Q+A – Clomipramine or Clomicalm for urine spraying

Dear Your Own Vet,

My vet recommended Clomicalm or Clomipramine to help treat my cat’s urine spraying. He said it is an anti depressant? Will it help? Surely my cat can’t be depressed? Do animals even get depressed?

Ros Stark,

Texas,

USA

 

male and female cats spray

Cats spray as territorial behavior or because of stress

WHAT IS CLOMICALM AND HOW DOES IT WORK?
WHICH ANIMALS CAN’T TAKE CLOMICALM?
SIDE EFFECTS
YOU CANNOT USE CLOMICALM WITH
USE CAUTIOUSLY WITH

Dear Ros,

The  human market for medication to treat anxiety disorders is large. People want to be free from worry and stress without suffering drowsiness, addictiveness, or other side effects. In the beginning, medications for anxiety relief such Valium caused sedation and chemical dependence. These side effects drove researchers to seek a better solution and developed tricyclic antidepressants. Pets also have anxiety issues. Many pets have separation anxiety from their owner, aggressive pets with whom they share their home, loud noises such as thunderstorms, and other issues. The medications used to help animals with these issues are the same medications that humans use.(5)

Although cats are less prone to separation anxiety issues than dogs are, they can still be anxious for other reasons, such as fear of other aggressive cats or taking trips either to the vet or other longer trips. (3) CLOMICALM® should be used for at least 2-3 months and at the same time behavioral modification techniques must be done for best results in the treatment of anxieties. See our behavior article  on urine spraying for these methods:

Feline Urine Spraying

Once the new behavior has been learned, the dose may be tapered and/or discontinued. (1)(2)

psychogenic alopecia

Compulsive overlicking can also be treated with clomicalm (6)

Clomicalm is helpful in treating:

  • Separation anxiety or other forms of anxiety
  • Feline innapropriate urination (urine spraying)
  • Obsessive compulsive disorders such as compulsive licking and overgrooming
  • Dominance aggression (5)

WHAT IS CLOMICALM AND HOW DOES IT WORK?

CLOMICALM®is a tricyclic antidepressant used to treat anxieties and control behavior problems.(1) It is  registered for dogs, but used with caution in cats.The active ingredient in CLOMICALM® is clomipramine hydrochloride, which is broken down to a chemical called desmethylclomipramine in the body. These two chemicals block nerves reabsorbing serotonin produced by the brain so it stays around at higher activity levels for longer. Serotonin is a “happy chemical” that   makes your cat feel cozy and happy and reduces stress levels. (1)(5) If the chemicals in the brain are unbalanced before treatment, Clomicalm can also help balance them out.  It is not a tranquilizer or sedative,  and thus will not affect your pet’s personality or memory. (4)

Clomipramine clomicalm urine spraying cat

Clomicalm is registered for dogs but may be used with caution in cats

(4) It is available in 5 mg, 20 mg, 40 mg, 80 mg tablets approved for veterinary use and in 25 mg, 50 mg, 75 mg capsules for human use (5)If a convenient dosage size for cats is not available, it can be compounded at a special pharmacy. (1)It may be given once or preferably twice daily, preferably with food (reduces vomiting).  Dividing the dose may minimize side effects and  allow your cat to get used to it more easily. Avoid feeding cheese while pet is on Clomipramine and give plenty of water. Give the exact amount prescribed and only as often as directed, for as long as directed at the same time daily.  If a dose is missed, give it as soon as you can. Do not double dose it if you run late, however. (2)  Clomicalm may not help symptoms right away. It may take a number of days before symptoms begin to lessen, several weeks before you can expect to see a therapeutic effect and must be used for up to 3 months until the new behavior is learned and usually tapered down gradually after that. (5) Do not stop giving Clomicalm suddenly as it may cause nausea and malaise.(4)

WHICH ANIMALS CAN’T TAKE CLOMICALM?

