Clomipramine, commonly known as Anafranil, is a tricyclic antidepressant medication, primarily used in the treatment of obsessive-compulsive disorder (OCD). It is important to take this medication exactly as prescribed and consult with your doctor before starting any other medication (prescribed or over the counter) while on clomipramine, as adverse effects can occur.

Clomipramine brand names

  • Anafranil

What is clomipramine prescribed for?

Clomipramine is approved by the US Food and Drug Administration (FDA) for use in the treatment of obsessive-compulsive disorder (OCD) for people aged 10 and above. The safety and efficacy of clomipramine in those under the age of 10 is not known, so it is not advised for use in this age group [1].

Medications can also be used off-label, which means that they are not approved by the FDA for this use, but a medical professional has deemed it necessary for treatment. Off-label uses of clomipramine include treating anxiety and panic disorders, depression and treatment-resistant depression, insomnia, and chronic pain [2].

How does clomipramine work?

Clomipramine is a serotonin reuptake inhibitor (SRI) and works in a similar way to other antidepressant drugs, by affecting certain neurotransmitters in the brain [3]. It increases the levels of serotonin, norepinephrine, and noradrenaline, which, along with improving mood, also impacts the development of obsessive and compulsive thoughts [4]. This type of drug differs from an SSRI; SSRI's bind only to serotonin while SRIs limit reuptake of serotonin along with dopamine and some other neurotransmitters)

Clomipramine also influences other areas of the brain, including sodium channels, which is believed to contribute to its pain-relieving effects [4].

How is clomipramine usually taken?

Clomipramine is available in 25mg, 50mg, and 75mg capsules, which should be swallowed whole without crushing, or opened and sprinkled on soft food (such as applesauce) and swallowed whole without chewing.

For the treatment of OCD, you will likely be prescribed an initial dose of 25mg per day. This will gradually be increased over 1-2 weeks, usually up to 100 mg daily, but potentially up to a maximum of 250mg per day for adults, and a maximum of 200mg per day for children, depending on weight [1]. For elderly patients, dose selection should begin cautiously.

During the initial two weeks, your prescription will be split into 3 or 4 doses per day, to prevent stomach upset. When the full therapeutic dose has been reached, you will likely take just one dose per day, at bedtime, to prevent daytime sedation.

If you are prescribed clomipramine for off-label use, your daily dose will likely be prescribed between 25mg-100mg per day, depending on your condition, to be taken in one dose at bedtime [2].

Your doctor will monitor your physical and mental health throughout your treatment and may eventually reduce your dose if clomipramine is to be used long-term, to find the lowest possible therapeutic dose.

This medication should be taken as prescribed, without missing a dose. If a dose is missed, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of side effects.

How long does clomipramine stay in your system?

When you start taking clomipramine, you may notice a change in symptoms within the first 1-2 weeks, but it will likely take several weeks after reaching the appropriate dose for the medication to take full effect [1].

After you stop taking clomipramine, it may take several weeks for the medication to entirely leave your system.

Do not suddenly stop taking clomipramine, even if you feel better, as this can have serious impacts on your physical and mental health and worsen your condition. If your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly, to prevent adverse effects and withdrawal symptoms.

Clomipramine side effects

When you begin a new medication, you may experience some common side effects. They will likely reduce within the first week or two, but if they continue or become problematic, consult your doctor immediately, as you may need a reduced dose or a change of medication.

Common side effects of clomipramine include:

  • Stomach upset
  • Constipation or diarrhea
  • Nausea or vomiting
  • Drowsiness or conversely restlessness
  • Dry mouth
  • Impaired memory and concentration
  • Headaches
  • Change in appetite and weight gain
  • Sexual dysfunction

Serious side effects of clomipramine are less common but may still occur. If you experience any of the following, call your doctor immediately for medical advice:

  • Shaking or tremors
  • Increased or irregular heartbeat
  • Breathing difficulties
  • Difficulty urinating or loss of bladder control
  • Stiff or weak muscles
  • Seizures
  • Sore throat and fever
  • Changes in mental state, including hallucinations, delusions, paranoia, or emerging or worsening anxiety or depression

Clomipramine precautions

Clomipramine can cause suicidal thoughts, particularly at the beginning of your treatment. This risk has been found to be higher in people under the age of 24 years old [1]. If you or your family notice any concerning changes in your mental state, or you experience thoughts of harming yourself, contact a medical professional immediately.

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on this medication, or to decide if it is safe for you. This includes mood disorders and other psychiatric disorders such as bipolar disorder and major depressive disorder.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Ensure you tell your doctor if you have experienced any heart, liver, kidney, or brain conditions, seizures, or urinary problems, as it may not be safe for you to take this medication, or your doctor may wish to prescribe a lower dose and closely monitor your physical health during your treatment [3].

Clomipramine can cause issues if you have glaucoma, so you may wish to monitor your eye health during your treatment. Ensure you tell your doctor if you experience any eye pain or changes in your vision.

