Clomipramine

Antidepressant Drug

Drug class: Tricyclic Antiperessant Drug

Clomipramine (ANAFRANIL)（中文：氯米帕明）

Common Strengths of Clomipramine

Clomipramine are available in the following strengths:

• 25 mg, 50 mg, 75 mg capsules

Drug Trade Names of Clomipramine

Anafranil

Drug Usage

• Primary use: Treatment of obsessive-compulsive disorder (OCD)
• Other use: Depression, panic disorder, chronic pain, premature ejaculation, narcolepsy with cataplexy

Mechanism of Action

Clomipramine works by inhibiting the reuptake of serotonin and norepinephrine in the brain, with a stronger effect on serotonin. This increase the levels of these neurotransmitters, which is thought to be important in regulating mood and obsessive-compulsive behaviors.

Route of Administration

Oral

Dosages

For obsessive-compulsive disorder (OCD):

• Initial dose: 25 mg/day, gradually increased to 100 mg/day over 2 weeks.
• Maximum dose: 250 mg/day.

Side Effects

Frequency	Adverse reactions
Common	These side effects are often mild and may diminish as the body adjusts to the mediation.
	Dry mouth
	Drowsiness or sedation
	Dizziness
	Constipation
	Nausea
	Increased appetite
	Tremors
	Blurred vision
	Changes in sexual function (e.g. impotence, decreased libido)
Serious	Serotonin Syndrome: A potentially life-threatening condition characterized by symptoms such as agitation, hallucinations, rapid heart rate, muscle rigidity, and gastrointestinal distress. This risk increase if clomipramine is taken with other serotenrgic drugs.
	Clomipramine can cause QT prolongation, which can lead to serious heart arrhythmia.
	Clomipramine may lower the seizure threshold, increasing the risk of seizures, especially in individuals with a history of seizure disorders.
	Hyponatremia: Low sodium levels can occur, leading to symptoms like headache, confusion, and severe weakness. This is particularly a risk in elderly patients.
	Mood Changes: New or worsening depression, anxiety, irritability, and thoughts of suicide or self-harm are serious concerns, especially in younger individuals.
	Allergic Reactions: Signs include hives, difficulty breathing, and swelling of the face or throat, which require immediate medical attention.

Pharmacokinetics

• Absorption: Rapidly absorbed from the gastrointestinal tract
• Metabolism: Primarily in the liver via CYP2D6
• Elimination: Mainly excreted in the urine, with a half-life of 19 to 37 hours
• Drug Onset time: 2-3 weeks for full effect in obsessive-compulsive disorder (OCD)

Drug Precautions

Pregnancy

Use only if clearly needed; potential risks to the fetus

Breastfeeding

Excreted in breast milk; use with caution

Children and Elderly

Nor recommended for children under 10; lower doses for elderly

Monitoring Requirements

Blood pressure, heart rate, mental status, suicidal thoughts

Drug Interactions

• Serotenergic Drugs: Combining clomipramine with other serotonergic medications (e.g. lithium, tramadol, St. John's Wort) can also increase the risk of serotonin syndrome.
• CNS Depressant: Taking clomipramine with other central nervous system depressants (e.g. benzodiazepines, alcohol) can enhance sedation and increase the risk of respiratory depression.
• Thyroid Medications: Use with thyroid medications (e.g. levothyroxine) can lead to increased heart rate and other cardiovascular issues.
• Warfarin: There is an icreased risk of bleeding when clomipramine is taken with anticogulants like warfarin.
• Digoxin: Clomipramine may increase the risk of digoxin toxicity, leading to symptoms like confusion and irregular heartbeats.

FAQ

How Should I Take the Tablet?

Usually with food to reduce stomach upset. Often taken at bedtime due to sedating effects.

What Should I Avoid While Taking?

Avoid alcohol, driving, or operating machinery until you know how the medication affects you.

What Happens if I Miss a Dose?

Take it as soon as you remember, unless it almos time for your next dose. Never take a double dose to make up for a missed one.