- Last edited on March 4, 2021
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
Cytochrome P450 Metabolism
See also article: Cytochrome (CYP) P450 Metabolism
Clomipramine: Cytochrome P450 Metabolism
Substrate of (Metabolized by) | |
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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 | |
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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