Clomipramine
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.
