Clomipramine

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 in cats, dogs, and birds, and may also be used for separation anxiety or aggression in dogs.

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 (extra label). Many drugs are commonly prescribed for off-label use in veterinary medicine. 

“Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they 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.
• Always provide access to fresh water while using clomipramine.
• This medication should be used in combination with behavior modification therapy.
• If your pet has worn a flea or tick collar in the past two weeks, do not give this medication without first consulting with your veterinarian.

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, and then continue with the regular dosing schedule. However, if the next scheduled dose is less than 12 hours away, either:

• skip the dose you missed, give it at the next scheduled time, and continue with the regular dosing schedule, or
• 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?

Cats are more susceptible to side effects. Common side effects include:

• Constipation
• Diarrhea
• Difficulty urinating
• Dry mouth
• Elevated liver enzymes
• Lack of appetite
• Tiredness
• Vomiting

Serious adverse reactions may occur. If any of the following signs develop, stop giving clomipramine and contact your veterinarian immediately:

• Abnormal bleeding
• Coma
• Excessive excitement
• Fast or irregular heartbeat
• Fever
• Seizures

Additional side effects seen in cats include:

• Drooling
• Ungroomed haircoat
• Unsteadiness

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?

DO NOT USE clomipramine in:

• Pets that are allergic to it or other tricyclic antidepressants
• Pets using monoamine oxidase inhibitors (MOIs) such as amitraz flea collars
• Breeding males
• Pets with a history of seizures

USE WITH CAUTION in pets that:

• Have aggression
• Have decreased gastrointestinal movement or difficulty urinating
• Have heart disease
• Have glaucoma
• Have liver disease
• Have diabetes
• Have adrenal tumors
• Have dry eye syndrome
• Have an overactive thyroid
• Are old, very young, pregnant, or lactating

Are there any drug interactions I should be aware of?

Several medications should be used with caution when given with clomipramine:

• Albuterol
• Anticholinergic agents
• Azole antifungals
• Other behavioral medications including bupropropion, clonidine, monoamine oxidase (MAO) inhibitors, selective serotonin reuptake inhibitors (SSRIs), and trazodone
• Certain antibiotics (fluoroquinolones, macrolides, metronidazole)
• Cimetidine
• Cisapride
• Central nervous system depressants
• Enalapril
• Levothyroxine
• Metoclopramide
• Nonsteroidal anti-inflammatories (NSAIDs)
• Ondansetron
• Opioids
• Tramadol

Do not give your pet aged cheeses while they are taking clomipramine.

This medication may also cause increases or decreases in blood glucose tests and may cause decreases in thyroid tests. Certain medications may interact with clomipramine, so be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.  

Is any monitoring needed 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.
• At home, monitor for any side effects such as those noted above. If any side effects occur, stop using the medication and contact your veterinarian.

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. Be prepared to provide information about the product and your pet’s weight and symptoms.