Clomipramine
Anafranil · Caniquell
Tricyclic AntidepressantGeneric availableTDM data
Clinical Pharmacology Clomipramine hydrochloride is a tricyclic antidepressant whose capacity to inhibit reuptake of serotonin in the central nervous system is believed to be the primary mechanism of action. Clomipramine also affects serotonergic and noradrenergic neuronal transmission in the central nervous system.
Compare Clomipramine →FDA-Approved Indications
- Obsessive-compulsive disorder (adults; children/adolescents 10+)
Common Off-Label Uses
- Body dysmorphic disorder
- Panic disorder
- Premature ejaculation
- Chronic pain
- Cataplexy
What Sets This Drug Apart
- Most serotonergic TCA and the only TCA with FDA-approved indication for OCD — distinguishes it from all other tricyclics
- Higher seizure risk than other TCAs (labeled warning); dose-dependent, especially above 250 mg/day
- Active metabolite desmethylclomipramine is noradrenergic; fluvoxamine (CYP1A2 inhibitor) shifts metabolism to favor serotonergic parent compound
- MAOI combination is always prohibited (unlike some other TCAs where expert co-prescription is occasionally attempted)
- Plasma level monitoring available: clomipramine + desmethylclomipramine combined levels guide dosing and toxicity risk
- Therapeutic dose range 100-250 mg/day; start low (25 mg) and titrate slowly due to GI and anticholinergic side effects
Boxed Warning
Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality)