Clomipramine may be better known by its brand name Anafranil®, but it has been in use since the 1960s so the generic form is widely available. It is in the class of tricyclic antidepressants (TCAs) and acts on the brain to promote greater free levels of norepinephrine and serotonin, which may help elevate mood. Due to TCA side effects these are normally not the first line treatments for conditions like depression. Yet clomipramine may be prescribed when first line treatments are ineffective, and the drug has also shown benefit in the treatment of obsessive-compulsive disorder (OCD). Off label uses include prescribing the medication to treat some symptoms of autism, panic disorder, and chronic pain.
Dosing of the medication depends on age and size of patients, and each person can respond to the drug differently. It is usually not given to children under the age of 10, and pregnant and nursing women are generally advised not to take the medication either. Dose should follow physician’s instructions exactly, and the medication should not be increased or discontinued without a doctor’s advice.
Like other antidepressants, clomipramine may hazard some risk when used in teens and young adults. It may increase suicidal ideation or suicidality, and any thoughts of suicide while on this drug should be immediately reported to doctors to assess continued benefits of the medicine. However, its uncommon to see this medication prescribed for depression, and it is really mostly used for people with OCD. This does not necessarily mean that suicidality cannot or wouldn’t develop in patients who mainly have OCD and who are in this age group most at risk.
Side effects of clomipramine can be transient and mild to severe and life threatening. Common ones include dizziness, especially when changing positions from sitting to standing, drowsiness, weight gain, reduced libido, stomach discomfort and heartburn, dry mouth, and feelings of anxiety or inner restlessness (akathisia). A very rare, but unharmful side effect includes having orgasms while yawning, which appears to affect under 10% of the people who take this medication.
Sometimes severe cardiac side effects develop, which is a medical emergency. If fainting, rapid heart rate, confusion, or chest pain occur get to a hospital immediately. Additionally, signs of allergy like sudden rash and difficulty breathing, though rare, are medically urgent symptoms.
Doctors may not prescribe clomipramine if a person has certain medical conditions or takes certain types of other medications. Some medications that may be contraindicated for use with this drug include monoamine oxidase inhibitors (MAOIs), and medications for heart conditions, particularly blood thinners and blood pressure drugs. Certain opiates, tranquilizers and other antidepressants may not be prescribed in conjunction with clomipramine. Medical conditions that might cause doctors not to prescribe this drug include heart disease, kidney disease, thyroid disorders, low blood pressure, enlargement of the prostate, and glaucoma.
Though this drug does have a heavy side effect profile, there is some evidence that it may be more beneficial in the treatment of OCD than are the few drugs in the selected serotonin reuptake inhibitor (SSRI) class. When people are not taking other medications or have conditions that would contraindicate clomipramine therapy, it may be considered as a first line treatment for OCD, or as a close second when SSRIs do not work effectively.