Clomipramine
Antidepressant (tricyclic)
Brand names: Anafranil
Oral health effects
Xerostomia (dry mouth)
Potent anticholinergic dry mouth.
Clinical management: Hydration, sugar-free gum/xylitol, salivary substitutes, high-fluoride products; reinforce caries prevention.
Bruxism
Antidepressant-associated jaw clenching/grinding can occur or worsen.
Clinical management: Assess for wear; consider an occlusal guard; discuss with prescriber if severe.
Taste disturbance (dysgeusia)
Altered taste is reported in 8% of adults and 4% of children ("taste perversion") in the FDA label.
Clinical management: Ask about altered or metallic taste, which can reduce appetite and oral comfort; reassure that it is drug-related and often fades. Rule out oral candidiasis or poor hygiene as contributors and encourage sugar-free options rather than sweet foods/drinks used to mask the taste.
Dizziness on standing (orthostatic hypotension)
Modest orthostatic drops in blood pressure were seen in about 20% of patients in trials; postural hypotension was reported as an adverse event in 6% of adults.
Clinical management: Raise the chair slowly at the end of the appointment and have the patient sit upright for a minute or two before standing; steady them as they get up. Ask about dizziness on standing, especially after dose changes or in older patients.
Sources
- A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Wolff A, Joshi RK, Ekström J, et al. Drugs in R&D, 2017.
- Association between psychotropic medications and presence of sleep bruxism: A systematic review. Melo G, Dutra KL, Rodrigues Filho R, et al. Journal of oral rehabilitation, 2018.
- Clomipramine prescribing information (FDA label) Micro Labs Limited / DailyMed, 2025.
- A review and guide to drug-associated oral adverse effects-Dental, salivary and neurosensory reactions. Part 1. Teoh L, Moses G, McCullough MJ. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 2019.