Clomicalm is a veterinary-labeled formulation of clomipramine manufactured by Elanco that is FDA-approved for the treatment of separation anxiety in dogs when used in conjunction with a behavior modification program. It is one of only two medications (along with fluoxetine/Reconcile) to receive FDA approval for a canine behavioral condition. Clomipramine is a tricyclic antidepressant (TCA) that works primarily by inhibiting serotonin and norepinephrine reuptake. Generic clomipramine (the same active ingredient sold as Anafranil for humans) is available at a lower cost. Clomicalm requires a veterinary prescription.
What Is Clomicalm Used For?
Clomicalm is prescribed for behavioral conditions:
- Canine separation anxiety — the FDA-approved indication, used with behavior modification
- Compulsive disorders in dogs — tail chasing, excessive licking (acral lick dermatitis), flank sucking
- Urine marking in cats (off-label) — clomipramine can reduce inappropriate urine spraying
- Thunderstorm/noise phobias (off-label) — as a daily maintenance medication
- Generalized anxiety (off-label) — in dogs and cats
Like Reconcile, Clomicalm is specifically approved for use alongside behavior modification training. Medication alone does not adequately treat separation anxiety.
How Does Clomicalm Work?
Clomipramine is a tricyclic antidepressant that works primarily by inhibiting the reuptake of serotonin and, to a lesser extent, norepinephrine at the presynaptic neuron. This increases the availability of both neurotransmitters in the synaptic cleft, which over time helps regulate mood, reduce anxiety, and decrease compulsive behaviors.
Compared to fluoxetine (an SSRI), clomipramine has a somewhat broader pharmacological profile due to its effects on both serotonin and norepinephrine, as well as antihistaminic and anticholinergic properties. This broader profile accounts for both its therapeutic effects and some of its side effects (sedation, dry mouth, constipation). Onset of therapeutic effect is typically 2-4 weeks, which is somewhat faster than fluoxetine’s 4-6 weeks.
Dosage
Your veterinarian will determine the exact dose.
Dogs
| Dog’s Weight | Typical Dose Range | Frequency |
|---|---|---|
| 10 lbs (4.5 kg) | 5-15 mg | Every 12 hours |
| 20 lbs (9 kg) | 10-25 mg | Every 12 hours |
| 40 lbs (18 kg) | 20-50 mg | Every 12 hours |
| 60 lbs (27 kg) | 30-75 mg | Every 12 hours |
| 80 lbs (36 kg) | 40-100 mg | Every 12 hours |
Standard dose: 1-3 mg/kg every 12 hours. Clomicalm tablets are available in 5 mg, 20 mg, 40 mg, and 80 mg strengths.
Cats (Off-label)
| Cat’s Weight | Typical Dose Range | Frequency |
|---|---|---|
| 6-12 lbs (2.7-5.4 kg) | 1.25-5 mg | Once daily or every 12 hours |
Standard feline dose: 0.25-0.5 mg/kg once to twice daily.
How to Give Clomicalm to Your Dog
- Clomicalm is available as scored tablets (5, 20, 40, 80 mg) that can be split for accurate dosing.
- Give twice daily (approximately every 12 hours).
- Can be given with or without food.
- Allow 2-4 weeks for initial effect and up to 8 weeks for full therapeutic benefit.
- Do not stop abruptly. Taper gradually over 2 or more weeks under veterinary guidance.
- Must be used alongside a behavior modification program for optimal results.
Side Effects
| Common Side Effects | Serious Side Effects (Contact Your Vet) |
|---|---|
| Sedation or drowsiness | Seizures |
| Decreased appetite | Rapid heart rate (tachycardia) |
| Dry mouth | Difficulty urinating (urinary retention) |
| Constipation | Tremors or agitation |
| Mild vomiting or diarrhea | Signs of serotonin syndrome |
| Elevated liver enzymes | Jaundice (yellowing of gums or skin) |
The anticholinergic side effects (dry mouth, constipation, urinary retention) distinguish clomipramine from SSRIs like fluoxetine. These are usually mild but can be significant in some animals. Periodic blood work (liver enzymes) is recommended during long-term treatment.
Drug Interactions
- MAO inhibitors (selegiline/Anipryl): NEVER combine — risk of fatal serotonin syndrome. Wait at least 2 weeks between stopping an MAOI and starting clomipramine.
- SSRIs (fluoxetine, sertraline): Risk of serotonin syndrome. Generally avoid combining.
- Tramadol: Increased serotonin syndrome risk.
- Cimetidine: May increase clomipramine blood levels.
- Other anticholinergic drugs: Additive effects (dry mouth, constipation, urinary retention).
- Thyroid medications: Clomipramine may affect thyroid hormone levels.
Contraindications
- Known hypersensitivity to clomipramine or other tricyclic antidepressants
- Concurrent use with MAO inhibitors
- Dogs with known cardiac arrhythmias or serious heart disease (TCAs can affect cardiac conduction)
- Dogs with glaucoma (anticholinergic effects can increase intraocular pressure)
- Dogs with urinary retention or prostatic disease
- Pregnant, lactating, or breeding dogs
- Dogs with seizure disorders (may lower seizure threshold)
Storage
- Store at controlled room temperature, 68-77degF (20-25degC).
- Protect from moisture.
- Keep in original container.
- Keep out of reach of children and pets.
Cost & Availability
Clomicalm is available as both a veterinary brand and a generic human medication.
- Clomicalm (brand): $30-$80 per month depending on dog size
- Generic clomipramine: 40-60% less expensive than brand
- Available forms: Clomicalm tablets (5, 20, 40, 80 mg); Generic clomipramine capsules (25, 50, 75 mg)
- Generic can be filled at human pharmacies with a veterinary prescription
Frequently Asked Questions
How does Clomicalm compare to Reconcile (fluoxetine)? Both are FDA-approved for canine separation anxiety with behavior modification. Key differences: Clomicalm is dosed twice daily (vs. once daily for Reconcile), has a somewhat faster onset (2-4 weeks vs. 4-6 weeks), and has more anticholinergic side effects (dry mouth, constipation). Fluoxetine (Reconcile/generic Prozac) is generally considered to have fewer side effects overall. Individual dogs may respond better to one over the other.
Can Clomicalm be used for cats? Yes, clomipramine is used off-label in cats for urine spraying, compulsive grooming, and anxiety. It can be effective for feline behavioral issues, though cats may be more sensitive to the sedating and anticholinergic effects.
Is the generic clomipramine just as effective? Yes, the active ingredient is identical. Generic clomipramine capsules (human formulation) are commonly prescribed by veterinarians as a cost-effective alternative to brand-name Clomicalm tablets.
How long will my dog need Clomicalm? Similar to fluoxetine, treatment duration varies. Most dogs remain on clomipramine for at least 6-12 months while behavioral modification training is ongoing. Some dogs can eventually be tapered off, while others benefit from long-term treatment. Your veterinarian will guide the decision to attempt weaning.
Sources & References
- FDA - Clomicalm (Clomipramine) Approval
- DailyMed - Clomicalm Label
- Elanco - Clomicalm Product Information
- AVSAB - Behavioral Medication Position Statement
- VCA Hospitals - Clomipramine
Verification Notes
The FDA approval of Clomicalm for canine separation anxiety is confirmed as TRUE in the fact-check report (Claim C8, which states “Only fluoxetine and clomipramine are FDA-approved for canine separation anxiety” — rated TRUE). The requirement for behavior modification is verified (Claim C9). Pricing and the availability of generic clomipramine are consistent with the research corpus.