People over the age of 65 may be at increased risk of serious side effects, so it is advisable for people in this age group to use alternative medications where available.

Tell your doctor about all medications you are currently taking, or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Depending on your prescription and the length of time you have been on this treatment, you may experience withdrawal symptoms when coming off this medication. Your doctor will likely reduce your prescription slowly to prevent this. Taking clomipramine exactly as prescribed by your doctor can also help to prevent withdrawal symptoms.

Ensure you tell your doctor if you are pregnant or planning to become pregnant while taking clomipramine, as it may cause harm to the fetus, and can cause withdrawal symptoms in newborns [2]. As such, it is advised to only start or continue clomipramine treatment while pregnant if the benefits of treatment outweigh the potential risks.

Tell your doctor if you are breastfeeding, as clomipramine may be excreted in small amounts in breast milk, so should be used with caution if required, with careful monitoring of your baby [1][5].

This medication can cause drowsiness and sedation, so it is important to avoid driving until you are aware of how clomipramine affects you and it is safe to do so.

Clomipramine interactions

Some medications may interact with clomipramine, causing a decrease in the effectiveness of your medication, or an increase in the risk of side effects. This includes blood thinners, methylphenidate, disulfiram, medications for nausea or dizziness, heart medications, other calsses of antidepressants, antipsychotics, tranquilizers, sedatives, and other mental health medications [3].

Do not take monoamine oxidase inhibitors (MAOIs) with clomipramine, as this can cause serious effects, such as serotonin syndrome. Allow 14 days between doses of clomipramine and MAOIs [1].

Always discuss your medications with your doctor before starting a new treatment.

Clomipramine storage

Always keep all medications out of reach of children.

Store clomipramine in its original packaging, in airtight containers, and at room temperature (68°F to 77°F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on clomipramine

If you overdose on clomipramine, call a medical professional, or Poison Control on 1-800-222-1222, or in case of an emergency, call 911. Symptoms of a clomipramine overdose include fever, sweating, stiff or unusual movements, slowed breathing, seizure, and coma.

Frequently asked questions about clomipramine

How long can you stay on clomipramine?

Most studies to investigate the use of clomipramine have been no longer than 10-12 weeks, so the effectiveness and safety of longer-term use has not been clearly established [1][6]. However, there is evidence of long-term clomipramine use being effective, so it can be prescribed indefinitely, if professionally advised [7].

If your doctor deems it necessary for you to remain on clomipramine long-term, they will ensure your safety by continuing to monitor your physical and mental health throughout your treatment, and may wish to reduce your dosage, to find the lowest possible therapeutic dose.

Is clomipramine good for anxiety?

Clomipramine has been found to be helpful in the treatment of panic disorder, by reducing the occurrence of panic attacks and anxiety-related symptoms within 1-3 weeks of commencing treatment and is considered equally or more effective than other medications for this use [8][9].

Clomipramine can be effective in treating anxiety disorders, but other antidepressant drugs, such as venlafaxine and sertraline, may be more effective in treating generalized anxiety disorder and social anxiety disorder [10].

Resources:

  1. Mallinckrodt Inc. (n.d). Anafranil Label. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019906s34lbl.pdf
  2. Wilson, M., & Tripp, J. (2022). Clomipramine. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK541006/#article-42905.r19
  3. American Society of Health-System Pharmacists, Inc. (Revised 2018). Clomipramine. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a697002.html
  4. National Center for Biotechnology Information. (2022). PubChem Compound Summary for CID 2801, Clomipramine. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Clomipramine
  5. Clomipramine. (2006). In Drugs and Lactation Database (LactMed). Bethesda, MD: National Library of Medicine (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK501175/
  6. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D.A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G.D., & Pompili, M. (2019). Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Current Neuropharmacology, 17(8), 710–736. Retrieved from https://doi.org/10.2174/1570159X16666180813155017
  7. Bloch, M.H., Green, C., Kichuk, S.A., Dombrowski, P.A., Wasylink, S., Billingslea, E., Landeros-Weisenberger, A., Kelmendi, B., Goodman, W.K., Leckman, J.F., Coric, V., & Pittenger, C. (2013). Long-Term Outcome in Adults with Obsessive-Compulsive Disorder. Depression and Anxiety, 30(8), 716–722. Retrieved from https://doi.org/10.1002/da.22103
  8. McTavish, D., & Benfield, P. (1990). Clomipramine. An Overview of its Pharmacological Properties and a Review of its Therapeutic Use in Obsessive Compulsive Disorder and Panic Disorder. Drugs, 39(1), 136–153. Retrieved from https://doi.org/10.2165/00003495-199039010-00010
  9. Cassano, G.B., Petracca, A., Perugi, G., Nisita, C., Musetti, L., Mengali, F., & McNair, D.M. (1988). Clomipramine for Panic Disorder: I. The First 10 Weeks of a Long-Term Comparison with Imipramine. