Clomipramine

What it is used for

• Urine marking/spraying; inter-cat aggression; redirected aggression; compulsive grooming/wool sucking
• Behavioral disorders
• Behavioral disorders
• Urine marking
• Anxiety-related disorders, compulsive behaviours, urine spraying
• Adjunctive treatment of feather picking
• Label directions (Clomicalm)
• Behavioral disorders
• Male dimorphic behaviors, fearful/fear aggression, noise phobias, obsessive/compulsive behaviors
• Adjunctive treatment of storm phobia
• Separation-related disorders, anxiety, compulsive behaviors, noise fears, cataplexy

How it is given

Possible side effects

• Emesis
• Diarrhea
• Sedation, lethargy, and depression
• Anticholinergic effects (dry mouth, tachycardia, urinary retention)
• Elevation of liver enzymes
• Pancreatitis (rarely reported in dogs)
• Birds: Ataxia, drowsiness, regurgitation
• Sporadic vomiting
• Changes in appetite
• Lethargy
• Urinary retention (especially in cats)
• Testicular hypoplasia (in male breeding animals)

Cautions & contraindications

• Prior hypersensitivity to clomipramine or other tricyclic antidepressants
• Concomitant use with monoamine oxidase inhibitors (MAOIs) within 14 days
• Concurrent ingestion of aged cheeses (high tyramine content)
• Known sensitivity to tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs)
• Concurrent use of Monoamine Oxidase Inhibitors (MAOIs) or within 2 weeks of their use
• Male breeding animals (due to risk of testicular hypoplasia)
• > **Seizure Warning**: TCAs may lower the seizure threshold. Use with extreme caution in animals with preexisting seizure disorders. * **Anticholinergic Risks**: Use cautiously in patients with decreased GI motility, urinary retention, cardiac rhythm disturbances, or increased intraocular pressure. * **Hepatic Function**: May cause hepatic abnormalities. Baseline and annual monitoring of liver enzymes is recommended for long-term use. * **Thyroid Disease**: Use cautiously in hyperthyroid patients or those on thyroid supplementation due to increased risk of cardiac arrhythmias. * **Reproductive Safety**: Not a known teratogen, but high doses have demonstrated testicular atrophy. The manufacturer warns against use in breeding male dogs. FDA Category C for human pregnancy. * **Species Sensitivity**: Cats may be more sensitive to adverse effects (sedation, anticholinergic signs) due to slower elimination of the desmethyl metabolite.

Drug interactions

• Anticholinergic agents: Additive anticholinergic effects; use cautiously
• Butyrophenone antipsychotics (e.g., haloperidol): Risk of extrapyramidal side effects (reported in a macaw)
• Cimetidine: May inhibit tricyclic antidepressant metabolism and increase the risk of toxicity
• Cisapride: Increased risk for prolonged QT interval
• Clonidine: May cause increased blood pressure
• CNS Depressants: Additive CNS depression; use cautiously
• Meperidine, Pentazocine, Dextromethorphan: Increased risk for serotonin syndrome
• Quinidine: Increased risk for QTc interval prolongation and tricyclic adverse effects
• Rifampin: May decrease tricyclic blood levels
• SSRIs (e.g., fluoxetine, paroxetine, sertraline): Increased risk for serotonin syndrome
• Sympathomimetic agents: May increase the risk of cardiac effects (arrhythmias, hypertension, hyperpyrexia)
• Monoamine Oxidase Inhibitors (MAOIs, e.g., amitraz, selegiline): Concomitant use is generally contraindicated due to high risk of fatal serotonin syndrome
• Selegiline (MAOIs): Risk of fatal serotonin syndrome; do not use concurrently or within 2 weeks of each other
• Atropine (Anticholinergics): Potentiation of anticholinergic effects (e.g., dry mouth, tachycardia, urinary retention)
• Barbiturates: Potentiation of CNS depressant effects
• Benzodiazepines: Potentiation of CNS depressant effects (though noted as safe to use together with care)
• Adrenaline (Sympathomimetics): Potentiation of sympathomimetic cardiovascular effects
• Coumarin derivatives: Potentiation of anticoagulant effects
• Phenytoin: Increased plasma levels of the antiepileptic drug
• Carbamazepine: Increased plasma levels of the antiepileptic drug
• Trazodone: Increased risk of serotonin syndrome; use only in exceptional cases with careful monitoring
• Monoamine oxidase inhibitors (e.g., selegiline): High risk of fatal serotonin syndrome. Do not use within 2 weeks of each other.
• Serotonergic agents (e.g., SSRIs, trazodone): Increased risk of serotonin syndrome. Use with trazodone only in exceptional cases with careful monitoring.
• Anticholinergic agents (e.g., atropine): May potentiate anticholinergic effects.
• CNS active drugs (barbiturates, benzodiazepines, general anaesthetics, neuroleptics): May potentiate CNS depressant effects.
• Sympathomimetics (e.g., adrenaline): May potentiate sympathomimetic effects.
• Antiepileptic drugs (e.g., phenytoin, carbamazepine): Plasma levels of the antiepileptic drugs may be increased by co-administration.

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