Disclaimer: Human Health is not recommending any specific medical treatment for any particular symptom, nor providing any other medical advice. Always seek the advice of your doctor regarding any medical concern.

Indications

Clomipramine is a medication approved by the FDA to treat obsessive-compulsive disorder (OCD).

It is sometimes used to treat other conditions, including:

• Major depressive disorder (depression)
• Anxiety
• Treatment-resistant depression
• Cataplexy syndrome
• Insomnia
• Neuropathic pain
• Chronic pain
• Body dysmorphic disorder
• Panic disorder
• Premature ejaculation
• Pediatric nocturnal enuresis
• Trichotillomania

Brand names

Clomipramine is available under a couple of different brand names, including:

• Anafranil
• Placil

Formats

Clomipramine is available as an oral tablet.

Drug class

Clomipramine is an antidepressant. It is a particular type of antidepressant known as a tricyclic antidepressant (TCA).

Mechanism of action

Clomipramine works by blocking the action of proteins in the brain called serotonin transporters. When serotonin transporters are deactivated, the amount of available serotonin in the brain increases.

Serotonin is a hormone that is involved in regulating processes such as mood, behavior, appetite, perception, fear and stress. Clomipramine may also increase the levels of noradrenaline, another hormone that is involved in regulating stress, alertness and attention.

Changing the level of serotonin and noradrenaline in the brain can therefore have an effect on conditions including OCD, depression and and anxiety.

What’s the difference between clomipramine and other antidepressants?

When determining an appropriate treatment plan, clinicians will consider a variety of factors relevant to the patient, including things like their age, the specific condition(s) they have, other treatments they are already on, and the side effects of the treatment.

Compared to other TCAs, including amitryptaline, nortriptaline, and imiprimine, clomipramine may be structurally different, may be effective at a different dose, and may be metabolized and excreted differently by the body.

Clomipramine is indicated for OCD, which other TCAs are not approved to treat.

Clomipramine is one of only a few antidepressants approved for use in pediatric patients with OCD.

Compared to some other classes of antidepressants, TCAs like clomipramine may have more side effects.

Side effects

It is important to note that there may be increased risk for suicidal thinking and behavior in children, adolescents and young adults taking antidepressants for depression or other psychiatric disorders.

The most common side effects of clomipramine may include:

• Dry mouth
• Constipation
• Nausea
• Indigestion
• Decreased appetite
• Increased appetite
• Weight gain
• Altered libido
• Sexual dysfunction
• Visual changes
• Tremors
• Twitching
• Fatigue
• Sleepiness
• Nervousness
• Increased sweating
• Dizziness
• Changes to urine volume
• Difficulty urinating

Special instructions

Clomipramine is not approved for use in pediatric patients <10 years old without OCD.

Patients taking another type of antidepressant called monoamine oxidase inhibitors (MOAIs) should not take clomipramine.

Patients taking an antipsychotic drug called pimozide should not take clomipramine.

Resources

1. Wilson M, Tripp J. Clomipramine. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541006/
2. Anafranil (clomipramine) US Prescribing Information. 2019. Available from: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=019906

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