Your vet needs to know all of the clinical and behavioral signs your pet showed before starting  on the medication, as , for example, he/she wouldn’t want to prescribe Clomicalm for urine spraying, when in fact the problem is a bladder infection, not behavioral at all! They will most likely ask you to come back for regular check ups to monitor the progress, check side effects your pet may experience and may take blood tests for liver function etc. during the course of the treatment. Also discuss with your vet any medications you give your pet, even those given without a prescription or herbal remedies. (2)

Cats that are allergic to Clomipramine or other tricyclic antidepressants (ex. amitriptyline), animals with a history of seizures, liver disease, kidney disease,  heart problems, asthma, diabetes, high blood pressure, glaucoma, thyroid problems, urinary retention problems, such as animals prone to bladder stones or cystitis or animals with slow gastrointestinal functions eg constipation, should avoid Clomicalm. (2) Tell your veterinarian if your pet is breeding or feeding kittens as it is secreted in the milk. (4)(5)

SIDE EFFECTS

Cats are more sensitive than dogs to tricyclic antidepressant drugs.(2)(5) Overdoses can be life-threatening.An overdose of approximately 12 times the recommended dose is often lethal.(5) The list of side effects to watch for includes:

  • Diarrhea/Constipation
  • Glaucoma
  • Heart rhythm disturbance (especially in patients with hyperthyroidism or taking thyroid supplementation) (4)
Hyperthyroid cats should avoid clomicalm

Clomicalm may cause blood problems in cats being treated for hyperthyroidism

  • Lethargy
  • Dizziness
  • Changes in appetite and weight
  • Vomiting and diarrhea or constipation
  • Panting and agitation
  • Tremors
  • Increased drinking and a dry mouth

Any of the following side effects are an emergency:

  • An allergic reaction (difficulty breathing; swelling of the lips, tongue or face, or hives)
  • Seizures or collapse
  • Fast or irregular heartbeat
Clomicalm may cause fast irregular heartbeat

Clomicalm may cause fast, irregular heartbeats – an emergency!

  • Difficulty urinating
  • Fever with increased panting,
  • Muscle stiffness or muscle weakness.
  • Vocalization,
  • Seizure
  • Collapse and fainting
  • Hallucination and confusion.  (2) (3)

Clomicalm may increase the effects of other drugs that may cause drowsiness, including other antidepressants, antihistamines, sedatives, pain relievers, anxiety medications, and muscle relaxants. (4)

YOU CANNOT USE CLOMICALM WITH

Do not give use at the same time as, or two weeks before and after in cats or dogs:

Cimetidine (Tagamet®) may slow the removal of clomipramine, effectively increasing the potential to reach a toxic blood level.

Anipryl® (selegeline)

Isoniazid

Mitaban®

Preventic Collar (dogs)

Amitraz dips for demodectic mange.

Promeris Canine for flea and tick control

Drugs which make an animal more likely to convulse, such as acepromazine based tranquillizers. (2)
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USE CAUTIOUSLY WITH

Antithyroid products. Methimazole can affect the blood cells if used toegther with Clopiramine. (5)

Anticholergics (some premeds and treatments for poisoning)

Barbiturates (sedatives and anesthetics),

Cimetidine (antacid) ,

CNS depressants (sedatives, anaesthetics, alccohol and tranquillizers) ,

Fluoxetine (Prozac)

Phenytoin (antiepileptic)

Sympathomimetic products (adrenalin type products most often found in nasal sprays and cough syrups)

Clomicalm may increase the effects of other drugs and may cause drowsiness. (4)

As with all prescribed medicines, clomipramine should only be given to the cat for which it was prescribed and for the condition for which it was prescribed. It is important to periodically discuss your pet’s response to clomipramine at regular check ups. Your veterinarian will best determine if your pet is responding as expected and if your pet should continue receiving clomipramine. (2)

Chemical Structure of Clomipramine

REFERENCES

1. http://www.drugs.com/vet/clomicalm-5-can.html

2. http://www.vetrxdirect.com/product/view/clomicalm

3.http://happyhealthycats.com/medicines/clomicalm/

4. http://www.1800petmeds.com/Clomicalm-prod10439.html

5. http://www.veterinarypartner.com/Content.plx?P=A&A=1537&S=1

6.http://www.medicinenet.com/script/main/art.asp?articlekey=107386

Claire Demmer

www.yourownvet.com

MRCVS

BVSc (Hons)

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