How does this medication work? What will it do for me?

Clomipramine belongs to the class of medications known as tricyclic antidepressants. It is used to treat depression and obsessive-compulsive disorders (OCD). These disorders are related to imbalances of certain brain chemicals. This medication helps to reestablish balance to these chemicals.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

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What form(s) does this medication come in?

This medication is available as 10 mg, 25 mg, and 50 mg tablets.

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How should I use this medication?

The recommended adult dose of clomipramine ranges from 25 mg to 200 mg daily in divided doses, preferably with meals and at bedtime. The dose depends on individual circumstances, but is usually started low and increased gradually as required and as prescribed by the doctor.

Children and adolescents (10 to 17 years old) usually begin with a dose of 25 mg daily, increasing the dose by 25 mg every 3 to 4 days as prescribed by the doctor.

When discontinuing the medication, the dosage should be reduced gradually to prevent withdrawal effects.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Clomipramine should not be taken by anyone who:

  • is allergic to clomipramine or to any of the ingredients of the medication
  • has acute congestive heart failure
  • has certain blood disorders
  • has glaucoma
  • has kidney or liver damage
  • has recently had a heart attack
  • has taken a MAO inhibitor such as moclobemide or phenelzine within 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • dizziness
  • drowsiness
  • dryness of the mouth
  • headache
  • heartburn
  • increased appetite
  • increased sweating
  • tiredness or weakness (mild)
  • tremor
  • visual changes
  • weight gain

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred vision
  • confusion or delirium
  • constipation (especially for seniors)
  • decreased sexual ability
  • difficulty speaking or swallowing
  • eye pain
  • fainting
  • fast or irregular heartbeat (pounding, racing, skipping)
  • hallucinations
  • loss of balance control
  • "mask"-like face
  • nervousness or restlessness
  • problems with urinating
  • shakiness or trembling
  • "shuffling" walk
  • slowed movements
  • stiffness of arms and legs

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Contact lens wearers: People who wear contact lenses should be cautious as clomipramine may decrease tear production in the eye, thereby increasing the chance of eye damage for those wearing contact lenses.

Dental effects: Lengthy treatment with clomipramine may lead to an increased incidence of dental cavities. You should have regular dental checkups and practice good dental hygiene while taking this medication.

Drowsiness/reduced alertness: Since clomipramine may cause drowsiness, especially at the beginning of treatment, caution should be used when engaging in activities requiring mental alertness, judgment, and physical coordination such as driving or operating machinery.

Medical conditions: Anyone with a history of seizures or conditions that lower the seizure threshold (such as alcoholism or withdrawal from alcohol) should be closely monitored by their doctor while taking clomipramine.

Anyone with the following conditions should be monitored by their doctor while taking clomipramine:

  • a history of heart disease
  • thyroid disorders
  • problems with urination
  • a history of liver disease

Orthostatic hypotension (dizziness upon arising): Move slowly when rising from a sitting or lying down position as clomipramine can cause sudden temporary low blood pressure resulting in dizziness.

Suicidal or agitated behaviour: People taking antidepressants such as clomipramine may feel agitated (restless, anxious, aggressive, emotional, trouble sleeping, and feeling not like themselves), or they may want to hurt themselves or others. If you notice any changes in mood, behaviours, thoughts, or feelings in yourself or someone who is taking this medication, contact a doctor immediately. Your doctor will monitor you closely for behaviour changes, especially at start of treatment or when your dose is increased or decreased.

Withdrawal: Withdrawal symptoms such as dizziness, nausea, headache, and sleep disturbance have occurred when clomipramine therapy is discontinued suddenly. This is not a sign of addiction. Check with your doctor before stopping this medication on your own.

Pregnancy: The safety of this medication for use by pregnant women has not been established. It should not be taken by pregnant women unless the benefits outweight the risks.

Breast-feeding: Since clomipramine passes into breast milk, breast-feeding women should gradually withdraw the medication or stop breast-feeding.

Children: Clomipramine has not been studied for use by people under 10 years of age, and specific recommendations for its use by this age group cannot be provided. The long-term effects of clomipramine on childhood growth and development have not been determined.

What other drugs could interact with this medication?

There may be an interaction between clomipramine and any of the following:

  • alcohol
  • amphetamines
  • anticholinergic medications (e.g., atropine)
  • barbiturates (e.g., phenobarbital)
  • benzodiazepines (e.g., diazepam, lorazepam)
  • buproprion
  • butyrophenones (e.g., haloperidol)
  • carbamazepine
  • cimetidine
  • ciprofloxacin
  • clonidine
  • codeine
  • duloxetine
  • ephedrine
  • estrogens
  • grapefruit juice
  • ketoconazone
  • lansoprazole
  • lithiium
  • MAO inhibitors (e.g., phenelzine, moclobemide)
  • methyldopa
  • methylphenidate
  • metoclopramide
  • nonsteroidal anti-inflammatory drugs (NSAIDS; e.g., ibuprofen, naproxen)
  • olanzaprine
  • phenothiazines (e.g., chlorpromazine, thioridazine)
  • phenylephrine
  • phenytoin
  • pimozide
  • quinidine
  • quinine
  • rabeprazole
  • rifabutin
  • rifampin
  • SSRI antidepressants (e.g., fluoxetine, fluvoxamine)
  • tamoxifen
  • tramadol
  • valproic acid

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.