(Capsule)

Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. These risks must be balanced with clinical need. Families and caregivers should closely observe the patient and stay in close contact with the prescriber. This drug is not approved for use in pediatric patients except for those with obsessive compulsive disorder (OCD) .

Classifications:

Therapeutic—

Antidepressant

Pharmacologic—

Antidepressant, Tricyclic

Uses of This Medicine:

Clomipramine is used to treat obsessive compulsive disorder (OCD). OCD is a nervous condition wherein a person has recurring thoughts or ideas or does repetitive things because they are anxious.

Clomipramine is a tricyclic antidepressant (TCA). It is thought to work in the brain by increasing the activity of the chemical serotonin.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of clomipramine in children 10 years of age and older. Safety and efficacy have not been established in children younger than 10 years of age.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of clomipramine in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving clomipramine.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Bepridil
Bromopride
Cisapride
Dronedarone
Furazolidone
Grepafloxacin
Iproniazid
Isocarboxazid
Levoketoconazole
Linezolid
Mesoridazine
Methylene Blue
Metoclopramide
Moclobemide
Pargyline
Phenelzine
Pimozide
Piperaquine
Potassium Citrate
Procarbazine
Ranolazine
Rasagiline
Safinamide
Selegiline
Sparfloxacin
Terfenadine
Thioridazine
Toloxatone
Tranylcypromine
Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abametapir
Abiraterone Acetate
Aceclofenac
Acemetacin
Adagrasib
Albuterol
Alfentanil
Alfuzosin
Almotriptan
Amantadine
Amiodarone
Amisulpride
Amitriptyline
Amoxapine
Amphetamine
Amtolmetin Guacil
Anagrelide
Apomorphine
Aripiprazole
Aripiprazole Lauroxil
Arsenic Trioxide
Artemether
Asenapine
Aspirin
Astemizole
Atazanavir
Azithromycin
Benzhydrocodone
Benzphetamine
Bromfenac
Bromocriptine
Bufexamac
Buprenorphine
Bupropion
Buserelin
Butorphanol
Capmatinib
Carbamazepine
Carisoprodol
Celecoxib
Ceritinib
Chloroquine
Chlorpromazine
Choline Salicylate
Ciprofloxacin
Citalopram
Clarithromycin
Clofazimine
Clonidine
Clonixin
Clothiapine
Clozapine
Cobicistat
Codeine
Crizotinib
Cyclobenzaprine
Dabrafenib
Darunavir
Dasatinib
Degarelix
Delamanid
Desipramine
Deslorelin
Desmopressin
Desvenlafaxine
Deutetrabenazine
Dexibuprofen
Dexketoprofen
Dexmedetomidine
Dextroamphetamine
Dextromethorphan
Diclofenac
Diflunisal
Dihydrocodeine
Dipyrone
Disopyramide
Dofetilide
Dolasetron
Domperidone
Donepezil
Droperidol
Droxicam
Duloxetine
Efavirenz
Encorafenib
Entrectinib
Epinephrine
Erythromycin
Escitalopram
Eslicarbazepine Acetate
Etodolac
Etofenamate
Etoricoxib
Etrasimod
Fedratinib
Felbinac
Fenfluramine
Fenoprofen
Fentanyl
Fepradinol
Feprazone
Fexinidazole
Fingolimod
Flecainide
Floctafenine
