Tricyclic antidepressants
Clomipramine
A tricyclic antidepressant used for depression and particularly for obsessive-compulsive disorder, effective but with notable side effects and danger in overdose.
What is Clomipramine?
Clomipramine is a tricyclic antidepressant used for depression and, particularly, for obsessive-compulsive disorder. It takes some weeks to work and commonly causes anticholinergic effects such as dry mouth, constipation and blurred vision. It is dangerous in overdose because of its effects on the heart, and should not be stopped suddenly.
Education and reference only. This is a plain-language guide to Clomipramine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Clomipramine is a tricyclic antidepressant (TCA), one of the older classes of antidepressant. In the UK it is used for depression and is especially well known for treating obsessive-compulsive disorder, as well as some other conditions. Newer antidepressants such as SSRIs are often tried first because they tend to be better tolerated and are much safer in overdose, but clomipramine remains valuable, particularly for OCD.
How it works
Clomipramine increases the levels of the brain chemicals serotonin and noradrenaline by stopping them being reabsorbed back into nerve cells, which gradually improves mood and reduces obsessive symptoms over weeks. It also blocks several other receptors, and this is responsible for its anticholinergic side effects, such as dry mouth and constipation, and for its effects on the heart that make it dangerous in overdose.
Company & origin
Originated / developed by: Geigy (now part of Novartis).
Clomipramine was developed by the Swiss company Geigy (later part of Novartis) and introduced in the 1960s. It is particularly associated with the treatment of obsessive-compulsive disorder.
What it treats
Conditions Clomipramine is used for
Practical use
How to take Clomipramine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it regularly as prescribed, even before you feel a benefit.
- It can take a few weeks to start working, so do not stop early if you feel no immediate change.
- It is sometimes taken in the evening, as it can be sedating; follow your prescriber's advice.
- Do not stop suddenly; coming off it should be done gradually with your prescriber.
- Keep it well out of reach of children, as it is dangerous in overdose.
- Tell your prescriber about any heart problems before starting.
Weighing it up
Advantages & disadvantages of Clomipramine
Advantages
- Effective for depression and especially for obsessive-compulsive disorder.
- A well-established option when newer antidepressants have not worked.
- Works on more than one brain chemical system.
Disadvantages
- Commonly causes anticholinergic effects (dry mouth, constipation, blurred vision).
- Dangerous in overdose because of effects on the heart.
- Takes some weeks to work.
- Should not be stopped suddenly, as this can cause withdrawal effects.
- Needs caution in people with heart disease.
Practical use
Good to know
Clomipramine takes time to work, often a few weeks before the benefit builds, so it is important to keep taking it and not give up too early. It commonly causes anticholinergic side effects such as dry mouth, constipation and blurred vision. It is dangerous in overdose because of its effects on heart rhythm, so it is prescribed with care, particularly where there is a risk of self-harm. It should not be stopped suddenly, and it is used with caution in people with heart disease.
Who should not take it / use with caution
- People who have recently had a heart attack or have certain heart rhythm problems.
- People with a known allergy to clomipramine.
- People taking, or who have recently taken, a type of antidepressant called an MAOI.
- Use with caution in people with heart disease, epilepsy, glaucoma, urinary problems or an enlarged prostate, and in older people.
Monitoring
- Mood, and any thoughts of self-harm, especially early in treatment.
- Heart health, particularly where there is existing heart disease.
- Side effects such as constipation, urinary problems and drowsiness.
Side effects
- Dry mouth, constipation and blurred vision.
- Drowsiness and dizziness.
- Weight changes and sweating.
- Difficulty passing urine.
- Effects on heart rhythm, which is why it is dangerous in overdose.
Key interactions
- MAOI antidepressants, which must not be combined with it.
- Other medicines that affect heart rhythm.
- Other sedating medicines and alcohol, which increase drowsiness.
- Tell your prescriber and pharmacist about all your medicines.
Available as: Tablets and capsules, and a modified-release form.
Answers
Clomipramine: frequently asked questions
How long does clomipramine take to work?
It usually takes a few weeks before the benefit builds, and sometimes longer for obsessive-compulsive symptoms. It is important to keep taking it and attend follow-up, even if you do not feel better straight away.
Is clomipramine dangerous in overdose?
Yes. Like other tricyclic antidepressants, clomipramine can be dangerous in overdose because of its effects on heart rhythm. It should be kept safely away from children, and you should seek urgent help if too much is taken.
Why do I have a dry mouth and constipation on clomipramine?
These are common anticholinergic side effects of tricyclic antidepressants. Simple measures help, such as sips of water and a high-fibre diet; tell your prescriber if they are troublesome.
Can I stop clomipramine suddenly?
No. Stopping suddenly can cause withdrawal effects such as nausea, restlessness and trouble sleeping. It should be reduced gradually under your prescriber's guidance.
What is the difference between clomipramine and Anafranil?
They are the same medicine. Clomipramine is the active-ingredient (generic) name and Anafranil is a brand name; both contain identical clomipramine.
The wider class
About Tricyclic antidepressants
Clomipramine belongs to the tricyclic antidepressants class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Clomipramine.
- NICE CKS: Clomipramine.
- electronic Medicines Compendium (SmPC): Anafranil (clomipramine).
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