Clomipramine

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Clomipramine is an active ingredient against depression (antidepressant) from the class of tricyclic antidepressants. It is also used for obsessive-compulsive disorder, phobias, panic disorder, chronic pain conditions and other illnesses. Read more about the effects, uses and side effects of clomipramine here.

This is how clomipramine works

Signals are transmitted in the brain via messenger substances (neurotransmitters) such as serotonin and noradrenaline: When an electrical impulse excites a nerve cell, it releases a messenger substance into the synaptic gap - a tiny gap that acts as a contact point to the neighboring nerve cell. The messenger substance migrates to the neighboring cell, where it binds to special docking points (receptors) and thereby transmits the signal. The neurotransmitter is then reabsorbed into the original cell, which ends its effect.

In the case of depression, the neurotransmitter balance in the brain is out of balance. A low serotonin and noradrenaline level are considered to be partly responsible for depressive symptoms. This is where clomipramine comes in: It prevents serotonin and norepinephrine from being reabsorbed into the original nerve cell, which means that they can work for longer. This has a mood-enhancing and antidepressant effect.

In addition, clomipramine also has a dampening effect on pain perception (antinociceptive).

Clomipramine uptake, breakdown and excretion

After oral ingestion, clomipramine is completely and rapidly absorbed from the small intestine into the blood. Nevertheless, up to 50 percent of the active ingredient is metabolized when it first passes through the liver. Maximum clomipramine plasma levels are reached after two to eight hours. Excretion occurs mainly via the kidneys with the urine.

When is clomipramine used?

Clomipramine is used in the following cases:

depressions
Panic disorder
Sleep paralysis, cataplexy (short-term loss of muscle tension) and hypnagogic hallucinations (hallucinations when falling asleep) in narcolepsy (sleeping sickness)

for long-term pain treatment as part of an overall therapeutic concept

This is how clomipramine is used

Clomipramine is given as a tablet or a prolonged release tablet (extended-release tablet). The dosage depends primarily on the type and severity of the disease to be treated and how the patient responds to the drug.

The treatment is usually started gradually, i.e. with a lower dose, which is then slowly increased until the desired treatment effect occurs. This amount of active ingredient is then used as a maintenance dose. To stop treatment, the dose will be gradually reduced again to avoid side effects that may result from abrupt discontinuation.

The treatment will generally start to work about seven to 28 days after you start taking it. How long the drug must be taken is determined by the doctor.

What are the side effects of clomipramine?

The most common side effects of clomipramine are drowsiness, tiredness, internal restlessness, dizziness, headache, shaking (tremor), rapid, involuntary muscle twitching (myoclonia), sweating, dry mouth, constipation, nausea, increased appetite, weight gain, bladder emptying disorders, sexual dysfunction, blurred vision and adjustment difficulties of the eye.

Common side effects are, for example, speech disorders, muscle weakness, hallucinations, states of confusion, sleep disorders, anxiety, vomiting, diarrhea, taste disturbances, ringing in the ears (tinnitus) and itching.

Occasionally, patients have seizures. Rare side effects include a reduction in white blood cells (leukocytopenia) and platelets (thrombocytopenia) and urinary retention.

If you suffer from severe side effects or unknown symptoms, please consult a doctor.

What should be considered when taking clomipramine?

Do not take clomipramine in the following cases:

Hypersensitivity to the active ingredient or any other component of the drug
acute delirium
untreated angle-closure glaucoma
paralytic ileus (intestinal obstruction due to intestinal paralysis)
AV block II. And III. Degree (types of arrhythmia)

Interactions

Clompiramine can interact with various other active substances. For example, irreversible MAOIs (medicines for depression and Parkinson's disease) must be stopped at least 14 days before starting clomipramine treatment.

Some other active substances must also not be used with clomipramine, such as quinidine-type arrhythmias or certain other antidepressants (such as SSRIs).

Caution is advised when using various other drugs at the same time, such as those that cause a potassium or magnesium deficiency (risk of cardiac arrhythmias!). Before starting treatment, the doctor will therefore carefully check which medication a patient is already using.

Simultaneous consumption of alcohol can increase the depressant effect of the drug.

If tricyclic antidepressants like clomipramine are taken with fiber-rich foods or laxatives, this prevents them from being absorbed into the body.

pregnancy and breast feeding period

If treatment with tricyclic antidepressants is necessary during pregnancy, agents other than clompramine (such as imipramine or amitriptyline) should be given. However, if a woman becomes pregnant during treatment with clomipramine and she is stable, the drug does not necessarily have to be discontinued.

If clomipramine is used during pregnancy, the growth of the unborn child should be closely monitored by ultrasound. When used until birth, the newborn may show adjustment disorders, which is why it should be carefully observed in the first few days.

The use of clomipramine during breastfeeding must be carefully considered. Depending on the dosage, the active ingredient can affect the child's well-being.

Driving and using machines

Because clomipramine affects the ability to react, patients should not drive, operate machines or other dangerous activities for at least the first few days of treatment.