Clomipramine
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Clomipramine
Clomipramine may be used to delay ejaculation. This medication is most commonly used to treat obsessive compulsive disorder (OCD). Delay of ejaculation was noted to be a side effect in men taking this medication, and has since been studied specifically with regard to premature ejaculation. It has been shown to delay the intra-vaginal ejaculatory latency time (IELT).
How Clomipramine works
Clomipramine is a tricyclic antidepressant (TCA). It works by raising the levels of serotonin, an important chemical in your brain that’s involved with regulating your mood, feelings and behavior. The exact mechanism for how it reduces PE is not well understood. Its use for this condition was discovered as a reported side effect for men taking clomipramine for OCD.
Typical dosing for Clomipramine
- On demand dose of 25 mg taken 4-24 hours before sexual activity
- Daily 25 -50 mg daily
- On average it takes 6-12 weeks of daily medication to have maximal effect
- Must start with 25 mg daily for one week before increasing to 50 mg daily
mensRxplus Recommendations:
- May take with or without food. If clomipramine causes nausea for you then take it with food.
- If taking a daily dose more than 25 mg you should slowly increase the dose by 25 mg per week. The maximum dose for OCD is 250 mg daily. Typically for PE 25-50 mg daily dosing has been studied. It should be stopped in a similar way, by reducing the dose weekly to avoid withdrawal symptoms of nausea, headache, and overall discomfort.
- Consider taking clomipramine at bedtime if taken daily, because it can make you sleepy.
- Clomipramine can cause drowsiness and dizziness, making you less alert. Avoid driving and doing anything that requires concentration or focus until you see how this medication affects you
- Drinking alcohol with clomipramine can increase the risk of drowsiness.
- Tell your primary medical provider that you are taking this medication because it can interact with many other medications.
- Interactions with other medications are less likely if taking clomipramine occasionally on-demand, compared to if taking daily.
Side Effects:
Side effects may improve overtime as your body adjusts. The following side effects are based on patients taking this medication for obsessive compulsive disorder (OCD):
Common Side Effects
- Dry mouth (63-84%)
- Sleepiness (46-54%)
- Dizziness (41-54%)
- Tremor (33-54%)
- Headache (28-52%)
- Constipation (22-47%)
- Sexual problems in males (6-42%)
- Tiredness (35-39%)
- Nausea (9-33%)
- Sweating more (9-29%)
- Trouble sleeping (11-25%)
Other less commonly reported side effects could include: changes in sex drive, stomach pain, anxiety, weight gain, vision changes, indigestion, urinary retention, changes in appetite, memory trouble, and rash.
Serious Side Effects
- Suicidal thoughts or behaviors
- Manic episode in those with bipolar disorder
- Seizures
- Low sodium level: headache, difficulty concentrating or remembering, weakness, feeling unsteady on your feet, seizure, coma
- Serotonin syndrome: fast heartbeat, sweating, muscle stiffness or spasms, fever, confusion
- Serious skin reaction: rash, itching, fever
- Cardiac: tachycardia, prolonged QT intervals, depressed ST segments
See detailed Warnings section.
Frequently Asked Questions
When taken as an on-demand medication for PE, clomipramine should be taken 4-24 hours before sexual activity.
There is not currently an FDA approved medication that is available in the US to treat premature ejaculation. Clomipramine has been studied in randomized controlled trials and found to be safe and efficacious for treatment of PE. Clomipramine has been prescribed for years in the US for PE despite being “off label.” Its use is supported in the American Urologic Association (AUA) guideline for PE. SSRI drugs like paroxetine are also commonly used for treatment of PE.
There have been several studies over the past 25 years supporting the safety of use. Also, clomipramine is widely used to treat OCD, including in children as young as 10 years old, so its side effects are generally well known. It is FDA approved for other indications, which means the FDA has determined it is safe for humans to take. Clomipramine is a supported treatment in the American Urologic Association (AUA) guideline for PE. This is the governing body for US Urologists / Andrologists who study and treat men with PE.
Yes, clomipramine may be combined with topical treatments for PE, along with behavioral therapy. In combination this may have an increased benefit for men with PE. However, it should not be combined with SSRI medications such as paroxetine or sertraline, that are also used for PE.
Drug Interactions
Let your healthcare provider know if you take any of the below medications because clomipramine may interact or may not be safe for you to take.
There is an extensive list of drugs that clomipramine may interact with. The following list does not contain all possible drug-drug interaction. You should avoid clomipramine when taking the following medications:
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Furazolidone
- Grepafloxacin
- Iproniazid
- Isocarboxazid
- Linezolid
- Mesoridazine
- Methylene Blue
- Metoclopramide
- Moclobemide
- Pargyline
- Phenelzine
- Pimozide
- Piperaquine
- Procarbazine
- Ranolazine
- Rasagiline
- Safinamide
- Selegiline
- Sparfloxacin
- Terfenadine
- Thioridazine
- Toloxatone
- Tranylcypromine
- Ziprasidone
The following medications also interact with clomipramine. You should inform your physician provider if you are taking any of the following as the dose may need to be adjusted.
