Clomipramine

Clomipramine is approved for OCD. Providers may also use it off-label for depression or certain anxiety conditions. For OCD, medication is often paired with exposure and response prevention therapy.

It strongly inhibits serotonin reuptake; an active metabolite also affects norepinephrine. Other receptor effects contribute to sedation, dry mouth, constipation, and sexual side effects.

OCD symptoms often improve slowly. A useful trial may take 10–12 weeks, including time at a tolerated therapeutic dose. Review intrusive thoughts, time spent on rituals, and daily functioning.

Side effects may appear earlier than benefit. Schedule an earlier appointment if your mood gets worse.

• Take with food during dose adjustment if directed to reduce stomach upset.
• If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
• Do not combine divided doses into a single dose without instructions.
• Avoid alcohol. Consult with your provider before stopping.

• Dry mouth, constipation, or blurred vision
• Drowsiness or dizziness when standing
• Sweating, weight change, or sexual side effects

Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.

Antidepressants can increase suicidal thoughts in people under 25. Watch for changes in mood or behavior at any age, especially when starting treatment or changing a dose.

Your provider may check pulse, blood pressure, weight, and an ECG, depending on your age, dose, other medications, and heart history. Report constipation or urinary problems before they become severe.

Seizure risk rises with higher exposure. Your provider may use a blood level or ECG when clinically indicated.

For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.

Discuss heart disease, a recent heart attack, fainting, glaucoma, difficulty urinating, severe constipation, seizures, bipolar symptoms, and kidney or liver problems.

Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.

Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.

Do not combine with an MAOI antidepressant. Switching requires a specific waiting period; fluoxetine can continue to affect other medications for weeks.

Some antidepressants raise tricyclic levels. Medicines that affect heart rhythm, sedating antihistamines, bladder medicines, opioids, and alcohol can add important risks.

Fluvoxamine, fluoxetine, paroxetine, and other inhibitors can raise levels. Other serotonergic drugs and medicines that lower the seizure threshold require close review.

Stand up slowly and use caution on stairs if you feel lightheaded.

Sugar-free gum, regular dental care, and adequate fluids may help dry mouth. Discuss persistent constipation.

Store your supply securely. An overdose can be life-threatening even before symptoms appear.

Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.