Body dysmorphic disorder, Cataplexy, Depression, Enuresis, Narcolepsy, Obsessive-compulsive disorder (OCD), Panic attack, Panic disorder, Phobias, Premature ejaculation, Severe anxiety disorders, Trichotillomania
Tricyclic & related anti-depressant drugs
Clomipramine is a potent inhibitor of serotonin re-uptake in the brain. Significant antagonism at cholinergic and α1-receptors. Weak antagonism at dopamine receptors. It has also antidepressant, sedative and anticholinergic effects.
Dosage & Administration
Adjunct in cataplexy associated with narcolepsy: Initial: 10 mg/day, up to 75 mg/day.
Obsessive-compulsive disorder; Panic disorder; Phobias: Initial: 25 mg/day, gradually increase up to 100-150 mg/day if needed. Max: 250 mg/day.
Depression: Initial: 10 mg/day, up to 30-150 mg/day if needed. ≥250 mg/day may be needed in severe cases.
Barbiturates increase metabolism of tricyclic antidepressants; conversely cimetidine, guanethidine, haloperidol and phenothiazines block the tricyclic metabolism. CNS effects of alcohol enhanced. If clomipramine is to be substituted for MAOIs, at least 3 wk should elapse after discontinuing MAOIs. Risk of hypertension and arrhythmias if co-administered with adrenaline and noradrenaline.
Hypersensitivity. Concomitant use of MAOIs; recovery phase following MI, heartblock or other arrhythmias; mania; childn.
Dryness of mouth; disturbances in micturition; drowsiness, increased sweating; sexual dysfunction; confusion, paraesthesia, ataxia, tremors; extrapyramidal symptoms; tinnitus, dizziness, fatigue, headache; wt gain esp in women; gynaecomastia and galactorrhoea.
Pregnancy & Lactation
Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Cardiovascular insufficiency; narrow-angle glaucoma; urinary retention; history of epilepsy; renal or hepatic dysfunction; electroconvulsive therapy; hypotension; hyperthyroidism or concomitant treatment with thyroid preparations; suicidal tendencies; surgery; pregnancy and lactation; tasks requiring mental alertness; elderly; avoid abrupt withdrawal.
Symptom: Initial CNS stimulation followed by severe CNS depression. Cardiac dysrhythmias, severe hypotension, convulsions, changes in the electrocardiogram, particularly in QRS axis or width, drowsiness, stupor, ataxia, restlessness, agitation, delirium, severe sweating, hyperactive reflexes, muscle rigidity, athetoid and choreiform movements. Respiratory depression, cyanosis, shock, vomiting, hyperpyrexia, mydriasis, and oliguria or anuria may also be present.
Management: Treatment is symptomatic and supportive. Plasma concentrations should not guide management of the patient. Peritoneal dialysis and hemodialysis are not effective in removing the drugs as it is highly protein bound. V diazepam to be used with caution for treatment of seizures.
Store below 30°C.