Clomipramine (Brand name
Anafranil) is a psychoactive/psychiatric drug used as an
antidepressantAn antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia. Drugs including the monoamine oxidase inhibitors , tricyclic antidepressants , tetracyclic antidepressants , selective serotonin reuptake inhibitors , and serotonin-norepinephrine...
and
anxiolyticAn anxiolytic is a drug used for the treatment of symptoms of anxiety. Anxiolytics have been shown to be useful in the treatment of anxiety disorders, as have antidepressants such as the selective serotonin reuptake inhibitors .Though not anxiolytics, beta-receptor blockers such as propranolol and...
agent. It is a member of the
tricyclic antidepressantTricyclic antidepressants are a class of psychoactive drugs used primarily as antidepressants, which were first discovered in the early 1950s, and subsequently introduced later in the decade...
(TCA) chemical class. It was developed in the 1960s by the Swiss drug manufacturer Geigy (now known as
NovartisNovartis International AG is a multinational pharmaceutical company based in Basel, Switzerland, ranking number one in revenues, which accounted over $53 billion in 2008, and number three in sales, which accounted 36.172 billon in 2008. Novartis is one of the largest healthcare companies in the...
) and has been in clinical use worldwide ever since.
Indications
- Major depression
- Obsessive compulsive disorder (OCD)
- Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
with or without agoraphobiaAgoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open, spaces such as shopping malls or airports...
- Narcolepsy
Narcolepsy is chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school...
- Premature ejaculation
Premature ejaculation is a condition where a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....
- Depersonalization disorder
Depersonalization disorder is a dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and/or derealization...
- Chronic pain
Chronic pain is defined as pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process....
with or without organic disease, particular headache of the tension type
- Enuresis
Bedwetting is involuntary urination while asleep after the age at which bladder control would normally be anticipated. The medical term for this condition is "nocturnal enuresis." Primary nocturnal enuresis is when a child has not yet stayed dry on a regular basis...
(involuntary nightly urinating in sleep) in children and adolescents
- Off label uses: sometimes antidepressants of this type have been found helpful in reducing relapses in cocaine addicts and to help repair cocaine-caused neurotransmitter
Neurotransmitters are endogenous chemicals which relay, amplify, and modulate signals between a neuron and another cell. Neurotransmitters are packaged into synaptic vesicles that cluster beneath the membrane on the presynaptic side of a synapse, and are released into the synaptic cleft, where they...
imbalances and early brain damage. Further studies are needed for clomipramine in this regard. Also has been used in dogs with severe anxiety disorders (separation anxiety, etc.), OCD, or cognitive dysfunction syndrome with some success.
It may take 2 to 3 weeks before the full effects of this medication are noticed in most indications and two months or more in OCD.
Along with SSRIs, clomipramine is a frequently prescribed drug for the treatment of OCD. As is typical with the older tricyclic antidepressants (the tertiary amines), it has more side effects than SSRIs, so some authorities regard it as a second-line treatment to be used if treatment with SSRIs fails. However, disregarding side effects, it may be slightly more effective in combating the symptoms of OCD. It is not commonly used for treating depression, and usually another tricyclic (or drug from a different class) would be used. Clomipramine and the SSRIs (specifically Paroxetine) have also been used to treat premature ejaculation.
Contraindications
- Concomitant therapy with an (irreversible) MAO inhibitor
Monoamine oxidase inhibitors are a class of powerful antidepressant drugs prescribed for the treatment of depression. They are particularly effective in treating atypical depression, and have also shown efficacy in smoking cessation....
(e.g. tranylcypromineTranylcypromine is a psychoactive drug of the phenethylamine and amphetamine chemical classes which acts as a monoamine oxidase inhibitor —it is a nonselective and irreversible inhibitor of the enzyme monoamine oxidase...
, phenelzinePhenelzine is a psychoactive drug of the hydrazine chemical class which is used as an antidepressant and anxiolytic or antipanic agent. It acts as a nonselective and irreversible monoamine oxidase inhibitor...
)
- Acute intoxication with central depressants (alcohol, psychoactive drugs, narcotics)
- States of confusion (caution), absolutely contraindicated in patients with coma and delirium tremens
Delirium tremens is an acute episode of delirium that is usually caused by withdrawal from alcohol, first described in 1813...
- Patients with severe agitation or anxiety (give sedative drugs concomitantly)
- Hypersensitivity/allergy against clomipramine or other related tricyclic compounds
- Hypertrophy of the prostate with urine retention
Urinary retention also known as ischuria is a lack of ability to urinate. It is a common complication of benign prostatic hypertrophy , although anticholinergics may also play a role, and requires a catheter or prostatic stent...
