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Clomipramine

Clomipramine (brand-name Anafranil®) is a tricyclic antidepressant. more...

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Indications

  • Depression with lack of energy or mild agitation
  • Obsessive Compulsive Disorders (OCD)
  • Panic attacks with or without Agoraphobia
  • Narcolepsy
  • chronic pain with or without organic disease, particular headache of the tension type
  • Enuresis (involuntary nightly urinating in sleep) in children / adolescents
  • Off label, sometimes antidepressants of this type have been found helpful in reducing relapses in cocaine addicts and to help repair cocaine-caused neurotransmitter imbalances and early brain damage. Further studies are needed for Clomipramine in this regard.

It may take 2 to 3 weeks before the full effects of this medication are noticed in all indications.

Contraindications

  • Concomitant therapy with an (irreversible) MAO-Inhibitor (e.g. Tranylcypromin, Phenelzin)
  • Acute intoxication with central depressants (alcohol, psychoactive drugs, narcotics)
  • States of confusion (caution), absolutely contraindicated in patients with coma and Delirium tremens
  • Patients with massive agitation or anxiety (give sedative drugs concomittantly)
  • Hypersensitivity/Allergy against Clomipramine or other related tricyclic compounds
  • Hypertrophy of the Prostate with urine retention (=difficulty in urinating)
  • Caution : Hypertrophy of the Prostate without urine retention
  • Preexisting closed angle glaucoma
  • Epilepsy and other conditions which lower the seizure-threshold (alcohol-withdrawal, active brain tumors)
  • Serious liver disease (elimination is decreased), if Clomipramine is given consider dose reduction
  • Serious kidney disease (elimination is decresed), if Clomipramine is given consider dose reduction
  • Severe hypotension, shock, serious cardiovascular dysfunction (postinfarctous states, heart insufficience, arrhythmias), avoid high oral doses or injections/infusions
  • Preexisting bone marrow depression (leukopenia, thrombopenia, anemia, pancytopenia), can be worsened by Clomipramine
  • Overfunction of the thyreoid gland makes the patient more sensitive to side-effects of Clomipramine. Cautious doses should be used and the overfunction should be treated.
  • Caution should be exerted when treating pediatric patients under 18 yrs. of age

Pharmacology

Clomipramine is the 3-chloro derivative of Imipramine. Clomipramine is a strong, but not completely selective Serotonic-Reuptake-Inhibitor (SRI), as the active main metabolite Desmethyclomipramine acts preferably as inhibitor of Noradrenaline-Reuptake. Other hydroxy-metabolites are also active. Alpha-1-Receptor blockage and beta-down-regulation as well as postsynaptic antagonism on H1 (histaminergic)-receptors have been noted. A blockade of Sodium-channels and NDMA-receptors might, as with other tricyclics, account for its effect in chronic pain, particular of the neuropathic type.

Read more at Wikipedia.org


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Drug approved for psychiatric disorder - clomipramine
From FDA Consumer, 3/1/90

FDA has approved the prescription drug clomipramine for the treatment of severe obsessive-compulsive disorder.

People with this disorder have recurrent ideas, thoughts, images, or impulses that they know are irrational but cannot control. They also engage in repetitive actions such as excessive hand-washing, which they also recognize as irrational.

Psychodierapy, behavior therapy, and various drugs have been used to treat obsessive-compulsive disorder without much success. Clomipramine is the first substantially effective drug treatment.

The drug's most serious side effect is seizure, which may occur in about 1.5 percent of treated patients each year. Other possible side effects include dry mouth, constipation, increased appetite, decreased sex drive, ejaculation failure, and impotence.

The drug is manufactured by Ciba-Geigy Pharmaceuticals of Summit, N.J., and will be marketed under the trade name Anafranil.

COPYRIGHT 1990 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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