Clomipramine for the treatment of cataplexy in narcolepsy

What is cataplexy in narcolepsy?

Narcolepsy is a long-term condition which causes excessive sleepiness during the day and may disrupt your sleep at night. You can also have sleep attacks where you fall asleep at inappropriate times during the day without any warning.

Cataplexy is a condition associated with narcolepsy that results in sudden muscle weakness. This can be triggered by strong emotions such as:

• laughter
• anger
• fright
• surprise

Muscle weakness can vary in severity, and cataplexy attacks can differ in both type and how long they last for.

What is clomipramine?

Clomipramine belongs to a group of medicines called anti-depressants. It can be used to treat cataplexy in narcolepsy. Clomipramine works by interfering with certain chemicals in the brain which may be involved in causing the symptoms of cataplexy.

How do I take the medicine?

For the treatment of cataplexy, clomipramine is taken 1 a day at bedtime. Clomipramine can be taken with or without food. Swallow the capsules whole with a drink of water.

Keep taking the capsules until your consultant tells you otherwise. Stopping suddenly can cause unwanted side effects and severe cataplexy attacks. Your consultant will want you to reduce your dose gradually if you need to stop treatment.

What should I do if I forget to take the medicine?

Don’t worry. Take the next dose when it is due.

Do not take an extra dose the following night to make up for the missed dose.

Are there any side effects?

Most medicines can cause unwanted side effects, although not everyone gets them. The unwanted effects often fade as your body adjusts to the new medicine, but speak with your GP or pharmacist if any of the following continue or become troublesome.

For further information on side effects, please see the manufacturer’s leaflet that comes with the medicine.

Can I take clomipramine with other medicines?

Clomipramine may interact with some medicines. It is important to let us know about any medicines that you are currently taking, so that we can check clomipramine is suitable for you.

If you are buying any medicines over the counter from a pharmacy always mention that you have been prescribed clomipramine. Although it is safe to take paracetamol with this medicine, ask for advice before buying any other painkillers, or any flu remedies or antihistamines.

You should also seek advice if you are thinking about buying herbal or homeopathic remedies.

How will my treatment be reviewed?

Your treatment will be reviewed regularly in the narcolepsy clinic. We can adjust your doses to help with your symptoms. Your consultant will want to check to make sure that the treatment is helping. You may need to have your blood pressure and heart rate checked regularly.

How do I get a repeat prescription?

Your GP will give you a repeat prescription for clomipramine. Please make sure you request your repeat prescription early to prevent you running out or risk missing any doses of your medication.

Is there anything else I need to know?

This medication needs to be taken regularly. It can take 1 or 2 weeks after starting this treatment before the effect builds up, and up to 4 weeks before you feel the full benefit. It is important that you continue taking it, even if you think it is not helping. The dose of clomipramine may need to be increased over time.

Sunlight

Clomipramine can make your skin more sensitive to sunlight. You should try to avoid exposure to strong sunlight, and use a sun cream with a high protection factor.

❌ Do not use sunbeds.

Diabetes

Clomipramine can alter the levels of sugar in your blood. If you have diabetes you may need to check your blood sugar more regularly. Your GP can advise you about this.

Alcohol

❌ Do not drink alcohol while you are taking clomipramine. Mixing alcohol with clomipramine may increase the risk of other side effects such as drowsiness, confusion, and blurred vision.

Sleep routines

Taking clomipramine is not a replacement for a good sleep routine. It is still important to aim to get around 9 to 11 hours of sleep at night, depending on your age. You should go to bed when you’re tired and get up at about the same time each day. 

Pregnancy and breastfeeding

We do not recommend the use of this medicine if you are pregnant or breastfeeding. You should let your consultant know if you are planning a pregnancy, so that a management plan can be agreed. If you discover that you are pregnant, please contact your consultant for advice as soon as possible.

Driving

If you are old enough to drive, you must let the Driver and Vehicle Licensing Authority (DVLA) know if you are diagnosed with narcolepsy.

You may be allowed to drive again when your symptoms are well controlled with medication, but you will need to have regular reviews. Your consultant will advise you about this.

If you are a driver, please be aware that clomipramine may affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, if you drive, you should carry some evidence with you which shows that the medicine has been prescribed for you. A repeat prescription form or the patient information leaflet from the packet is generally enough.

Other medical procedures

If you are due to have any medical treatment, tell the person carrying out the treatment that you are taking this medicine, as it can interfere with some anaesthetics.

Clomipramine should be kept out of reach of children. If anyone other than you takes this medicine, you, they, or their parent or carer should contact NHS 111 for advice. If they are unwell then they should call for an ambulance.

Expiry

Do not use the medicine after the expiry date.

The expiry date is printed on the container. Any that have gone out of date should be returned to your local pharmacy to be properly disposed of.