Clomipramine - Side Effects

Side Effects

Clomipramine may have a broad range of side effects:

• Central nervous system: Often, fatigue, dizziness, lightheadedness, headaches, confusion, agitation, insomnia, nightmares, increased anxiety, seizures (0.5% to 2%, see below), rarely hypomania or induction of schizophrenia (immediate termination of therapy required), and extrapyramidal side effects (pseudoparkinsonism, dyskinesia, rarely tardive dyskinesia) are noted.
• Anticholinergic side effects in different grades of severity are quite common: dry mouth, constipation, rarely ileus (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 caries may be increased due to dry mouth.
• Antiadrenergic 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 tachycardia, bradycardia, AV block, rarely other forms of cardiac problems). Pre-existing 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 with increased frequency of sunburns are seen in a few percentage of cases. Rarely liver damage of the cholostatic type, hepatitis, 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, weight loss, but also nausea and bruxism–teeth-grinding while asleep–(the latter due to the strong inhibition of reuptake of serotonin).
• The drug often causes sexual problems in men (e.g. impotence, ejaculation difficulties).
• In a few patients (both male and female), it can cause inadvertent orgasms when yawning.

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%).