Clomipramine is used to treat depression.
It can also be used to treat phobias (irrational or disabling fears), and obsessive-compulsive disorder or OCD (a disorder characterised by uncontrollable urge to do repetitive and ritualised behaviours).
Clomipramine may also be used together with other medicines to treat cataplexy (a sudden and uncontrollable muscle weakness usually triggered by strong emotions such as laughter) in people with narcolepsy (a sleep disorder that causes a person to suddenly fall asleep).
This medicine may be used to treat other conditions as decided by your doctor.
Take Clomipramine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
Take it together with food or immediately after a meal. Try to take it at the same time each day.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and response to the medication.
Clomipramine must be taken regularly for it to be effective. Continue taking it even when you feel better. Do not stop taking this medicine unless instructed otherwise, as stopping it suddenly may worsen your condition. Your doctor will gradually reduce the dose before stopping it or changing it to another medicine.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Alert your doctor if you have the following conditions:
- recent heart attack within the last 3 months
- any type of heart block and irregular or abnormal heartbeat
- mania (mental illness of feeling highly excited, being over-active and easily irritated or distracted)
- narrow-angle glaucoma (increased pressure in the eye)
- urinary retention (inability to completely empty the bladder when urinating)
- severe liver disease
as this medicine may not be suitable for you.
Do not take Clomipramine with medicines used to treat depression, certain antibiotic, and a dye for certain procedures classified as monoamine oxidase inhibitors (MAOIs). Please see section “Can I take it with other medicines?” below for more information.
Inform your doctor if you have the following conditions:
- depression and other mood disorders e.g. schizophrenia
- bipolar disorder (mood changes between feeling very high and very low)
- with or a history of epilepsy (fits or seizures)
- conditions predisposing to fits or seizures e.g. brain damage, alcoholism
- with or a family history of heart disease or heart rhythm disorder
- bleeding tendencies
- phaeochromocytoma (rare tumour of the adrenal gland causing high blood pressure)
- bowel diseases e.g. long-term constipation, slow bowel motility
- paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
- history of narrow-angle glaucoma (increased pressure in the eye)
- hypokalaemia (low potassium level in the blood)
- low blood volume circulating in the body
- prostate enlargement
- thyroid disease
- kidney disease
- liver disease
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Clomipramine to an elderly. Elderly people may be more sensitive to the side effects.
Notify your doctor if you have recently undergone electroshock therapy (also known as electroconvulsive therapy or ECT).
If you are going to have an operation, including minor surgery and dental work, inform your doctor or dentist that you are taking Clomipramine.
If you are going for certain laboratory test (e.g. urine test for methadone), inform your doctor that you are taking this medicine.
Medicines for depression such as Clomipramine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Certain enzymes called CYP2D6 and CYP2C19 are involved in the metabolism of this medicine. Individuals who are poor metabolisers of CYP2D6 and CYP2C19 may experience enhanced side effects of Clomipramine (e.g. dry mouth, constipation) that may require dose adjustments. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have this gene type, inform your doctor.
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
What lifestyle changes should I make to cope with depression?
- Your blood pressure and pulse may rise to unsafe levels without you noticing it. You may need to monitor your blood pressure and pulse before and periodically during your treatment.
- You may need to have routine tests (e.g. kidney and liver function, blood sodium levels, ECG) while you are being treated with Clomipramine. Your doctor will advise you about how often you will need to have these tests.
- Monitoring of signs of suicidal thoughts or attempts, and unusual changes in behaviour may also be needed.
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Clomipramine may cause dizziness, drowsiness, or some problems with your eyesight such as blurred vision. If affected, do not drive or take part in any activity in which you need to be alert.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Other side effects include any of the following: headache, dry mouth, constipation, nausea, vomiting, diarrhoea, increased appetite, weight gain or loss, excessive sweating, hot flushes, ringing in the ears, yawning, tremors, restlessness, tiredness, and difficulty sleeping.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- having thoughts of self-harm
- unusual changes in mood or behaviour (being too depressed, irritable, confused, too excited, aggressive, or having compulsive and impulsive behaviour)
- hallucinations (seeing, hearing or feeling things that are not existent)
- being agitated, very high fever, rigid muscles, involuntary spasm or movements, fits or seizures
- severe stomach pain, unusual tiredness, yellowing of the skin or eyes, dark-coloured urine, frequent and persistent sore throat or mouth ulcers with fever, unusual bleeding or bruising
- fast or irregular heartbeat, chest pain, unexplained fainting or loss of consciousness
- difficulty or inability in passing out urine
- rashes, breathlessness, swollen eyes, face or throat
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Clomipramine if you are currently taking or have taken a medicine to treat depression known as monoamine oxidase inhibitor (MAOI) such as moclobemide, phenelzine, isocarboxazid and tranylcypromine in the last 21 days of stopping the MAOI.
Do not take this medicine if you are taking or using other MAOIs such as:
- linezolid (antibiotic)
- injectable methylene blue (dye for certain procedures)
Inform your doctor and pharmacist if you are taking any of these medicines:
- other medicines to treat depression e.g. fluvoxamine, fluoxetine, sertraline, amitriptyline
- medicines for mood disorders e.g. lithium, clozapine, pimozide, thioridazine
- medicines for epilepsy (fits or seizures) e.g. phenytoin, carbamazepine, phenobarbital
- medicines for anxiety or sleeping disorder e.g. alprazolam, temazepam, diazepam
- medicines for high blood pressure e.g. clonidine, guanethidine, betanidine, methyldopa
- medicines for irregular heartbeat e.g. quinidine, disopyramide, amiodarone, verapamil
- medicines for cold or allergy e.g. terfenadine, phenylephrine, phenylpropanolamine
- medicines to treat Parkinson’s disease e.g. levodopa, biperiden, selegiline, entacapone
- NSAIDs (medicines for pain and inflammation) e.g. aspirin, ibuprofen, piroxicam
- water pills or medicines for water retention e.g. bendroflumethiazide, furosemide
- medicines for HIV infection e.g. ritonavir, indinavir
- strong painkillers e.g. fentanyl, tramadol, nefopam, morphine
- cholesterol-lowering medicines e.g. colestipol, cholestyramine
- blood-thinning medicines e.g. warfarin, apixaban, dabigatran
- methylphenidate (medicine to treat hyperactivity disorders)
- levacetylmethadol (medicine to treat addiction to certain substance)
- altretamine (medicine for cancer)
- terbinafine (medicine to treat fungal infection)
- cimetidine (gastric medicine)
- rifampicin (medicine to treat tuberculosis or TB)
- quinine (medicine for malaria)
- baclofen (medicine for muscle relaxation)
- herbal medicine e.g. St. John’s wort
This list does not include all medicines that may interact with Clomipramine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Avoid excessive consumption of grapefruit, cranberry juice and grapefruit juice (more than 1 litre a day).
Avoid foods that are rich in tyramine, such as cheese, sausages, soya beans, fava beans, broad beans and pickled foods like sauerkraut. Ask your doctor or dietitian about the types of food you should avoid.
Store in a cool, dry place, away from the reach of children. Protect from moisture.
Medicines must not be used past the expiry date.