- Abametapir
- Aceclofenac
- Acemetacin
- Albuterol
- Alfentanil
- Alfuzosin
- Almotriptan
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Aspirin
- Astemizole
- Atazanavir
- Azithromycin
- Benzhydrocodone
- Benzphetamine
- Bromfenac
- Bromocriptine
- Bufexamac
- Buprenorphine
- Bupropion
- Buserelin
- Butorphanol
- Capmatinib
- Celecoxib
- Ceritinib
- Chloroquine
- Chlorpromazine
- Choline Salicylate
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clonidine
- Clonixin
- Clozapine
- Codeine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Diflunisal
- Dihydrocodeine
- Dipyrone
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Droxicam
- Efavirenz
- Encorafenib
- Entrectinib
- Epinephrine
- Erythromycin
- Escitalopram
- Eslicarbazepine Acetate
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Fingolimod
- Flecainide
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Foscarnet
- Fostemsavir
- Frovatriptan
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibuprofen
- Ibutilide
- Iloperidone
- Imipramine
- Indomethacin
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Ivabradine
- Ivosidenib
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lapatinib
- Lasmiditan
- Lefamulin
- Lenvatinib
- Levalbuterol
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lopinavir
- Lorcaserin
- Lornoxicam
- Loxapine
- Loxoprofen
- Lumefantrine
- Lumiracoxib
- Macimorelin
- Meclofenamate
- Mefenamic Acid
- Mefloquine
- Meloxicam
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Metronidazole
- Mifepristone
- Mirtazapine
- Moricizine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nabumetone
- Nafarelin
- Nalbuphine
- Naproxen
- Naratriptan
- Nefopam
- Nepafenac
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Norepinephrine
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxaprozin
- Oxycodone
- Oxymetazoline
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Paliperidone
- Palonosetron
- Panobinostat
- Parecoxib
- Paroxetine
- Pasireotide
- Pazopanib
- Peginterferon Alfa-2b
- Pentazocine
- Phenylbutazone
- Piketoprofen
- Pimavanserin
- Piroxicam
- Pitolisant
- Pixantrone
- Ponesimod
- Posaconazole
- Pranoprofen
- Procainamide
- Prochlorperazine
- Proglumetacin
- Promethazine
- Propafenone
- Propyphenazone
- Proquazone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Remifentanil
- Revefenacin
- Ribociclib
- Rofecoxib
- Salicylic Acid
- Salsalate
- Saquinavir
- Scopolamine
- Secretin Human
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- Solifenacin
- Sorafenib
- Sotalol
- Sufentanil
- Sulindac
- Sulpiride
- Sumatriptan
- Sunitinib
- Tacrolimus
- Tapentadol
- Telavancin
- Telithromycin
- Tenoxicam
- Tetrabenazine
- Tiaprofenic Acid
- Tiotropium
- Tolfenamic Acid
- Tolmetin
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Valdecoxib
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Vilanterol
- Vilazodone
- Vinflunine
- Voclosporin
- Voriconazole
- Vortioxetine
- Zuclopenthixol
Warnings
Suicidal Thoughts
Taking clomipramine can make your depression worse and cause suicidal thoughts, or thoughts of self harm. The risk is highest if you’re 24 years of age or younger, during the first few months of taking the medication, and when your dose changes. If you or anyone around you notice that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while taking clomipramine, get medical help right away.
Withdrawal Symptoms
Stopping daily clomipramine suddenly, or rapidly reducing your dose, can cause withdrawal symptoms such as nausea, anxiety, agitation ,flu-like symptoms, trouble sleeping, and dizziness. To reduce the risk of withdrawal symptoms, those taking a daily dose over 25mg should reduce the dose by 25 mg per week.
Mania
Treating someone with bipolar disorder with an antidepressant like clomipramine can cause a manic episode. Symptoms of a manic episode include great excitement, euphoria, delusions, and overactivity. This is more likely to happen if you or someone in your family has had bipolar disorder. Your healthcare provider should make sure you’re evaluated for bipolar disorder before starting clomipramine. Talk to your provider right away if you notice unusual changes in your behavior.
Serotonin Syndrome
Serotonin syndrome is a rare, but potentially life-threatening, condition that happens when there’s too much serotonin active in the brain. This is more likely to happen if you’re also taking other medications that affect serotonin levels, such as other antidepressants, monoamine oxidase inhibitors (MAOIs), lithium, and triptans. Symptoms of serotonin syndrome include fast heartbeat, sweating, muscle stiffness or spasms, fever, and confusion. Go to the emergency room right away if you think you are having these symptoms.
Low Blood Sodium Levels
Clomipramine can lower blood sodium levels. This is more of a risk if you take diuretic medications that also lower your sodium. Symptoms of low sodium (hyponatremia) are weakness, confusion, difficulty concentrating, headache, or memory problems. Seek medical help right away if you have any of these symptoms.
Seizures
Clomipramine can raise the chance of seizures for some people, including those who have had seizures in the past, or are taking other medications that can increase seizure risk. Combining this medication with alcohol can also increase the seizure risk. Clomipramine is generally not recommended if you have a history of seizures.
Dizziness and Falls
While taking clomipramine, you could experience dizziness and falls due to a sudden drop in blood pressure when changing positions (such as going from sitting to standing). If you’re sensitive to low blood pressure or are on medications to control your blood pressure, change positions slowly until your body is used to clomipramine. This risk is higher in older age individuals and with higher dosage of clomipramine. If you still feel dizzy after a week or two after starting clomipramine or increasing your dose, you should talk to your provider and/or consider an alternative medication.
Eye problems (Angle-closure glaucoma)
Clomipramine can cause your pupils to widen, which, for some people with an underlying eye condition, can lead to an eye problem called angle-closure glaucoma. Symptoms of this can include eye pain, headache, changes in vision, nausea, and vomiting.
Serious skin reactions - DRESS
Although rare, serious skin reactions called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome have been reported with clomipramine. Symptoms of DRESS include fever, rash, and internal organ involvement and notify your provider immediately.
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