Some Major side effects that can lead to complications- clomipramine

While taking antidepressants you might ignore the possible side effects of the medication, which can land you in trouble at times. Knowing about these side effects can help you contact emergency medical help in advance. Let us know about the major side effects of clomipramine that can lead to complications.

Common side effects of clomipramine

  • fatigue
  • tremor
  • constipation
  • urination disorder
  • weight gain
  • dyspepsia
  • ejaculatory disorder
  • nausea
  • nervousness
  • visual disturbance
  • myoclonus
  • paresthesia
  • anorexia
  • xerostomia
  • drowsiness
  • headache
  • dizziness
  • insomnia
  • diaphoresis

Other side effects are

  • hot flash
  • skin rash
  • taste disorder
  • anxiety
  • sleep disorder
  • muscle twitching
  • hypertonia
  • memory impairment
  • non-puerperal lactation
  • fever
  • vomiting
  • orthostatic  hypotension
  • tachycardia
  • tinnitus

Major side effects

You should call medical help immediately in case you experience any of the below mentioned side effects

  • body pain or aches
  • bladder pain
  • blurred vision
  • cloudy or bloody urine
  • confusion
  • crawling, itching, crawling, numbness, tingling or prickling feelings
  • nervousness or fear
  • fever
  • feeling empty or sad
  • irritability
  • hearing changes
  • side pain or lower pain
  • poor concentration
  • sneezing
  • poor concentration
  • voice changes
  • chest wheezing or tightness
  • unusual weakness or tiredness
  • faintness, light-headedness or dizziness when rising suddenly from a sitting or lying position

Less common

  • chills
  • breast enlargement
  • Anger that is difficult to control
  • speech problems
  • burning sensation while urinating
  • hyperventilation
  • vomiting or nausea
  • paranoia
  • painful sexual intercourse
  • Throbbing and severe headache
  • shaking
  • restlessness
  • Swelling of lower legs, feet, fingers or face
  • change in moods
  • dry mouth
  • racing, fast, irregular, pounding pulse or heart beat

Minor side effects

Some minor side effects of clomipramine do not need medical help. As the body gets used to the treatment, these side effects disappear with time.  Your health care provider can help you know how to reduce or prevent these minor side effects. In case these side effects continue to exist for a longer period, contact your health care provider immediately.

More Common

  • constipation
  • dry skin
  • sour or acid stomach
  • heartburn
  • welts, skin rash or hives
  • joint pain
  • swelling
  • pimples
  • scaly, dry or cracked skin
  • shaking or trembling of  feet or hands
  • redness of arms, neck, face or upper chest
  • diarrhea

Less common

  1. irregular, absent or missed menstrual period
  2. sores, white spots, ulcers on tongue, lips or inside mouth
  3. breast pain

The side effects can range from mild to severe and any side effect that lasts long or is bothersome, need immediate medical attention. Do not ignore these side effects as they can be fatal too. Seek emergency help to treat these side effects. Your doctor can help you reduce the side effects.

Effects of Clomipramine on pregnancy and breastfeeding

Certain medicines are not safe for use during breastfeeding or pregnancy. However some other medicines can be used safely in breastfeeding or pregnancy provided the benefits are higher than the risks to the unborn baby. Always discuss with your doctor if you are planning to conceive or if pregnant, before you use any medication.

Clomipramine and pregnancy

There are certain situations where it is not safe to use clomipramine and pregnancy is the one.  Although clomipramine doesn’t lead to birth defects in animal studies, but it was linked to defects in heart in humans.  Also it is linked to various withdrawal symptoms like blue skin, seizures and muscle weakness in babies born to woman who used clomipramine during third trimester of their pregnancy.

For pregnant women, clomipramine is not safe for use. Clomipramine hydrochloride is not safe. This is reported based on human and animal studies and looking at the effects of clomipramine in pregnancy.

