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Clomipramine

    Brands

    DEA Class;  Rx

    Common Brand Names; Anafranil

    • Antidepressants, TCAs

    Tricyclic antidepressant with significant serotonin reuptake inhibitor activity; anticholinergic and orthostatic effects
    Used primarily for obsessive-compulsive disorder (OCD) in adults and pediatric patients 10 years and older
    Boxed warning for use in pediatric patients and young adults due to risk for suicidality

    Indicated for treatment of obsessive-compulsive disorder (OCD).

    For the treatment of behavioral symptoms associated with autistic disorder.
    For the treatment of premature ejaculation.

    Hypersensitivity

    Severe cardiovascular disorder

    Narrow angle glaucoma

    Any drugs or conditions that prolong QT interval

    Acute recovery post-MI

    Xerostomia (84%)

    Headache (50-55%)

    Constipation (47%)

    Ejaculation failure (42%)

    Fatigue (35-40%)

    Nausea (30-35%)

    Impotence (20-25%)

    Weight gain (18%)

    Weight loss (5%)

    Hepatotoxicity (1-3%)

    Dyspepsia

    Blurred vision

    Urinary retention

    Orgasm incapacity, libido change

    BPH, urinary/GI retention, hyperthyroidism, seizure disorder, brain tumor, respiratory impairment

    Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

    Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 yr)

    Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue)

    Risk of anticholinergic side-effects

    Rare cases of drug rash with eosinophilia and systemic symptoms (DRESS) reported with use; in event of severe acute reactions such as DRESS, discontinue clomipramine therapy immediately and institute appropriate treatment

    Pregnancy Category: C

    Lactation: distributed in breast milk, do not nurse (AAP states effect on nursing infants is unknown but may be of concern)

    Adults

    250 mg/day PO.

    Elderly

    250 mg/day PO.

    Adolescents

    3 mg/kg/day PO or 200 mg/day PO, whichever is smaller.

    Children

    >= 10 years: 3 mg/kg/day PO or 200 mg/day PO, whichever is smaller.
    < 10 years: Safety and efficacy have not been established.

    Clomipramine hydrochloride

    capsule

    • 25mg
    • 50mg
    • 75mg