Clomipramine is a type of medicine known as an anti-depressant. It's been used to treat depression for many years. It acts on the nerve cells in the brain to prolong the feel-good effect that certain brain chemicals, called serotonin and noradrenaline, normally give us.
There's some anecdotal evidence about clomipramine being effective in treating a group of brain tumours, known as gliomas. There's also been some laboratory research into its effect on brain tumour cells. However, the use of clomipramine to treat brain tumours is debated.
How might clomipramine work in brain tumours?
Studies carried out in laboratories looked at how clomipramine affects the way cells use glucose (sugar) to grow and divide, leading to an increase in number and the growth of a tumour. This process is called cellular respiration.
Clomipramine is thought to stop cellular respiration and therefore stop cells dividing. This would slow or stop the rapid increase in the number of cells that happens in tumours and cause the cells to die.
In further studies on rats, clomipramine has been shown to cause cell death in a chemotherapy-resistant glioma, when combined with other drugs, by both stopping cell growth and causing cell death.
What is the evidence for its use in treating brain tumours?
The use of clomipramine in treating brain tumour is debated because there hasn't been a randomised clinical trial showing if the drug is effective in treating brain tumours.
In a randomised clinical trial, some of the patients would receive clomipramine while others would receive a 'dummy drug', known as a placebo. Comparing the results from the two groups would show scientifically whether clomipramine is an effective treatment for brain tumours.
The debate comes from stories of real people with gliomas, who appeared to have a good response after taking clomipramine. However, such anecdotal evidence is not usually accepted as scientific evidence.
Without a clinical trial, it's not possible to tell whether any improvements are because of clomipramine or for other factors. For example, clomipramine is sometimes taken alongside other medicines, so it could be these, or a combination of the other medication and clomipramine, that explains the effect.
Without a trial, we also cannot be sure if the laboratory results can be repeated in people, nor what doses would be needed and if these doses are safe.
However, it's proved difficult to run a clinical trial. As clomipramine is readily available in the UK as a treatment for depression, people are unlikely to enter a trial where there's a chance they'll not receive the drug, when they can already access it relatively easily through the NHS. This can prevent people from volunteering to take part in such a trial.
Without scientific evidence, clomipramine will not be licensed for use with brain tumours. There are no NICE guidelines at present for the use of clomipramine in the treatment of brain tumours.
Your doctor may therefore be unwilling to prescribe this drug.
As with all drugs, clomipramine can have some unwanted side-effects and these may be different from person to person. These side-effects usually improve as your body adjusts to the medicine.
Common side-effects include:
- abdominal pain
- impaired memory
- hot flushes
- muscle spasms or weakness
You may also have some side-effects when you stop taking clomipramine. These include:
- flu-like symptoms
- sleep disturbance
- feeling shaky.
It is important to read the literature that comes with all medication and talk to your doctor if you feel unwell, or if the side-effects do not improve.
When you should NOT take clomipramine
Some people must NOT take clomipramine.
You need to talk to your doctor if you:
- ever had an allergic reaction to any anti-depressants
- had a heart attack in the last 3 months
- have heart or liver disease
- have had any mental illness other than depression
- are on other medicines, e.g. epilepsy medicines - carbamazepine or phenytoin.
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