氯米帕明
Clomipramine
Clomipramine HCl
別名: Clomicalm · Anafranil · clomipramini hydrochloridum · G-34586 · monochlorimipramine hydrochloride · Clofranil · Clopram · Clopress · Equinorm · Hydiphen · Maronil · Novo-Clopamine · Placil · Tranquax · Zoiral · Clomipraminum · Clomipramine hydrochloride
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Label directions (Clomicalm) | 2-4 mg/kg | PO | once daily or divided twice daily | — | 🌎 NA |
| Behavioral disorders | 3 mg/kg | PO | q12h | — | 🌎 NA |
| Male dimorphic behaviors, fearful/fear aggression, noise phobias, obsessive/compulsive behaviors | 1 mg/kg PO every 12 hours for 2 weeks; then 2 mg/kg PO q12h for 2 weeks, then 3 mg/kg PO q12h for 4 weeks and maintain | PO | q12h | Maintain after 8 weeks | 🌎 NA |
| Adjunctive treatment of storm phobia | Clomipramine 2 mg/kg PO q12h for 3 months, then 1 mg/kg PO q12h, then 0.5 mg/kg PO q12h for 2 weeks | PO | q12h | 3.5 months | 🌎 NA |
| Separation-related disorders, anxiety, compulsive behaviors, noise fears, cataplexy | 1-2 mg/kg | PO | q12h | Long-term (e.g., 3 months for cataplexy) | 🌍 EU |
- Behavioral disorders: start at a low dose (e.g., 1 mg/kg for 2 weeks, then 2 mg/kg for 2 weeks, then 3 mg/kg)
- Male dimorphic behaviors, fearful/fear aggression, noise phobias, obsessive/compulsive behaviors: May take 4-6 weeks to see apparent improvement.
- Adjunctive treatment of storm phobia: Used with alprazolam (0.02 mg/kg PO as needed 1 hour before anticipated storms and q4h as needed) and behavior modification
- Separation-related disorders, anxiety, compulsive behaviors, noise fears, cataplexy: Licensed for use in association with a behaviour modification plan for separation-related disorders.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Urine marking/spraying; inter-cat aggression; redirected aggression; compulsive grooming/wool sucking | 0.5 mg/kg | PO | once daily | — | 🌎 NA |
| Behavioral disorders | 0.3-0.5 mg/kg | PO | q24h | — | 🌎 NA |
| Behavioral disorders | 0.5-1 mg/kg | PO | once daily | — | 🌎 NA |
| Urine marking | 0.3-0.5 mg/kg PO q24h (2.5-5 mg per cat q24h) | PO | q24h | — | 🌎 NA |
| Anxiety-related disorders, compulsive behaviours, urine spraying | 0.25-1 mg/kg | PO | q24h | — | 🌍 EU |
- Anxiety-related disorders, compulsive behaviours, urine spraying: Monitor for urinary retention.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Adjunctive treatment of feather picking | 0.5-9 mg/kg | PO | q12-24h | — | 🌎 NA |
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
氯米帕明是一種三環類抗憂鬱藥 (TCA)，主要用於獸醫行為醫學。
- 犬：獲 FDA 核准用於治療強迫症（儀式性刻板行為）和分離焦慮。也常標示外用於支配性攻擊和噪音恐懼症。
- 貓：標示外用於行為問題，如噴尿、心因性脫毛和強迫性理毛。
- 鳥類：用於治療啄羽行為。
臨床提示：與大多數 TCA 和 SSRI 一樣，氯米帕明需要較長的治療時間（通常為 4-8 週）才能觀察到最大的臨床療效。理想情況下，它應作為全面行為矯正計畫的輔助手段，而非單一療法。
作用機轉
The exact mechanism of action of tricyclic antidepressants involves the blockade of monoamine reuptake in the central nervous system.
- Primary Action: Clomipramine predominantly inhibits the presynaptic reuptake of serotonin (5-HT) via the serotonin transporter (SERT) → increasing synaptic serotonin concentrations.
- Active Metabolite: Its primary active metabolite, desmethylclomipramine, primarily inhibits the reuptake of norepinephrine (NE) via the norepinephrine transporter (NET).
- Receptor Downregulation: The chronic elevation of these neurotransmitters leads to the gradual down-regulation of post-synaptic receptors, which correlates with the delayed onset of clinical behavioral effects (taking several weeks).
- Off-target Effects: TCAs also exhibit antagonism at muscarinic (cholinergic), histamine (H1), and alpha-1 adrenergic receptors, which are responsible for many of their adverse effects (e.g., dry mouth, sedation, hypotension).
安全性與警告
禁忌症
- Prior hypersensitivity to clomipramine or other tricyclic antidepressants
- Concomitant use with monoamine oxidase inhibitors (MAOIs) within 14 days
- Concurrent ingestion of aged cheeses (high tyramine content)
- Known sensitivity to tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs)
- Concurrent use of Monoamine Oxidase Inhibitors (MAOIs) or within 2 weeks of their use
- Male breeding animals (due to risk of testicular hypoplasia)
不良反應
- Emesis
- Diarrhea
- Sedation, lethargy, and depression
- Anticholinergic effects (dry mouth, tachycardia, urinary retention)
- Elevation of liver enzymes
- Pancreatitis (rarely reported in dogs)
- Birds: Ataxia, drowsiness, regurgitation
- Sporadic vomiting
- Changes in appetite
- Urinary retention (especially in cats)
- Testicular hypoplasia (in male breeding animals)
注意事項
Seizure Warning: TCAs may lower the seizure threshold. Use with extreme caution in animals with preexisting seizure disorders.
- Anticholinergic Risks: Use cautiously in patients with decreased GI motility, urinary retention, cardiac rhythm disturbances, or increased intraocular pressure.
