Changes

*Unlicensed

*Unlicensed

:*Anxiety related problems, especially those involving panic.

:*Anxiety related problems, especially those involving panic.

:*Stereotypy/compulsive disorders such as acral lick dermatitis (ALD), compulsive grooming

:*Stereotypy/compulsive disorders such as acral lick dermatitis (ALD), compulsive grooming <ref>Thoren, P., Asberg, M. & Cronholm, B. (1980). Clomipramine treatment of obsessive-compulsive disorder. Archives of General Psychiatry 37, 1281–5.</ref><ref>Flament, M. F., Rappoport, J. L. & Berg, C. J. (1985). Clomipramine treatment of childhood obsessive compulsive disorder. A double-blind controlled study. Archives of General Psychiatry 42, 977–83.</ref><ref>Ananth, J. (1986). Clomipramine: an anti-obsessive drug. Canadian Journal of Psychiatry 31, 253–8.</ref><ref>Perse, T. (1988). Obsessive-compulsive disorder: A treatment review. Journal of Clinical Psychiatry 49, 48–55.</ref><ref>McTavish, D. & Benfield, P. (1990). Clomipramine: an overview of its pharmacological properties and a review of its therapeutic use in obsessive-compulsive behavior and panic attack. Drug 39, 136–53.</ref><ref>Overall, K. L. (1994). Use of clomipramine to treat ritualistic motor behavior in dogs. Journal of the American Veterinary Medical Association 205, 1733–41.</ref><ref>Hewson, C. J., Luescher, A., Parent, J. M., Conlon, P. D. & Ball, R. O. (1998b). Efficacy of clomipramine in the treatment of canine compulsive disorder. Journal of the American Veterinary Medical Association 213, 1760–6.</ref><ref>Moon-Fanelli, A. A. & Dodman, N. H. (1998). Description and development of compulsive tail chasing in terriers and response to clomipramine treatment. Journal of the American Veterinary Medical Association 212, 1252–7.</ref><ref>Dodman, N. H., Donnelly, R., Shuster, L., Mertens, P. & Miczek, K. (1996). Use of fluoxetine to treat dominance aggression in dogs. Journal of the American Veterinary Medical Association 209, 1585–7.</ref><ref>Seksel, K. & Lindeman, M. J. (1998). Use of clomipramine in the treatment of anxiety-related and obsessive-compulsive disorders in cats. Australian Veterinary Journal 76, 317–21.</ref>

:*Aggression where anxious apprehension is an obstacle to treatment

:*Aggression where anxious apprehension is an obstacle to treatment

:*Spraying where anxiety, especially chronic, is a factor (if problem is longstanding or refractory to behavioural treatment)

:*Spraying where anxiety, especially chronic, is a factor (if problem is longstanding or refractory to behavioural treatment)

:*Some narcopleptic disorders

:*Some narcoleptic disorders

Onset of action is 4 or more weeks. The dose of Clomipramine may need to be increased from an initial dose rate once daily, to a higher dose rate if initial response is insufficient after 6-8 weeks. Higher doses are associated with increased adverse effects such as sedation and it is important that genuine response to therapy is not confused with undesirable profound sedative effects which will suppress all sorts of behaviour.

Onset of action is 4 or more weeks. The dose of Clomipramine may need to be increased from an initial dose rate once daily, to a higher dose rate if initial response is insufficient after 6-8 weeks. Higher doses are associated with increased adverse effects such as sedation and it is important that genuine response to therapy is not confused with undesirable profound sedative effects which will suppress all sorts of behaviour.

Once the condition being treated is deemed under control drug therapy should be gradually phased out over approximately 4-8 weeks. This is preferable to stopping administration of a drug all at once and reduces potential central withdrawal signs, as well as allowing establishment of the lowest dose that is still effective if problem behaviour is resumed during the weaning process. Although treatments are long term, maintenance doses are generally significantly lower than doses used at the beginning of the treatment regime. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

Once the condition being treated is deemed under control drug therapy should be gradually phased out over approximately 4-8 weeks. This is preferable to stopping administration of a drug all at once and reduces potential central withdrawal signs, as well as allowing establishment of the lowest dose that is still effective if problem behaviour is resumed during the weaning process. Although treatments are long term, maintenance doses are generally significantly lower than doses used at the beginning of the treatment regime. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

==Adverse Effects==

==Adverse Effects<ref>Wiersma, J., Honig, A. & Peters, F. P. J. (2000). Clomipramine-induced allergic hepatitis: a case report. International Journal of Psychiatry in Clinical Practice 4, 69–71.</ref>==

{| class="wikitable"

{| class="wikitable"

'''Caution should be taken if the animal suffers from any of the following pre-existing medical conditions:'''

'''Caution should be taken if the animal suffers from any of the following pre-existing medical conditions:'''

*Heart disease, especially heart block and arrythmias

*Heart disease, especially heart block and arrythmias <ref>Pouchelon, J. L., Martel, E., Champeroux, P., Richard, S. & King, J. N. (2000). Effect of clomipramine hydrochloride on the electrocardiogram and heart rate of dogs. American Journal of Veterinary Research, in press.</ref><ref>Reich, M. R., Ohad, D. G., Overall, K. L. & Dunham, A. E. (2000). Electrocardiographic assessment of antianxiety medication in dogs and correlation with drug serum concentration. Journal of the American Veterinary Medical Association 216, 1571–5.</ref>

*Diabetes: increases hyperglycaemia

*Diabetes: increases hyperglycaemia

*Glaucoma (closed angle type)

*Glaucoma (closed angle type)

*Impaired liver function (TCAs metabolised by liver)

*Impaired liver function (TCAs metabolised by liver)

*Hyperthyroidism (enhanced response to TCAs)

*Hyperthyroidism (enhanced response to TCAs)

*Urinary retention <ref name="Overall2">Overall, K.L. Pharmacological Treatment in Behavioural Medicine: The Importance of Neurochemistry, Molecular Biology and Mechanistic Hypotheses. The Veterinary Journal 2001, 162, 9-23</ref>.

*Urinary retention <ref name="Overall2">Overall, K.L. 2001. Pharmacological Treatment in Behavioural Medicine: The Importance of Neurochemistry, Molecular Biology and Mechanistic Hypotheses. The Veterinary Journal, 162, 9-23</ref>.

'''Care should be taken if used in conjunction with any of the following drugs, which may interact and cause adverse effects:'''

'''Care should be taken if used in conjunction with any of the following drugs, which may interact and cause adverse effects:'''

*SSRIs: Fluoxetine inhibits Cytochrome p450, leading to toxic levels of TCA. Cimetidine also has this effect.

*SSRIs: Fluoxetine inhibits Cytochrome p450, leading to toxic levels of TCA. Cimetidine also has this effect.

*Fibre rich diets reduce availability of TCAs.

*Fibre rich diets reduce availability of TCAs.

*Thyroid medications: can interfere, therefore if simultaneously used must be carefully monitored <ref name="Overall2"/ >

*Thyroid medications: can interfere, therefore if simultaneously used must be carefully monitored <ref name="Overall2"/>

If the drug is overdosed/combined with an inappropriate drug (see above) an increased sedation and degree of adverse effects as listed will be seen. If the drug dose is persistently high or the drug is combined with an MAOI, serotonin syndrome is a possible consequence:

If the drug is overdosed/combined with an inappropriate drug (see above) an increased sedation and degree of adverse effects as listed will be seen. If the drug dose is persistently high or the drug is combined with an MAOI, serotonin syndrome is a possible consequence: