By Rania Gollakner, BS, DVM, MPH

What is clomipramine?

Clomipramine (brand names: Clomicalm®, Anafranil®, Clofranil®, Clopram®, Clopress®, Equinorm®, Hydiphen®, Maronil®, Novo-Clopramine®, Placil®, Tranquax®, Zoiral®) is a tricyclic antidepressant medication used to treat obsessive-compulsive disorders and may also be used for separation anxiety or aggression.

In cats, it is used for urine spraying, and in birds, it is used to treat feather picking.

While some uses for dogs are on label, its use in cats, birds, or dogs at higher doses to treat behavior disorders is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

How is clomipramine given?

Clomipramine is given by mouth in the form of a tablet or capsule. It may also be compounded into a liquid suspension. Measure liquid forms carefully. It may be given with or without food, but if vomiting occurs when dosed on an empty stomach, give future doses with food. Provide access to fresh water at all times while using clomipramine. This medication should be used in combination with behavior modification therapy.

Do not give this medication without first consulting with your veterinarian if your pet has worn a flea or tick collar in the past two weeks.

This medication can take a few weeks before full effects are noted, but side effects can occur immediately. Gradual improvements are usually noticeable after a few days.

What if I miss giving my pet the medication?

If you miss giving your pet a dose, give the next dose as soon as you remember, but if it is closer than 12 hours before the next scheduled dose, either:

  1. skip the dose you missed, give it at the next scheduled time, and continue with the regular dosing schedule, OR
  2. give the missed dose and then wait the recommended interval before giving the next dose (continue giving it regularly at that new time).

Are there any potential side effects?

Common side effects include lack of appetite, vomiting, diarrhea, constipation, dry mouth, elevated liver enzymes, difficulty urinating, or tiredness. Cats are more susceptible to side effects. Serious side effects include abnormal bleeding, fever, seizures, coma, excessive excitement, or a fast or irregular heartbeat. In cats, serious side effects include drooling, unsteadiness, or ungroomed haircoat.

This moderate-acting medication should stop working in a few days, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Clomipramine should not be used in pets that are allergic to it or other tricyclic antidepressants. Do not use concurrently with monoamine oxidase inhibitors (MOIs) such as amitraz flea collars. Do not give your pet aged cheeses while it is taking clomipramine. Do not use in breeding males or pets with a history of seizures. Use cautiously in pets with aggression, decreased gastrointestinal movement, difficulty urinating, heart disease, glaucoma, liver disease, diabetes, adrenal tumors, dry eye syndrome, or overactive thyroid. Clomipramine should be used cautiously in old or very young pets and in pregnant or lactating pets.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with clomipramine: albuterol, anticholinergic agents, azole antifungals, bupropion, butyrophenone antipsychotic agents, cimetidine, cisapride, clonidine, central nervous system depressants, cyclobenzaprine, cyproheptadine, dextromethorphan, enalapril, fluoroquinolones, levothyroxine, linezolid, macrolides, meperidine, metoclopramide, metronidazole, monoamine oxidase inhibitors, nonsteroidal anti-inflammatories (NSAIDs), ondansetron, opioids, pentazocine, phenytoin, procainamide, quinidine, rifampin, SSRIs, sympathomimetic agents, tramadol, trazodone, or yohimbine.

This medication may also cause increases or decreases in blood glucose tests and may cause decreases in thyroid tests.

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

Before starting this medication, your veterinarian may measure baseline liver function and an electrocardiogram (ECG). There is no specific monitoring that needs to be done while your pet is taking this medication. Your veterinarian may monitor your pet to be sure that the medication is working. Monitor your pet for serious side effects.

How do I store clomipramine?

Store the veterinary tablet and capsule form of this medication at room temperature between 59°F and 86°F (15°C and 30°C), protected from moisture and sunlight. Store compounded formulations according to the label.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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