Fluconazole
Flufenamic Acid
Fluoxetine
Flurbiprofen
Fluvoxamine
Formoterol
Foscarnet
Fostemsavir
Frovatriptan
Gatifloxacin
Gemifloxacin
Gepirone
Glasdegib
Glucagon
Glycopyrrolate
Glycopyrronium Tosylate
Gonadorelin
Goserelin
Granisetron
Halofantrine
Haloperidol
Histrelin
Hydrocodone
Hydromorphone
Hydroxyamphetamine
Hydroxychloroquine
Hydroxytryptophan
Hydroxyzine
Ibuprofen
Ibutilide
Iloperidone
Imipramine
Indomethacin
Inotuzumab Ozogamicin
Iobenguane I 123
Iobenguane I 131
Ivabradine
Ivosidenib
Ketoconazole
Ketoprofen
Ketorolac
Lapatinib
Lasmiditan
Lefamulin
Lenvatinib
LetibotulinumtoxinA-wlbg
Leuprolide
Levalbuterol
Levofloxacin
Levomilnacipran
Levorphanol
Lisdexamfetamine
Lithium
Lofexidine
Lopinavir
Lorcaserin
Lornoxicam
Loxapine
Loxoprofen
Lumefantrine
Lumiracoxib
Macimorelin
Meclofenamate
Mefenamic Acid
Mefloquine
Meloxicam
Meperidine
Metaxalone
Methacholine
Methadone
Methamphetamine
Methotrexate
Methylphenidate
Metronidazole
Mifepristone
Milnacipran
Mirtazapine
Mobocertinib
Moricizine
Morniflumate
Morphine
Morphine Sulfate Liposome
Moxifloxacin
Nabumetone
Nafarelin
Nalbuphine
Naproxen
Naratriptan
Nefopam
Nepafenac
Niflumic Acid
Nilotinib
Nimesulide
Nimesulide Beta Cyclodextrin
Norepinephrine
Norfloxacin
Nortriptyline
Octreotide
Ofloxacin
Olanzapine
Oliceridine
Ondansetron
Osilodrostat
Osimertinib
Oxaliplatin
Oxaprozin
Oxycodone
Oxymetazoline
Oxymorphone
Oxyphenbutazone
Ozanimod
Pacritinib
Paliperidone
Palonosetron
Panobinostat
Parecoxib
Paroxetine
Pasireotide
Pazopanib
Peginterferon Alfa-2b
Pentazocine
Phenylbutazone
Piketoprofen
Pimavanserin
Piroxicam
Pitolisant
Pixantrone
Ponesimod
Posaconazole
Pranoprofen
Procainamide
Prochlorperazine
Proglumetacin
Promethazine
Propafenone
Propyphenazone
Proquazone
Protriptyline
Quetiapine
Quinidine
Quinine
Quizartinib
Relugolix
Remifentanil
Revefenacin
Ribociclib
Rofecoxib
Salicylic Acid
Salsalate
Saquinavir
Scopolamine
Secretin Human
Selpercatinib
Sertraline
Sevoflurane
Siponimod
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Sodium Salicylate
Solifenacin
Sorafenib
Sotalol
Sufentanil
Sulindac
Sulpiride
Sumatriptan
Sunitinib
Tacrolimus
Tapentadol
Telavancin
Telithromycin
Tenoxicam
Tetrabenazine
Tiaprofenic Acid
Tiotropium
Tolfenamic Acid
Tolmetin
Toremifene
Tramadol
Trazodone
Triclabendazole
Trifluoperazine
Trimipramine
Triptorelin
Valdecoxib
Vandetanib
Vardenafil
Vemurafenib
Venlafaxine
Vilanterol
Vilazodone
Vinflunine
Voclosporin
Voriconazole
Vortioxetine
Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acenocoumarol
Arbutamine
Atomoxetine
Desogestrel
Dicumarol
Dienogest
Drospirenone
Enalaprilat
Enalapril Maleate
Ethinyl Estradiol
Ethynodiol
Gestodene
Levonorgestrel
Mestranol
Modafinil
Nomegestrol
Norethindrone
Norgestimate
Norgestrel
Phenprocoumon
S-Adenosylmethionine
Valproic Acid
Yohimbine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Tobacco

