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.

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