Withdrawal symptoms in babies were been reported in cases wherein mothers used clomipramine during third trimester of pregnancy. The symptoms seen in new born are

  • blue skin
  • shakiness
  • jitteriness
  • muscle weakness or muscle tension
  • seizures

Clomipramine and breastfeeding

If you are using clomipramine while breastfeeding, it is very important to be aware of the fact that this medication is secreted into breast milk. Generally, doctors often say that it is fine to breastfeed your baby while using the medication as in some cases the benefits of breastfeeding are higher than risks. However, complete data regarding the risks to the child is still unknown because there are no studies available that explain the benefits and risks of using clomipramine while breastfeeding.

As clomipramine transfers in breast milk and looking at the side effects of the medication, manufacturers often warn to calculate the risks of the medication to the baby before clomipramine is used by breastfeeding mothers.  So, check with your paediatrician or physician to know if you can use clomipramine while breastfeeding.

Depending upon your current health condition, your physician can help you take the right decision. Each and every situation is different, so let your doctor judge what is right for you. Many women undergo depression during this stage and seek immediate medication to overcome the unbearable symptoms of depression, but taking any hasty decision without discussing with your doctor can ham your baby.

Make sure you inform your doctor if you are pregnant or planning to conceive and using clomipramine already.  Use of clomipramine during pregnancy can affect how your pregnancy progresses. You can always check with your doctor if he can suggest you any alternative medication to manage depression. Try not to take clomipramine during pregnancy or breastfeeding as antidepressants can harm your baby as they are linked to many side effects too.

It is better to be on the safer side and avoid antidepressants during pregnancy/breastfeeding to avoid severe withdrawal symptoms in your baby or complications in pregnancy. Try to treat depression using safe and non narcotic drugs.

Dosage information and directions for Clomipramine capsules

During the starting phase of titration, Clomipramine should be prescribed in split doses with food to lessen gastrointestinal side effects. The main objective of starting phase of titration is to reduce side effects by allowing tolerance to different side effects to build patient time, in case tolerance is not built.

Initial Treatment or Dose adjustment in Adults

Treatment using Clomipramine should be started with an initial dose of 25mg/daily, which can be gradually increased based on patient’s tolerance to 100mg during the period of first two weeks. While starting with titration, Clomipramine should be prescribed in split doses with food to lessen gastrointestinal side effects. Later the dosage can be increased gradually in coming several weeks up to maximum -250mg/daily. After titration the complete daily dose can be given once in a day at bedtime to reduce daytime sedation.

Initial Treatment or Dose adjustment in Adolescents and Children

As in adults, the initial dose of 25mg/daily should be prescribed, which can be gradually increased (also given in split doses with food to lessen gastrointestinal side effects.) in first two weeks, based on patient’s tolerance up to maximum dosage of 3mg/kg or 100mg. Later the dosage can be increased gradually in coming several weeks up to maximum -200mg/daily. After titration the complete daily dose can be given once in a day at bedtime to reduce daytime sedation.

Continuation/Maintenance Treatment in Children, Adults and Adolescents

Well, there are no standard studies available that can answer the question as how long you can continue to take Clomipramine, OCD is basically a chronic condition and it is sensible to observe continuation for a patient who responds well to the treatment. Although the ability of Clomipramine after ten weeks is not yet documented in controlled trials, patients have been given the therapy on a continual basis under trial period for up to one year. However, the dosage adjustments are made to maintain lowest effective dose for the patient. The patient should also be examined on a regular basis to check if they still need treatment. During maintenance the daily dose should be given once in a day during bedtime.

Clomipramine – Over dosage and treatment

Over dosage of Clomipramine can even lead to death in many cases. Over dosage can take place either with use of Clomipramine in combination with other drugs or alone with Clomipramine. Symptoms and signs of over dosage entirely depends on the severity and other factors for example the quantity of drug absorbed, time gap of drug ingestion and age of the patient. An ECG and cardiac monitoring should be initiated immediately. The patient must be kept under medical supervision for at least 6 hours with cardiac monitoring and for signs of hypotension, respiratory or CNS depression, seizures, cardiac dysrhythmias or conduction blocks.

