Available on prescription. Safe storage is important due to overdose risk.
What it treats
Which conditions is Clomipramine used for?
Overview
What is Clomipramine?
Clomipramine is a tricyclic antidepressant that stands out within its class for having a particularly strong effect on serotonin, the brain chemical most closely linked to obsessive-compulsive disorder. This is why it became the benchmark treatment for OCD.
It is listed in both the World Health Organization's Model Essential Medicines List and Kenya's Essential Medicines List 2023.
Although newer medicines called SSRIs are often tried first for OCD because they are easier to tolerate, clomipramine remains an important option, particularly for people who have not responded well to SSRIs.
How it works
What does it do in the brain?
Formulations in Kenya
How is it available?
Availability across Africa
Where is it available in Africa and what is it called?
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| Kenya | Anafranil, Clopram, generic | On KEML 2023 Level 4-6. |
| South Africa | Anafranil, generic | On South Africa EML. Widely available. |
| Nigeria | Anafranil, generic | Available at tertiary hospitals and urban pharmacies. |
| Ghana | Anafranil | Available at teaching hospitals. |
| Uganda | Generic clomipramine | Available at national referral facilities. |
| Tanzania | Generic clomipramine | Available at regional referral hospitals. |
| Ethiopia | Generic clomipramine | Available through psychiatric services in major cities. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Dry mouth (very common)
- Sedation and fatigue. Usually taken at night for this reason.
- Constipation
- Nausea
- Dizziness when standing up too quickly
- Weight gain
- Changes in sexual desire or response
- Tremor of the hands
- This medicine is dangerous in large amounts. It must be stored safely.
- At higher doses, there is an increased risk of seizures. Tell your doctor immediately if you experience a fit.
- Chest pain, fainting, or a noticeably irregular heartbeat
- A sudden shift into an unusually elevated or erratic mood
Risks
Important risks you should understand before taking this medicine
- Clomipramine is highly dangerous in overdose. The cardiac toxicity of this medicine means that even a moderate excess can cause life-threatening heart rhythm disturbances. It must be stored securely and prescribed in limited quantities for people at any risk of self-harm.
- Clomipramine significantly lowers the seizure threshold. At higher doses, the risk of a seizure increases substantially. People with epilepsy must not take it without careful specialist review.
- Like other tricyclics, clomipramine has strong anticholinergic effects, including urinary retention, constipation, and cognitive impairment, which are more serious in elderly patients.
- Combined with MAOIs, clomipramine can cause a life-threatening crisis. This combination must never be used.
- Stopping suddenly causes a severe cholinergic rebound with nausea, diarrhoea, headache, and flu-like symptoms. Gradual reduction under supervision is required.
Who should not take it
Important warnings before starting
- You have recently had a heart attack
- You are currently taking or have recently taken a medicine from the MAOI class
- You have closed-angle glaucoma
- You have a significant heart rhythm disorder
Special care needed
Situations that need extra attention
- Must be stored in a safe place away from others due to overdose risk
- Tell your doctor if you have epilepsy or have ever had a seizure
- Elderly patients need closer monitoring
- Tell your doctor about any heart, liver, or prostate conditions before starting
- Do not drive or operate machinery until you understand how it affects you
SSRIs are generally preferred during pregnancy. Speak to your doctor before making any changes.
Clomipramine passes into breast milk. Generally not recommended during breastfeeding. Discuss with your doctor.
Other medicines
Medicines and substances that can interact with it
- MAOIs: Extremely dangerous. These medicines must never be taken together.
- SSRIs or other serotonergic medicines: Can increase serotonin to unsafe levels and may raise clomipramine levels in the blood.
- Medicines that cause sedation: Drowsy effect is strongly amplified.
- Alcohol: Significantly increases sedation and dizziness. Avoid alcohol while taking this medicine.
Tests and follow-up
What your doctor will monitor
- Review in the first few weeks to check tolerability
- An ECG may be requested before or during treatment if you have heart disease
- Report unusual fatigue, fever, or sore throat as a precaution
- Periodic check-ups for long-term users
Stopping this medicine
What happens if you stop taking it?
In Kenya
What you should know about this medicine in Kenya
Clomipramine fills an important gap in Kenya's mental health treatment options, particularly for severe or treatment-resistant OCD, which remains significantly underdiagnosed and undertreated across the country.
Because access to psychological therapy for OCD is limited in most parts of Kenya, medicine plays a larger role than it would in settings with more therapy resources.
Its listing in the Kenya EML at Level 4-6 means it should be accessible at sub-county and county referral hospitals.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- Soomro, G. M., et al. (2008). Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews.
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.