IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

02 December 2021
Medically reviewed by
Freny Menezes
Pharm. D
DOES CLOMIPRAMINE CAUSE WEIGHT GAIN OR WEIGHT LOSS
Table of Contents

Clomipramine is a TCA with unique serotonergic properties used for treating obsessive-compulsive disorders. It was first approved for treating OCD in 1989. 

The DSM-III-R (approximately 1989) diagnosis of OCD requires that the obsessions or compulsions be distressing, time-consuming, or significantly impair social or occupational functioning. Obsessions are egodystonic, repeated, persistent ideas, thoughts, pictures, or emotions. Compulsions are acts that a person recognizes as excessive or irrational, recurrent, intentional, and conducted in response to an obsession or in a stereotyped way.

Clomipramine is available in capsule form as a hydrochloride salt, with dosages of 25 mg, 50 mg, and 75 mg. The common adverse effects of clomipramine include dry mouth, fatigue, vertigo, nausea, headache, and constipation. Clomipramine also reports having caused weight changes in some users.

Does Clomipramine cause weight fluctuations? Let us know more.

What Is Clomipramine?

Clomipramine is an antidepressant used as a medication for obsessive-compulsive disorder (OCD). It belongs to the drug class named Tricyclic antidepressants. Clomipramine helps to reduce the unwanted thoughts and urge to perform repetitive tasks. 

It works by increasing the level of serotonin in the brain, which helps to maintain a balance in mental health. It is an not an OTC medication that means you will need a prescription to buy Clomipramine

Indications of Clomipramine

FDA approved Indications

  • Obsessive-compulsive disorder in aged ten years and older
  • Off-label Indications
  • Depression
  • Anxiety
  • Treatment-resistant depression
  • Cataplexy syndrome
  • Body dysmorphic disorder
  • Panic disorder
  • Premature ejaculation
  • Insomnia
  • Neuropathic pain
  • Chronic pain
  • Pediatric nocturnal enuresis
     
    Yes, Clomipramine can make people have suicidal thoughts and actions. Below-age-24 young adults are more likely to experience this. Tell your doctor if you experience any of these kinds of thoughts while taking this medicine.
    Grapefruit may cause the clomipramine levels in your body to increase. It may lead to potentially dangerous adverse effects.
    The tricyclic antidepressant clomipramine reduces attention deficit hyperactivity disorder (ADHD) symptoms in the short term in children and adolescents.

How Does Clomipramine Work?

Clomipramine is a tricyclic antidepressant that works by inhibiting the reuptake of norepinephrine and serotonin in the central nervous system, thereby enhancing the effects of these neurotransmitters. Clomipramine has an affinity for central dopamine-D2, histamine-H1, and α1-adrenergic receptors.

Clomipramine also elevates plasma prolactin levels in depressed patients and exhibits anticholinergic effects both in vitro and in vivo. Some of the side effects of clomipramine medication may be due to these effects.

Can Clomipramine Cause Weight Gain Or Weight Loss?

Clomipramine does not lead to weight loss. However, this medication leads to weight gain. As most people taking antidepressants experience weight gain as one of the side effects of the drug,

Clomipramine may also lead to weight gain in an individual. Clomipramine might cause weight loss too in some rare conditions, but it contributes more to weight gain. 

Study Of Clomipramine And Change In Weight

A study by Giuseppe Maina et al. examined the change in weight during the treatment of obsessive-compulsive disorder.

Aim: To assess changes in weight in patients suffering from OCD (obsessive-compulsive disorder) treated for 2.5 years with Clomipramine or selective serotonin reuptake inhibitors.

Method: 138 patients suffering from OCD who underwent the 6-month acute treatment participated in the research. They were assigned medication of Clomipramine and other antidepressants such as Sertraline, Fluoxetine, and Paroxetine.

Observation: The patients had gained a mean weight of roughly 2.5% after the study's 2.5-year observational period. About 14.5% of participants experienced weight gain of more than 7% of their initial body weight.

The Clomipramine group of participants experienced the majority of the weight gain. About 34.8% of participants of the Clomipramine group experienced weight gain of more than 7% of initial body weight.

4.5% of people experienced weight gain from the Sertraline group, while 8.7% of people gained weight who had the medication of Fluoxetine.

Result: There is a risk of weight gain associated with antidepressant use to treat obsessive-compulsive disorder. Clomipramine may have a higher chance of weight gain in people as compared to other medications.

Side Effects Causing Weight Gain In Clomipramine Users

Clomipramine may cause some side effects such as

These side effects can affect the weight of the individual taking Clomipramine. Side effects such as drowsiness and tiredness can make a person feel lazy and unproductive and find it challenging to work. Many people may also find it difficult to exercise and burn some calories. It can contribute to weight gain in individuals.