All patients suspected of Clomipramine over dosage should get gastrointestinal decontamination treatment. This includes gastric lavage accompanied by activated charcoal. If consciousness is disabled, the airway should be obtained before lavage.

In case Clomipramine over dosage make sure you call medical help immediately.

Clomipramine Drug interactions that you should consider

Taking Clomipramine with other medications that slow your breathing or make you drowsy can enhance these effects. Check with your doctor before using clomipramine with a pain medicine (narcotic), sleeping pill, anxiety medication, depression, muscle relaxer or medicine for seizures.

Before taking clomipramine, inform your doctor if you have taken an SSRI in last 5 weeks like Sarafem, paroxetine, fluvoxamine, vilazodone etc., many drugs may interact with Clomipramine. Tell your health care provider about the medicines you are using or any you stopped or started using during Clomipramine treatment especially

Some other drugs that can interact with clomipramine are

  • amphetamines
  • methylphenidate
  • buproprion
  • metoclopramide
  • olanzaprine
  • phenytoin
  • pimozide
  • carbamazepine
  • rifabutin
  • quinine
  • rifampin
  • ciprofloxacin
  • lansoprazole
  • tramadol
  • valproic acid
  • estrogens
  • SSRI antidepressants
  • grapefruit juice
  • duloxetine
  • codeine
  • rabeprazole

If you are using any of the above mentioned medications, discuss with your doctor/pharmacist. Depending on your medical condition, your doctor can ask you to

  1. change the existing medication to another
  2. discontinue one of the current medication
  3. continue with the same schedule
  4. change the dose or frequency of either or both medicines

MAOIs and clomipramine

Clomipramine and MAOIs when used together can lead to a medical condition known as serotonin syndrome, which is fatal syndrome, low blood pressure and hypertensive reactions.

Duloxetine and clomipramine

Using clomipramine and Duloxetine together can lead to rare yet serious condition known as setotonnin syndrome, which includes symptoms like seizure, hallucination, and confusion, fluctuations in blood pressure, excessive sweating, vomiting, nausea, stomach cramp, stiffness, tremor, muscle spasms, blurred vision, and irregular heart beat. If these symptoms persist, speak to your health care provider immediately as he can help you treat these side effects effectively. You can take precautions in advance to avoid fatal complications.

A drug interaction between two drugs does not necessarily mean that you should discontinue either of them. Discuss with your health care provider how the drug interactions are controlled or should be controlled.

Tell your physician if you are using any other drugs apart from clomipramine like herbal preparation, dietary supplements, alcohol, cigarettes or even street drugs. Do not hesitate to share with your doctor if you are using street drugs as you don’t know how they are going to interact with clomipramine.

Clomipramine- antidepressant to control obsessive-compulsive disorder

The generic name is Clomipramine and brand name is Anafranil. Clomipramine is basically used to treat OCD (obsessive-compulsive disorder). It works by enhancing the action of specific chemicals present in brain, which helps control OCD.

Avoid using Clomipramine if

  1. You are allergic to the ingredient (any) present in Clomipramine or to similar medications.
  2. You have used MAOIs or linezolid in last 14 days.
  3. You are re gaining health after a recent heart attack

Discuss with your health care provider if any of the above condition is applicable to you

Some important information

Certain medical conditions can interact with Clomipramine. Speak to your doctor if you have any of the below listed medical conditions like

  • If you are pregnant or planning to conceive or a nursing mother
  • If you consume alcohol or have history of alcohol addiction
  • If you are using any prescription/non prescription medication, herbal preparation or a dietary supplement
  • If you use thyroid medicine or had an overactive thyroid in the past.
  • if you have a history of glaucoma, liver or kidney problems, adrenal gland issues, diabetes, heart problems, porphyria, seizures, urinating problems or other blood problems
  • If you are allergic to medicines, food or other elements
  • Have a history of suicidal behaviour or thoughts, mental disorders or bipolar disorders.
  • If you are about to undergo a surgery or an electroshock therapy.
  • If you are using medicines comprising of methylene blue

