Clomipramine

Clomipramine: Uses, Dosage and Side Effects

Overview

Both clomipramine and its primary metabolite desmethyl-clomipramine are active in blocking serotonin and noradrenaline reuptake in the brain, with resultant anxiolytic,
antidepressant and anticompulsive effects.

Uses of Clomipramine

• Licensed for use in association with a behavior modification plan for the management of separation-related disorders in dogs.
• Also used in the management of a wider range of anxiety-related disorders in dogs and cats, including compulsive behaviors, noise fears, and urine spraying.
• Has been reported in the treatment of cataplexy in the dog, with a resolution of signs after 3 months of treatment.
• Care is required before use in animals with a history of constipation, epilepsy, glaucoma, urinary retention, or arrhythmias.
• Can be used with benzodiazepines.

Dose of Clomipramine in Dogs and Cats

Dogs:

1–2 mg/kg p.o. q12h.

Cats:

0.25–1 mg/kg p.o. q24h.

Side Effects of Clomipramine in Dogs and Cats

• May cause sporadic vomiting, changes in appetite or lethargy.
• Vomiting may be reduced by co-administration with a small quantity of food.
• May cause urinary retention in cats.
• The safety margin is quite low with toxic side effects observed at 2–3 mg/kg, although fatal does is >10 times the recommended dose.

Contraindications of Clomipramine in Dogs and Cats

• Patients sensitive to tricyclic or serotonin reuptake inhibitor antidepressants.
• Do not give with or within 2 weeks of, monoamine oxidase inhibitors (e.g. selegiline).
• Not recommended for use in male breeding animals, as testicular hypoplasia may occur.

Some Notes:

• May potentiate the effects of anticholinergic agents (e.g. atropine), other CNS active drugs (e.g. barbiturates, benzodiazepines, general anesthetics, neuroleptics),
  sympathomimetics (e.g. adrenaline) and coumarin derivatives.
• Simultaneous administration with cimetidine may lead to increased plasma levels of clomipramine.
• Plasma levels of certain antiepileptic drugs, e.g. phenytoin and carbamazepine, may be increased by co-administration with clomipramine.
• Should not generally be used alongside other serotonergic agents given the risk of serotonin syndrome, although use alongside trazodone may be considered in exceptional cases, so long as the patient is carefully monitored for signs of serotonin syndrome.