Clomipramine (Anafranil)

Primer

Clomipramine (Trade name: Anafranil) is a tricyclic antidepressant used in the treatment of obsessive compulsive disorder.

Pharmacokinetics

See also article: Introduction to Pharmacology

Pharmacokinetics of Clomipramine

Absorption
Distribution
Metabolism
Elimination
Half-life

Cytochrome P450 Metabolism

See also article: Cytochrome (CYP) P450 Metabolism

Clomipramine: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits

Pharmacodynamics

Mechanism of Action

Clomipramine is a potent inhibitor of serotonin reuptake, but its desmethyl metabolite inhibits norepinephrine (NE) reuptake.

Toxicity

Clomipramine can be fatal in overdose.

Indications

Dosing

Dosing for Clomipramine

Starting
Titration
Maximum	Doses are typically < 250mg
Taper

Formulations

Clomipramine comes in oral (PO) and intravenous (IV) formulations
- The IV formulation may be especially helpful in obsessive compulsive disorder

Monitoring

Contraindications

Absolute

Relative

Drug-Drug Interactions

Side Effects

Clomipramine may have a more problematic side effect profile due to its antiadrenergic, anticholinergic, and antihistaminergic-related side effects
Common side effects include sedation, constipation, weight gain, postural hypotension, and anticholinergic side effects such as dry mouth, blurry vision, and urinary retention).

Adverse Events

Clinical Pearls

Clomipramine is the most serotonergic of the tricyclic antidepressants.

Special Populations

Geriatric

See main article: Geriatric Pharmacology

Pediatric

See main article: Pediatric Pharmacology

Obstetric and Fetal

See main article: Obstetric and Fetal Pharmacology

Medically Ill

See main article: Psychotropic Dosing in the Medically Ill

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