- Hepatic Function: May cause hepatic abnormalities. Baseline and annual monitoring of liver enzymes is recommended for long-term use.
- Thyroid Disease: Use cautiously in hyperthyroid patients or those on thyroid supplementation due to increased risk of cardiac arrhythmias.
- Reproductive Safety: Not a known teratogen, but high doses have demonstrated testicular atrophy. The manufacturer warns against use in breeding male dogs. FDA Category C for human pregnancy.
- Species Sensitivity: Cats may be more sensitive to adverse effects (sedation, anticholinergic signs) due to slower elimination of the desmethyl metabolite.
藥物交互作用
Additive anticholinergic effects; use cautiously
Risk of extrapyramidal side effects (reported in a macaw)
May inhibit tricyclic antidepressant metabolism and increase the risk of toxicity
Increased risk for prolonged QT interval
May cause increased blood pressure
Additive CNS depression; use cautiously
Increased risk for serotonin syndrome
Increased risk for QTc interval prolongation and tricyclic adverse effects
May decrease tricyclic blood levels
Increased risk for serotonin syndrome
May increase the risk of cardiac effects (arrhythmias, hypertension, hyperpyrexia)
Concomitant use is generally contraindicated due to high risk of fatal serotonin syndrome
Risk of fatal serotonin syndrome; do not use concurrently or within 2 weeks of each other
Potentiation of anticholinergic effects (e.g., dry mouth, tachycardia, urinary retention)
Potentiation of CNS depressant effects
Potentiation of CNS depressant effects (though noted as safe to use together with care)
Potentiation of sympathomimetic cardiovascular effects
Potentiation of anticoagulant effects
Increased plasma levels of the antiepileptic drug
Increased plasma levels of the antiepileptic drug
Increased risk of serotonin syndrome; use only in exceptional cases with careful monitoring
High risk of fatal serotonin syndrome. Do not use within 2 weeks of each other.
Increased risk of serotonin syndrome. Use with trazodone only in exceptional cases with careful monitoring.
May potentiate anticholinergic effects.
May potentiate CNS depressant effects.
May potentiate sympathomimetic effects.
Plasma levels of the antiepileptic drugs may be increased by co-administration.
監測
- Clinical efficacy (behavioral improvement)
- Baseline and annual liver function tests
- EKG (especially in patients with cardiac risks or hyperthyroidism)
- Clinical efficacy (reduction in anxiety/compulsive behaviors)
- Signs of serotonin syndrome (agitation, tremors, hyperthermia, tachycardia) if used with other serotonergic drugs
- Urinary output and frequency, particularly in cats
- Appetite and gastrointestinal tolerance
藥物動力學
半衰期
吸收
Dogs: Rapidly converted in the liver to active metabolite desmethylclomipramine. Food decreases AUC for the parent compound by ~25% but not the metabolite. Cats: Oral bioavailability averages 90%. Humans: Well absorbed but substantial first-pass effect reduces systemic bioavailability to ~50%.
分佈
Highly lipophilic and widely distributed throughout the body (Vd = 17 L/kg). Highly bound to plasma proteins (96%). Crosses the placenta, maternal milk, and the blood-brain barrier.
代謝
Metabolized principally in the liver to several metabolites, including the active desmethylclomipramine. Cats metabolize clomipramine more slowly than dogs (male cats slower than females).
排除
About two-thirds of metabolites are eliminated in the urine and the rest in the feces.
過量
Clomipramine has a narrow margin of safety. Significant clinical signs can be seen at or slightly above the therapeutic range (2-3 mg/kg).
- Lethal Dose: In dogs, lethal doses are approximately 50-100 mg/kg/day PO (12.5-25X recommended dose).
- Clinical Signs (Dogs): Lethargy, tachycardia, ataxia, depression, vocalization, and vomiting.
- Clinical Signs (Cats): Lethargy, mydriasis, tachypnea, ataxia, depression, and tachycardia.
- Severe Toxicity: Overdosage with TCAs can be life-threatening, leading to severe arrhythmias, seizures, and cardiorespiratory collapse.
Action: Because toxicities and therapies are complicated and controversial, contact an animal poison control center immediately in any potential overdose situation.
可用產品
劑型
- Oral tablets
- Oral capsules
- 5 mg tablet
- 20 mg tablet
- 80 mg tablet
獸醫用
- Clomipramine HCl Oral Tablets: 5 mg, 20 mg, 40 mg, & 80 mg (Clomicalm®)
- Clomicalm 5 mg tablets
- Clomicalm 20 mg tablets
- Clomicalm 80 mg tablets
人用標示
- Clomipramine Oral Capsules: 25 mg, 50 mg, & 75 mg (Anafranil®)
- Anafranil 10 mg, 25 mg, 50 mg, 75 mg capsules/tablets
各地核准狀態
Licensed for separation-related disorders in dogs.
POM-V classification.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Veterinary tablets should be stored in a dry place at controlled room temperature (15-30°C) in the original closed container. Human capsules should be stored at <30°C in tight containers and protected from moisture.
飼主須知
- 需要耐心：此藥物可能需要數週（通常為 4-8 週）才能在寵物的行為上看到有益的效果。
- 訓練結合：通常與獸醫師或獸醫行為學家提供的行為矯正計畫結合使用時效果最佳。
- 給藥方式：可與食物一起餵食或空腹餵食。如果您的寵物服藥後嘔吐，請嘗試隨餐餵食。
- 請勿突然停藥：未經獸醫師指導，請勿突然停止治療，因為這可能會導致戒斷反應或行為復發。
- 毒性警告：請務必將此藥物存放在寵物和兒童接觸不到的地方。過量服用具有高度毒性，甚至可能危及生命。
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