Take Clomipramine exactly as prescribed by your doctor. Check the label and read the dosing instructions carefully. Do not consume alcohol with Clomipramine as it can lead to drowsiness. Children, young adults or teenagers who use Clomipramine are at higher risk of suicidal actions or thoughts. Even adults are affected.  This risk can be higher in people who have suicidal actions or thoughts in the past and also in people suffering from bipolar illness. Such patients should be monitored closely. Contact your health care provider if the symptoms worsened or arise suddenly like restlessness, depressed mood, anxious, panic attacks, irritable behaviour and abnormal change in mood. In case suicidal behaviour or thoughts occur, contact medical help immediately.

Is Clomipramine Addictive?

Clomipramine is not addictive.  Do not stop taking medication suddenly as it can lead to unwanted withdrawal symptoms.  Withdrawal symptoms are temporary and they do not occur as a result of drug dependency or addiction. They can be prevented by stopping the medication slowly over a period of months or weeks depending on the medical condition of an individual.

If you are planning to take Clomipramine, speak to your doctor and let him know about all other medicines you are taking to avoid drug interactions. You should also speak to your doctor if you want to stop using Clomipramine as stopping the medication suddenly can lead to unwanted withdrawal symptoms. Your doctor will help you gradually stop the medication by reducing the doses over a period of time. This way you can stop using the medication safely without withdrawal symptoms.

Uses of Clomipramin and related Side effects

Clomipramin is basically used for treating OCD(obsessive compulsive disorder). It helps reduce unwanted thoughts and also reduces urge to do repeated tasks like counting, hand washing, checking that disturb the daily life.

The medication is also used for treating panic attacks, depression and ongoing pain. Let us understand how to take the medication(Clomipramin).

You can take this medication orally without or with food as advised by the doctor. To reduce the side effects like stomach upset, Clomipramin can be started with a lower dose, given in many doses throughout the day along with meals and increase the dose gradually as your body starts getting used to the medication. Once you get to know the right dose for you, you can take the complete dose once on a daily basis.

It is better to follow the instructions of your doctor carefully in order to avoid further complications. You should avoid drinking grapefruit and eating grapefruit while you are on this medication(Clomipramin). Consult your physician to know more about it.

Side effects related to Clomipramin

The side effects associated with Clomipramin are dry mouth, constipation, dizziness, flushing, vomiting, change in weight/appetite, blurred vision, tiredness can occur. Anxieties symptoms may get worsen temporarily when you start taking Clomipramin for the first time. You should consult your health care provider about the symptoms.

To get relief from dry mouth, you can suck ice chips, sugarless candies, drink water, chew gum or any other option that can act as a substitute for saliva. To prevent the problem of constipation you can focus on an adequate diet rich in fiber, exercise and drink a lot of water.

You should consult your doctor immediately if some serious side effects which though are rare occur like bleeding, infection signs, bruising, uncontrolled movements (facial) dark urine, yellowing of skin/eyes, abdominal pain or stomach pain.

Thought the serious side effects are rare, but they can occur if you are using other drugs that lead to increased serotonin. So if you experience the following symptoms consult your doctor immediately.

Twitching muscles

Unexplained fever

Restlessness

Unusual agitation

Fast heartbeat

Severe dizziness

Co-ordination loss

Hallucinations

Vomiting

Diarrhea

You also need medical help in case of side effects that are very serious like

Chest pain

Seizures

Vision changes

Swelling/redness/eye pain

Faster heart beat

Black stools

Drug interactions – Clomipramin

Drug interactions actually change how any medication works for you and may increase the risk of dangerous side effects. So you need to maintain a list of all your medications you are taking like all prescription.non prescription drugs, herbal products and let your doctor know about it.

Do not try to change the dose of any medications without consulting your doctor. Some drugs that lead to interactions with this medication are : anticholinergics, some drugs used for blood pressure, thyroid supplements etc.,

There are other medications which also remove Clomipramin from our body, which also impacts how the drug(Clomipramin) works. So one needs to be very careful and consult the doctor with the list of medications you are taking already.