People also feel a change in their appetite during the medication of Clomipramine, making an individual adopt improper eating habits, which may include irregular timing of diet, unbalanced diet, eating in larger quantities, etc. These habits can lead to weight gain in some individuals to the same extent.

Other Side-effects Of Clomipramine

Side effects are common for antidepressants. This drug has potential side effects because it belongs to the tricyclic antidepressant class. It can be common or serious side effects. If severe reactions occur, seek immediate medical care.

Common

Serious

Drowsiness

Confusion

Constipation

Depression

Dry mouth

Shakiness

Nausea

Problems urinating

Increased sweating

Ringing in the ears

Changes in weight and appetite

Painful or enlarged breasts

Other antidepressants that are less likely to cause weight gain

Escitalopram

Escitalopram, widely sold under the brand Lexapro, is used to treat anxiety and depression. A lot of experts recommend and promote purchasing Escitalopram to cure anxiety.

Duloxetine

Duloxetine is an antidepressant drug used to treat major depressive disorder and Anxiety. Duloxetine is used in the treatment of Neuropathic pain.

Precautions Of Clomipramine

These are necessary for the safe use of the drug. A few safety measures are essential for drugs to avoid any undesired effects.
To learn about the recommended dosages for each drug, make sure you've read the labels and informational booklets that come with everything you're taking. Understand the dosages, adverse effects, and usage guidelines. Once you've done that, keep tabs on any unusual side effects, and let your doctor know about them. 

Before taking Clomipramine

1. Patients who have a history of suicide-related incidents are known to be more likely to have suicidal thoughts or attempt suicide. They should be closely monitored while undergoing treatment.
2. If you have a clomipramine allergy, avoid taking it.
3. Before you begin taking it, let your doctor know if you have any of the following: 

  • heart issues, 
  • severe liver or kidney disease, 
  • seizures, or 
  • high eye pressure from any cause (such as glaucoma).

4. Take the tablets with a meal or after a snack if you have stomach discomfort after taking the pills.
5. Take this medication until your physician instructs you to stop taking it.
6. Tell your doctor if you are pregnant or plan to become pregnant.
7. If you take this medication while you're pregnant, particularly during the last seven weeks, it could affect the health of your unborn child.
8. It is not advised to breastfeed while taking Anafranil. The active component enters breast milk and can harm your infant.
9. Inform your doctor if you use any other medications while taking clomipramine, including prescription drugs, OTC drugs, or herbal treatments.
10. If you forget to take a dose, skip it and take the next dose as scheduled. Do not take two doses at once.
11. While taking Anafranil, exercise caution when operating machinery, vehicle, or other tasks that call for alertness.
12. Refrain from alcohol when on Clomipramine.

Interactions of Clomipramine

Drug interactions could reduce the effectiveness of your medication, result in undesirable side effects, or enhance the effects of a drug. Even serious drug interactions are likely.

  • Coadministration of Terbinafine and clomipramine may lead to increased exposure and accumulation of clomipramine and its N-demethylated metabolite. 
  • Use caution while taking Clomipramine with other CNS-active medications. Avoid concurrent use of MAO inhibitors and Clomipramine.
  • The concurrent administration of haloperidol raises the plasma levels of CMI.
  • Tricyclic antidepressant plasma levels may rise due to co-medication with antipsychotics (such as phenothiazines), which may lower the convulsion threshold and cause seizures.
  • The potential interactions with drugs that increase the risk of bleeding, such as non-steroidal anti-inflammatory drugs should be considered due to the increased risk of bleeding with concomitant clomipramine.
  • Clomipramine may reduce the antihypertensive effects of guanethidine, betanidine, reserpine, clonidine, and alpha-methyldopa.
  • Alcohol and other central depressants may have stronger effects when used with tricyclic antidepressants ( barbiturates, benzodiazepines, or general anesthetics). 

Bottom Line From Practical Anxiety Solutions

Clomipramine is a tricyclic antidepressant with a unique pharmacologic profile. Clomipramine does not cause weight loss except in rare cases. It may lead to weight gain during the treatment. Compared to other antidepressants, people taking Clomipramine experience weight gain to a greater extent. But not every person may face this issue.

If taken for a short duration, Clomipramine may not cause weight gain. Before taking Clomipramine, people should always consult the doctor and tell them about their medical history. The doctor can adjust the dosage or change the medication depending on the medical record, tolerance, and side effects to reduce the risk of adverse results.

People taking Clomipramine should consult a doctor if they immediately notice side effects such as weight gain. The doctor can help overcome the problem with some medication or exercise.

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  • Wilson M, Tripp J. Clomipramine. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541006/ Obtain on 03/11/2022
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  • Calegari, Leonardo, et al. "Effect of chronic treatment with clomipramine on food intake, macronutrient selection and body weight gain in rats." Biological and Pharmaceutical Bulletin 30.8 (2007): 1541-1546. From https://doi.org/10.1248/bpb.30.1541 Obtain on 03/11/2022
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