(=difficulty in urinating)
- Caution: hypertrophy of the prostate without urine retention
- Preexisting closed angle glaucoma
Glaucoma is a group of diseases that affect the optic nerve and involves a loss of retinal ganglion cells in a characteristic pattern. It is a type of optic neuropathy. Raised intraocular pressure is a significant risk factor for developing glaucoma...
- Epilepsy and other conditions which lower the seizure threshold (alcohol withdrawal, active brain tumors)
- Serious liver disease (elimination is decreased), if clomipramine is given consider dose reduction
- Serious kidney disease (elimination is decreased), if clomipramine is given consider dose reduction
- Severe hypotension
In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the opposite of hypertension, which is high blood...
, shock, serious cardiovascular dysfunction (postinfarctous states, heart insufficience, arrhythmias), avoid high oral doses or injections/infusions
- Preexisting bone marrow depression (leukopenia
Leukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection....
, thrombocytopeniaThrombocytopenia is the presence of relatively few platelets in blood.Generally speaking, in humans, a normal platelet count ranges from 150,000 and 450,000 per mm3. These limits, however, are determined by the 2.5th lower and upper percentile, and a deviation does not necessarily imply...
, anemiaAnemia is a decrease in normal number of red blood cells or less than the normal quantity of hemoglobin in the blood...
, pancytopeniaPancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets.If only two parameters from the full blood count are low, the term bicytopenia can be used...
), can be worsened by clomipramine
- Hyperthyroidism
Hyperthyroidism is the term for overactive tissue within the thyroid gland,resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine , triiodothyronine , or both...
(overfunction of the thyroid gland) makes the patient more sensitive to side effects of clomipramine. Cautious doses should be used and the overfunction should be treated.
- Caution should be exerted when treating pediatric patients under 18 years of age
Pharmacology
Clomipramine is the 3-chloro derivative of
imipramineImipramine is an antidepressant medication, a tricyclic antidepressant of the dibenzazepine group...
. Clomipramine is a strong, but not completely
selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders...
(SSRI), as the primary active metabolite desmethylclomipramine acts preferably as
norepinephrine reuptake inhibitorA norepinephrine reuptake inhibitor or adrenergic reuptake inhibitor , is a type of drug which acts as a reuptake inhibitor for the neurotransmitters norepinephrine and epinephrine by blocking the action of the norepinephrine transporter...
. Other hydroxy-metabolites are also active.
α1 receptorThe adrenergic receptors are a class of G protein-coupled receptors that are targets of the catecholamines, especially noradrenaline and adrenaline ....
blockage and β receptor downregulation as well as postsynaptic
antagonismA receptor antagonist is a type of receptor ligand or drug that does not provoke a biological response itself upon binding to a receptor, but blocks or dampens agonist-mediated responses...
on histamine H
1 receptors and dopamine receptors have been noted.
As with other TCAs, downregulation of
NMDA receptorThe NMDA receptor , a glutamate receptor, is the predominant molecular device for controlling synaptic plasticity and memory function....
s may also partially account for its effects.
Clomipramine has the disadvantage of a higher incidence of seizures than seen with other TCAs (up to a dose of 250 mg daily in 0.5%, more than 300 mg in 2%).
Some studies have indicated that clomipramine is slightly more effective in the treatment of depression than other TCAs.
Side effects
Clomipramine may have a broad range of side effects:
- central nervous system: Often, fatigue, dizziness, lightheadedness, headaches, confusion, agitation, insomnia
Insomnia is a symptom of any of several sleep disorders, characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both"...
, nightmares, increased anxiety, seizures (0.5% to 2%, see above), rarely hypomaniaHypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. An unequivocal change in functioning that is uncharacteristic when asymptomatic...
or induction of schizophreniaSchizophrenia , from the Greek roots skhizein and phrēn, phren- is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality...
(immediate termination of therapy required), and extrapyramidalIn human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. The system is called "extrapyramidal" to distinguish it from the tracts of the motor cortex that reach their targets by traveling through...
side-effects (pseudoparkinsonism, dyskinesiaDyskinesia is a movement disorder which consists of effects including diminished voluntary movements and the presence of involuntary movements, similar to tics or chorea. Dyskinesia is a symptom of several medical disorders and is distinguished by the underlying cause...