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Grapefruit Juice

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

Adrenal gland tumor (eg, neuroblastoma, pheochromocytoma) or
Alcohol abuse, or history of or
Brain damage, history of or
Heart disease or
Hyperthyroidism (overactive thyroid) or
Hypovolemia (low blood volume)—Use with caution. May cause side effects to become worse.

Behavior or mood changes (eg, aggression, panic attacks) or
Bipolar disorder (mood disorder with mania and depression), or risk of or
Depression, history of or
Glaucoma (angle-closure type) or
Kidney disease or
Liver disease or
Mania or hypomania, history of or
Psychosis (mental illness) or
Schizophrenia (mental illness) or
Seizures, history of or
Urinary retention (trouble urinating), history of—Use with caution. May make these conditions worse.

Heart attack, recent—Should not be used in patients with this condition.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

It is best to take this medicine with food. Take this medicine at bedtime to lessen drowsiness during the day.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):
- For obsessive-compulsive disorder:
  - Adults—At first, 25 milligrams (mg) once a day at bedtime. Your doctor may adjust your dose as needed and tolerated. Higher doses may be given in evenly divided portions during the day. However, the dose is usually not more than 250 mg per day.
  - Children 10 years of age and older—At first, 25 mg once a day at bedtime. Your doctor may adjust your dose as needed and tolerated. Higher doses may be given in evenly divided portions during the day. However, the dose is usually not more than 200 mg per day.
  - Children younger than 10 years of age—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your or your child's progress at regular visits to allow for changes in your dose and to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Clomipramine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some children, teenagers, and young adults to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, or your caregiver notice any of these side effects, tell your doctor right away. Let the doctor know if you, your child, or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not use clomipramine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start using clomipramine during the 2 weeks after you stop an MAO inhibitor. Wait for 2 weeks after stopping clomipramine before you start using an MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions (seizures).

Clomipramine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use clomipramine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before taking any other medicines with clomipramine.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Check with your doctor right away if you have a fever, chills, cough, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be symptoms of a serious condition called drug reaction with eosinophilia and systemic symptoms (DRESS).

Clomipramine may lower the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with clomipramine may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause men to have problems with sex. Check with your doctor if you are having an abnormal ejaculation or decreased sexual performance or desire.

Weight changes may occur during treatment with this medicine. Talk with your doctor if this is a concern for you.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Taking clomipramine together with medicines used during surgery or emergency treatment may increase the risk of side effects.

Do not stop using this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent possible worsening of your condition and reduce the possibility of withdrawal symptoms such as dizziness, headache, nausea, vomiting, trouble sleeping, irritability, high fever, or a general feeling of discomfort or illness.

This medicine may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common: Bladder pain; bloody or cloudy urine; blurred vision; body aches or pain; burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings; confusion; difficult, burning, or painful urination; dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position; excessive muscle tone; fear or nervousness; feeling sad or empty; fever; hearing changes; hives or welts, skin rash; irritability; lower back or side pain; muscle stiffness, tension, or tightness; poor concentration; rhythmic movement of muscles; sneezing; tightness of the chest; trouble breathing; unusual tiredness or weakness; voice changes

Less common: Anger that is hard to control; anxiety; breast enlargement; changes in vision; chest pain or discomfort; chills; decrease in the frequency of urination; deep or fast breathing with dizziness; difficulty in speaking; dry mouth; fast, irregular, pounding, or racing heartbeat or pulse; headache, severe and throbbing; nausea; numbness of the feet, hands, and around the mouth; numbness, tingling, pain, or weakness in the hands or feet; pain during sexual intercourse; paranoia; rapidly changing moods; restlessness; shaking; sores, ulcers, or white spots on the lips or tongue or inside the mouth; sweating; swelling of the face, fingers, feet, or lower legs; vomiting

Incidence not known: Agitation; blindness; cough; decreased awareness or responsiveness; depression; dizziness; eye pain; hostility; increased thirst; loss of consciousness; muscle pain, cramps, or twitching; rapid weight gain; seizures; severe sleepiness; sore throat; swollen, painful, or tender lymph glands in the neck, armpit, or groin; tearing; unusual drowsiness, dullness, or feeling of sluggishness; yellow skin or eyes

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common: Blistering, crusting, irritation, itching, or reddening of the skin; change in taste; constipation; cracked, dry, or scaly skin; change in interest in sexual intercourse; diarrhea; dry skin; heartburn; inability to have or keep an erection; increased interest in sexual intercourse; joint pain or swelling; pimples; redness of the face, neck, arms, and occasionally, upper chest; shakiness in the legs, arms, hands, or feet; stomach discomfort, upset, or pain; swelling; trembling or shaking of the hands or feet

Less common: Absent, missed, or irregular menstrual periods; breast pain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 4/24/2024

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