Clomipramine, the 3-chloro analog of imipramine, is a dibenzazepine-derivative tricyclic antidepressant (TCA). TCAs are structurally similar to phenothiazines. They contain a tricyclic ring system with an alkyl amine substituent on the central ring. In non-depressed individuals, clomipramine does not affect mood or arousal, but may cause sedation. In depressed individuals, clomipramine exerts a positive effect on mood. TCAs are potent inhibitors of serotonin and norepinephrine reuptake. Tertiary amine TCAs, such as clomipramine, are more potent inhibitors of serotonin reuptake than secondary amine TCAs, such as nortriptyline and desipramine. TCAs also down-regulate cerebral cortical β-adrenergic receptors and sensitize post-synaptic serotonergic receptors with chronic use. The antidepressant effects of TCAs are thought to be due to an overall increase in serotonergic neurotransmission. TCAs also block histamine-H1 receptors, α1-adrenergic receptors and muscarinic receptors, which accounts for their sedative, hypotensive and anticholinergic effects (e.g. blurred vision, dry mouth, constipation, urinary retention), respectively. See toxicity section below for a complete listing of side effects. Clomipramine may be used to treat obsessive-compulsive disorder and disorders with an obsessive-compulsive component (e.g. depression, schizophrenia, Tourette’s disorder). Unlabeled indications include panic disorder, chronic pain (e.g. central pain, idiopathic pain disorder, tension headache, diabetic peripheral neuropathy, neuropathic pain), cataplexy and associated narcolepsy, autistic disorder, trichotillomania, onchophagia, stuttering, premature ejaculation, and premenstrual syndrome. Clomipramine is rapidly absorbed from the gastrointestinal tract and demethylated in the liver to its primary active metabolite, desmethylclomipramine.
The T-value in the score for hazard refers to acute toxicity. Underlying data for P, B and T are from Fass. Below is Hazard and Risk from Fass environmental information for Anafranil (clomipramine) (downloaded date 2018-10-05) Hazard Persistence: "34 % degradation in 28 days, not readily biodegradable (OECD 301E). [---] According to the pass criteria for OECD301 studies, klomipramin can be classified as ‘Klomipramin is potentially persistent'." Bioaccumulation: Log P = 2.1 (23°C, experimentally determined; method unknown). Acute toxicity: There is data for 2 trophic levels, lowest fish (Danio rerio, zebrafish) 430 microg/L. Risk Sales data are presented in Sweden for 2016. "No PNEC can be calculated since there is not sufficient environmental toxicity data available, therefore the phrase "Risk of environmental impact of klomipramin cannot be excluded, since there is not sufficient ecotoxicity data available." is used." Pharmaceutical analyses of water in Stockholm County and nationally respective in fish Clomipramine has been found in purified wastewater at concentrations up to 3 ng/L in Stockholm County during the last five-year period (2012–2016) and in Swedish purified wastewater at concentrations up to 49 ng/L. In the Swedish national screening programme, clomipramine levels have been found in fish up to 8.1 microg/kg. Comparative assessment of environmental risk in the use of citalopram, escitalopram, sertraline, fluoxetine, venlafaxine, paroxetine and clomipramine in Sweden (Report Goodpoint 2018) Overall, there is a risk profile for the studied antidepressants.
Fass.se för vårdpersonal
Goodpoint. Jämförande bedömning av miljörisk vid användning av citalopram, escitalopram, sertralin, fluoxetin, venlafaxin, paroxetin och klomipramin. Stockholm: Goodpoint; 2018.
SLL. Sammanställning av läkemedelsprovtagningar - Bearbetning av regional försäljningsstatistik av läkemedel samt datamaterial från Stockholms läns landstings mätprogram för läkemedelssubstanser i vattenmiljö, 2012–2016.
IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3, B 2014 Pharmaceuticals.