, rarely tardive dyskinesiaTardive dyskinesia is a variety of dyskinesia manifesting as a side effect of long-term or high-dose use of dopamine antagonists, usually antipsychotics. Other dopamine antagonists that can cause tardive dyskinesia are drugs for gastrointestinal disorders and neurological disorders...
) are noted.
- Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicyclomine....
side effects in different grades of severity are quite common: dry mouth, constipation, rarely ileusIleus is a disruption of the normal propulsive gastrointestinal motor activity due to non-mechanical causes. In contrast, motility disorders that result from structural abnormalities are termed mechanical bowel obstruction...
(paralysis of the large intestine, life-threatening), difficulties in urinating, sweating, precipitation of glaucoma (may lead to permanent eye-damage or even blindness, if untreated). The incidence of dental cariesCaries is a progressive destruction of any kind of bone structure, including the skull, ribs and other bones, or the teeth. Caries can be caused by osteomyelitis, which is a bacterial disease. A disease that involves caries is mastoiditis, an inflammation of the mastoid process, in which the bone...
may be increased due to dry mouth.
- antiadrenergic
An adrenergic is a drug, or other substance, which has effects similar to, or the same as, epinephrine . Thus, it is a kind of sympathomimetic agent...
side effects occur very frequently due to strong central and peripheral blockage of alpha receptors: hypotension, postural collapse (when patient is rising too fast from lying or sitting position to standing), arrhythmias (sinus tachycardiaSinus tachycardia is a heart rhythm with elevated rate of impulses originating from the sinoatrial node, defined as a rate greater than 100 beats/min in an average adult. The normal heart rate in the average adult ranges from 60–100 beats/min...
, bradycardiaBradycardia , as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min....
, AV block, rarely other forms of cardiac problems). Preexisting heart insufficiency can be worsened.
Most of these side-effects are dose related and/or tolerance will develop with continued use.
- Allergic/toxic: skin reactions and photosensitivity
Photosensitivity is the amount to which an object reacts upon receiving photons, especially visible light.-Interpretation in medicine:Sensitivity of the skin to a light source can take various forms. People with particular skin types are more sensitive to sunburn...
with increased frequency of sunburns are seen in a few percentage of cases. Rarely liver damage of the cholostatic type, hepatitisHepatitis implies injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from ancient Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, and leukopenia or other forms of blood dyskrasia are seen, also severe acute allergy including difficulties in breathing, skin reaction, chest pain etc.
- Other side effects may include heartburn
Heartburn or pyrosis is a painful and burning sensation in the esophagus, just behind the breastbone usually associated with regurgitation of gastric acid. The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw...
, weight gain, but also nausea and bruxismBruxism is characterized by the grinding of the teeth and is typically accompanied by the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
- teeth-grinding while asleep - (the latter due to the strong inhibition of reuptake of serotoninSerotonin is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements...
).
- The drug often causes sexual problems in men (e.g. impotence, ejaculation difficulties). In about 5% of patients, it can instead cause inadvertent orgasms when yawning.
Drug abuse and dependence
Clomipramine has no known potential for abuse and dependence. It is not a controlled substance.
Withdrawal symptoms occurring when clomipramine is stopped abruptly (agitation, fatigue, nausea, headaches, insomnia, sometimes activation of mania and rebound of depression or anxiety) is not indicative of dependence and can be avoided, if clomipramine is gradually withdrawn by reducing the daily dose by approximately 25% weekly. If medical reasons dictate an immediate termination of treatment, a short-term course of
benzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s (up to four weeks as needed) will usually suppress the unpleasant withdrawal symptoms.
Other reasons for caution
Depression itself can lead to thoughts or attempts of suicide. Emotionally unstable patients or those with suicidal thoughts should receive the smallest amount of the drug feasible. Often cotreatment with a sedative drug (e.g. a benzodiazepine or
chlorprothixeneChlorprothixene is a typical antipsychotic drug of the thioxanthene class. It has a low antipsychotic potency . Its principal indications are the treatment of psychotic disorders Chlorprothixene is a typical antipsychotic drug of the thioxanthene class. It has a low antipsychotic potency (half to...
) is necessary until remission of depression is evident.
Caution is advised when using clomipramine in the elderly, because they may be more sensitive to the effects of the drug (e.g., confusion may occur or worsen). Clomipramine should be used during pregnancy only if clearly needed. It is excreted into breast milk. The effects on the infant are not known at this time.
