Formulary
Clomipramine hydrochloride: Indications, Dosing, Side Effects and Interactions
Clomipramine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Clomipramine hydrochloride: Indications, Dosing, Side Effects and Interactions
Clomipramine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness**
- **Adult** (By Mouth): Initially 10 mg daily, then increased if necessary to 30-150 mg daily in divided doses, dose to be increased gradually, alternatively increased if necessary to 30-150 mg once daily, dose to be taken at bedtime; maximum 250 mg per day.
- **Elderly** (By Mouth): Initially 10 mg daily, then increased to 30-75 mg daily, dose to be increased carefully over approximately 10 days.
**Phobic and obsessional states**
- **Adult** (By Mouth): Initially 25 mg daily, then increased to 100-150 mg daily, dose to be increased gradually over 2 weeks; maximum 250 mg per day.
- **Elderly** (By Mouth): Initially 10 mg daily, then increased to 100-150 mg daily, dose to be increased gradually over 2 weeks; maximum 250 mg per day.
**Adjunctive treatment of cataplexy associated with narcolepsy**
- **Adult** (By Mouth): Initially 10 mg daily, dose to be gradually increased until satisfactory response; increased if necessary to 10-75 mg daily.
Cautions
Cardiovascular disease; chronic constipation; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; risk factors for QT interval prolongation-correct hypokalaemia before initiating treatment; susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Treatment should be stopped or dose reduced if the patient enters a manic phase. M Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects. M
Contraindications
Acute porphyrias ; arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Side effects
Common or very common Aggression; anxiety; arrhythmias; breast enlargement; concentration impaired; confusion; constipation; delirium; depersonalisation; depression exacerbated; diarrhoea; dizziness; drowsiness; dry mouth; fatigue; galactorrhoea; gastrointestinal disorder; hallucination; headache; hot flush; hyperhidrosis; memory loss; mood altered; movement disorders; muscle tone increased; muscle weakness; mydriasis; nausea; palpitations; paraesthesia; photosensitivity reaction; postural hypotension; sexual dysfunction; skin reactions; sleep disorders; speech disorder; taste altered; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight increased; yawning Uncommon Psychosis; seizure Rare or very rare Agranulocytosis; alopecia; cardiac conduction disorders; eosinophilia; glaucoma; hepatic disorders; hyperpyrexia; interstitial lung disease; leucopenia; neuroleptic malignant syndrome (discontinue-potentially fatal); oedema; QT interval prolongation; SIADH; thrombocytopenia; vaginal haemorrhage Frequency not known Increased risk of fracture; rhabdomyolysis; serotonin syndrome; suicidal behaviours; withdrawal syndrome Side-effects, further information The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2-3 days). Consider using a lower starting dose in elderly patients. Overdose Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning .
Interactions
**Severe interactions:**
- Cytotoxic Altretamine: risk of severe postural hypotension.
- Clomipramine should be used cautiously when co-administered with: Buprenorphine/ opioids as the risk of serotonin syndrome, a potentially life-threatening condition is increased (see section 4.4).
**Other interactions (33):**
- There is evidence to suggest that clomipramine may be given as little as 24 hours after a reversible MAO-A inhibitor such as moclobemide, but the 3-week wash-out period must be observed if the MAO-A...
- Interactions resulting in a concomitant use not recommended Diuretics Diuretics may lead to hypokalaemia, which increases the risk of QTc prolongation and torsades de pointes.
- Quinidine Tricyclic antidepressants should not be employed in combination with antiarrhythmic agents of the quinidine type.
- Selective serotonin reuptake inhibitors (SSRIs) SSRIs which are inhibitors of CYP2D6, such as fluoxetine, paroxetine, or sertraline, and of others including CYP1A2 and CYP2C19 ( e.g.
- Serotonergic agents Serotonin Syndromecan possibly occur when clomipramine is administered with other serotonergic co-medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin...
- For fluoxetine, a wash-out period of two to three weeks is advised before and after treatment with fluoxetine.
Pregnancy
Neonatal withdrawal symptoms reported if used during third trimester.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises caution; avoid in severe impairment (risk of hypertensive crisis).
Medicinal forms
Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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