Clomipramine (Anafranil)

Clomipramine was developed by Geigy Pharmaceuticals (now known as Novartis) in the 1960"s. It was derived from imipramine and is a tricyclic antidepressant and antiobsessive medication

The Bottom Line: What You Really Need to Know


Clomipramine is not usually used to treat depression. It is used more frequently to treat obsessive-compulsive disorder. It has also been used to treat panic disorder, narcolepsy, chronic pain, bedwetting, premature ejaculation, cocaine addiction with neurologic damage, hair pulling or nail biting and repetitive behaviors in autism.

Dosage and instructions

The initial dose of clomipramine is 25 mg/day divided into three doses and taken with meals. The dose is increased by 25 mg/day every 3-4 days, reaching 150 mg/day by the end of two weeks. It takes 2-3 weeks to achieve the full therapeutic effect of clomipramine, so most doctors wait for another week or two before increasing the dose any further. If necessary, it can gradually be increased to 200 mg/day. Hospitalized patients may be increased to 300 mg/day.

After the therapeutic effect has been obtained, the dose is gradually decreased to the lowest one that works for this person.

The usual therapeutic dose for depressed adults is 200 mg/day; people with OCD may need 250 mg/day.

Children and elderly people often need smaller doses. The dose should be increased very gradually in older people.

How clomipramine works

Clomipramine inhibits the reuptake of serotonin and norepinephrine at the junctions of nerve cells. It also has anticholinergic and antihistamine effects.

Clomipramine is absorbed from your stomach quickly. It is broken down in your liver; 2/3 of it is excreted in urine, 1/3 in feces. One metabolite (substance formed when clomipramine breaks down) is active (has a therapeutic effect). This makes clomipramine effective for a longer time.

Side Effects

The most frequently experienced side effects of clomipramine are sleepiness, tremors, dizziness, nervousness, muscle spasms, diminished libido and sexual functioning, sweating, increased appetite and weight gain and vision changes.

Many other side effects can occur including:


Clomipramine interacts with many medications. Some of them are:

Some medications cause clomipramine to be metabolized more slowly, so that the level increases. The dose may need to be decreased if you are taking these medications:

Some medications have the opposite effect. You could need a larger dose of clomimipramine if you are taking:


Clomimipramine is not addictive, but if you suddenly stop taking it you could experience withdrawal symptoms, or "discontinuation syndrome." Symptoms are nausea and vomiting, headache, irritability, fever, inability to sleep and feeling lousy. Clomimipramine should be tapered gradually before you stop taking it.

Warnings, precautions and contraindications

Suicide risk: There is an increased risk of suicide with all antidepressants, especially in the first several weeks that you take it. Anybody who starts taking an antidepressant should be monitored frequently with weekly physician or therapist visits. Friends and family should check with the person daily and any unusual symptoms or worsening depression should be reported to the physician immediately.

Mania: Clomimipramine can trigger mania in bipolar individuals and can cause rapid cycling from depression to mania. The mania can be severe and can progress to psychosis, delusions, paranoia, hostility and aggression and violence.

Seizures: Clomipramine lowers the seizure threshold and can increase seizure activity in people susceptible to it.

Clomimipramine should be used with caution in patients who are have hyperactive thyroid, enlarged prostate, glaucoma, adrenal gland tumors, liver disease or kidney disease.

Elderly people may experience oversedation and delirium, especially at night. This could lead to falls.

Clomimipramine may increase the incidence of dental caries.

People who have severe heart failure or have recently had a heart attack should not take clomimipramine.

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