Drug interactions
Clomipramine shows a number of clinical significant interactions, either due to central depressant or stimulant activity of the other drug or due to interference of the other drug with the metabolization and elimination of clomipramine or vice versa. Some examples are:
- MAO inhibitors (e.g., furazolidone
Furazolidone is an antibacterial. It is marketed by Roberts Laboratories under the brand name Furoxone and by GlaxoSmithKline as Dependal-M.-Uses:It is used to treat diarrhoea and enteritis caused by bacteria or protozoan infections....
, linezolidLinezolid is a synthetic antibiotic used for the treatment of serious infections caused by Gram-positive bacteria that are resistant to several other antibiotics...
, phenelzinePhenelzine is a psychoactive drug of the hydrazine chemical class which is used as an antidepressant and anxiolytic or antipanic agent. It acts as a nonselective and irreversible monoamine oxidase inhibitor...
, selegilineSelegiline is a drug used for the treatment of early-stage Parkinson's disease, depression and senile dementia. In normal clinical doses it is a selective irreversible MAO-B inhibitor, however in larger doses it loses its specificity and also inhibits MAO-A...
, tranylcypromineTranylcypromine is a psychoactive drug of the phenethylamine and amphetamine chemical classes which acts as a monoamine oxidase inhibitor —it is a nonselective and irreversible inhibitor of the enzyme monoamine oxidase...
): severe reactions including central excitation, hypertensive crisis, bizarre behaviour, psychosis, seizures, coma and death are possible. Serotonin syndromeSerotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs...
is likely.
- Central stimulants: Potentially dangerous central excitation with agitation and anxiety may be encountered.
- SSRI type antidepressants (eg. fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. Fluoxetine is approved for the treatment of major depression , obsessive-compulsive disorder , bulimia nervosa, anorexia nervosa, panic disorder and premenstrual dysphoric disorder...
): Side effects of clomipramine are increased.
- Drugs with central depressant activity (tranquilizers, alcohol, narcotics): Increased central depression (dizziness, drowsiness etc.) is frequently noted.
- Antihypertensive drugs: The risk of hypotension, collapse, and tachycardia is increased.
- Interactions with OTC
Over-the-counter drugs are medicines that may be sold to a customer without a prescription from a health care professional, as compared to prescription drugs, which may only be sold to customers possessing a valid prescription...
medications against colds and sleeping aids with diphenhydramineDiphenhydramine hydrochloride is a chemical mainly used as an antihistamine, antiemetic, sedative, and hypnotic. It is produced and marketed under the trade name Benadryl by McNeil-PPC in the U.S. and Canada, and Dimedrol in other countries...
, doxylamineDoxylamine succinate is one of the many sedating antihistamines used by itself as a short-term sedative, in combination with other drugs as a night-time cold and allergy relief drug, in combination with the analgesics paracetamol and codeine as an analgesic / calmative preparation, and is...
and St. John's wort may occur.
Dosage
Initial doses are usually 25 mg 2 or 3 times daily or 75 mg once daily in slow released form. The dose may be increased in regular intervals (the usual dose per day is 100 to 225 mg). Doses up to 300 mg may be used, but these are associated with an increased risk of seizures. This medication may be taken with food to prevent stomach upset.
In hospitalized patients initial intramuscular injections and very slow intravenous infusions can be used, but the risk of hypotension and seizures may be increased with parenteral drug use. The advantage is that the onset of action may be faster.
Usually, clomipramine needs some weeks to reach its maximum effects and needs to be given as longterm treatment, sometimes for life (narcolepsy). In cases of narcolepsy, antidepressant compounds like clomipramine are used to manage symptoms of cataplexy, which usually manifests as
sleep paralysisSleep paralysis is a condition that may occur in normal subjects or be associated with narcolepsy, cataplexy, and hypnagogic hallucinations. The pathophysiology of this condition is closely related to the normal hypotonia that occur during REM sleep. When considered to be a disease, isolated sleep...
(the inability to move skeletal muscles upon waking from REM sleep). In most patients with narcolepsy, clomipramine monotherapy is not sufficient to control non-cataleptic symptoms, such as excessive daytime fatigue and sleep attacks. In these cases, a commonly used CNS stimulant medication (e.g.
modafinilModafinil is an analeptic drug manufactured by Cephalon, and is approved by the U.S...
,
dextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having...
or
methylphenidateMethylphenidate is the most commonly prescribed psychostimulant and is indicated in the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome and narcolepsy, although off-label uses include treating lethargy, depression, neural insult, and obesity.In...
