Table of contents

  • Brand Names
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Unlabeled Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Caution and personalized dose adjustment in patients with the following genotypes
  • Other genes that may be involved
  • Substrate of
  • Inhibits
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names


Austria: Anafranil; Belgium: Anafranil; Bulgaria: Anafranil; Cyprus: Anafranil, Clomipramine, Zoiral; Czech Republic: Anafranil; Denmark: Anafranil, Clomicalm, Klomipramin; Estonia: Anafranil; Finland: Anafranil, Clomicalm; France: Anafranil, Clomipramine; Germany: Anafranil, Clomicalm, Clomipramin, Hydiphen; Greece: Anafranil; Hungary: Anafranil; Ireland: Anafranil; Italy: Anafranil; Latvia: Anafranil; Lithuania: Anafranil; Luxembourg: Anafranil; Malta: Anafranil, Clomipramine; Netherlands: Anafranil, Clomipramine; Poland: Anafranil, Hydiphen; Portugal: Anafranil; Romania: Anafranil, Clomipramine; Slovakia: Anafranil; Spain: Anafranil; Sweden: Anafranil, Klomipramin; UK: Anafranil.

North America

Canada: Anafranil, Clomicalm, Clomipramine; USA: Anafranil, Clomipramine.

Latin America

Argentina: Anafranil; Brazil: Anafranil, Clomipramina, Clomipran; Mexico: Anafranil.


Japan: Anafranil.

Drug combinations


Clomipramine Hydrochloride: C~19~H~23~ClN~2~ HCl. Mw: 351.31. (1) 5H-Dibenz[b,f]azepine-5-propanamine, 3-chloro-10,11-dihydro-N,N-dimethyl-, monohydrochloride; (2) 3-Chloro-5-[3-(dimethylamino)propyl]-10,11-dihydro-5H-dibenz[b,f]azepine monohydrochloride. CAS-17321-77-6; CAS-303-49-1 (clomipramine)(1970).

Pharmacologic Category

Antidepressants; Tricyclics and Other Norepinephrine-reuptake Inhibitors. (ATC-Code: N06AA04).

Mechanism of action

Tricyclic antidepressants increase the synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibition of their reuptake by the presynaptic neuronal membrane. Exhibits marked anticholinergic activity, which may account for sedation, adverse cardiovascular effects, and reduced seizure threshold (particularly at relatively high dosages).

Therapeutic use

Obsessive-compulsive disorder (OCD).

Pregnancy and lactiation implications

There are no adequate studies in pregnant women. Withdrawal symptoms observed in neonates whose mothers took clomipramine up to delivery. Use in pregnancy only if the benefits to the mother outweigh the potential risks to the fetus. Not recommended during lactation.

Unlabeled use

Depression, panic attacks, chronic pain.


Hypersensitivity to clomipramine, other tricyclic agents, or any component of the formulation. Use of MAO inhibitors within 14 days. Use during the acute recovery phase of myocardic infarct.

Warnings and precautions

Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive and other psychiatric disorders. Clomipramine is FDA approved for the treatment of obsessive-compulsive disorder in children ≥10 years of age. May worsen psychosis in some patients or precipitate a shift to mania or hypomania in bipolar disorder. Clomipramine is not FDA approved for the treatment of bipolar depression. May cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention); use with caution in decreased gastrointestinal motility, paralytic ileus, urinary retention, BPH, xerostomia, or visual problems. The degree of anticholinergic blockade produced by this agent is very high relative to other antidepressants. May rarely cause bone marrow suppression. May cause orthostatic hypotension (use with caution in cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). May cause seizures (use with caution in previous seizure disorder or condition predisposing to seizures such as brain damage, alcoholism, or concurrent therapy with other drugs which lower the seizure threshold). Has been associated with a high incidence of male sexual dysfunction. May cause weight gain. Use with caution in history of cardiovascular disease (risk of conduction abnormalities is high relative to other antidepressants). Use with caution in hepatic/renal impairment. Use with caution in patients with hyperthyroidism or those receiving thyroid supplementation due to concerns of pro-arrhythmogenesis. Hyperpyrexia has been observed with tricyclic antidepressants in combination with anticholinergics and/or neuroleptics, particularly during hot weather. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Recommended to discontinue prior to elective surgery requiring general anesthesia. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. May increase the risks associated with electroconvulsive therapy.



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