) is used in lieu of, or in addition to, a tricyclic antidepressant like clomipramine. Concomitant use of a psychostimulant medication and an antidepressant is common in narcolepsy. Other antidepressants used to help control cataplexy include
desipramineDesipramine is a tricyclic antidepressant that inhibits the reuptake of norepinephrine. It is sold under the brand names Norpramin and Pertofrane. It is used to treat depression, but not considered a first line treatment since the introduction of SSRI antidepressants...
,
protriptylineProtriptyline is a tricyclic antidepressant , specifically a secondary amine, indicated for depression and ADHD. Unique among the TCAs, protriptyline tends to be energizing instead of sedating, and it is sometimes used in narcolepsy to achieve a wakefulness-promoting effect...
and
venlafaxineVenlafaxine is an arylalkanolamine SNRI, although some authors dispute the claim that it inhibits NE reuptake. First introduced by Wyeth in 1993, it is licensed for the amelioration of MDD, as an anxiolytic, & comorbid indications. In 2007, venlafaxine was the sixth most commonly prescribed...
.
Clomipramine is not able to elevate the mood of non-depressive persons and any unindicated use may be dangerous.
Overdose
If overdose is suspected, medical authorities recommending contacting the local
poison control centerA poison control center or poison information center is a medical facility that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in case of exposure to poisonous or hazardous substances...
or emergency room/
A&EThe emergency department , sometimes termed the emergency room , emergency ward , accident & emergency department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be...
immediately. Other worldwide poison centers can be found at the
World directory of poison centers
Ten out of 12 patients presenting with manifest clomipramine overdose survived with appropriate treatment. These 10 patients took clomipramine doses of up to 5 grams. The 2 patients who died ingested 5.75 and 7 grams, respectively. Outside the US one patient died who took only 0.75 grams. Lethal doses may be lower, if other drugs have been taken in an overdose, too, particular central nervous depressants.
The symptoms and the treatment of an overdose are largely the same as for the other tricyclic antidepressants.
Veterinary uses
Clomipramine is widely used for the treatment of disturbed behaviour of dogs, cats, and horses. Marketed by Novartis for veterinary use under the name 'Clomicalm', clomipramine is given orally and has different licensed uses in different countries.
In the US, clomipramine is currently only licensed to treat separation anxiety in dogs . However it is often prescribed in off-label use for many other conditions including other anxiety disorders, phobias (
noise phobia in dogsDog Noise Phobia, along with Dog Noise Anxiety, are terms sometimes used by dog owners and veterinarians to describe canine fear of and the corresponding stress responses to loud noises....
, et al), obsessive-compulsive disorders (tail chasing, excessive grooming, et al), and "mood" problems. It has also been used in older dogs suffering from canine cognitive dysfunction (CCD) or canine cognitive dysfunction syndrome (CDS or CCDS), though it is important to note that unlike Anipryl clomipramine is not thought to reverse the condition by increasing dopamine levels in the brain to improve function; it only "treats the symptoms" so to speak and only those related to anxiety to make the dog feel more relaxed and calmer.
The UK license is restricted to the drug being used:
"As an aid in the treatment of separation-related disorders in dogs manifested by destruction and inappropriate elimination (defecation and urination) and only in combination with behavioural modification techniques."
In Australia the license is broader:
"Treatment of stereotypic behaviours (obsessive-compulsive disorders) in dogs such as acral lick dermatitis, excessive grooming and tail chasing. An aid in the treatment of anxiety disorders in dogs such as destructiveness, excessive vocalisation, loss of toilet control, associated with separation anxiety. An aid in the treatment of urine spraying in desexed and female cats." (Product Information for Clomicalm, Novartis Animal Health Australasia Pty Limited).
Off-label use: If a drug is used outside of its license in a given country, this constitutes "off-label" use. For example, use of clomipramine in urine spraying cats would be off-label in the UK, but within the Australian license. This is important because legal restrictions on the off-label use of drugs apply nationally, and must be considered when using such drugs in a given problem in a particular species. Clomipramine has been used for cognitive dysfunction syndrome to alleviate anxiety associated with the disease; however it is not believed to manage the underlying cause of the problem.
Brands
- Anafranil registered TM of Mallinckrodt
Mallinckrodt Incorporated is a set of pharmaceutical, chemical, imaging, and respiratory equipment suppliers based in the St. Louis, Missouri area. Founded in 1867 when the Mallinckrodt brothers formed G. Mallinckrodt & Company to manufacture pharmaceutical chemicals, Mallinckrodt was purchased by...
in the United States
- Anafranil registered TM of Novartis, sold worldwide
- Generics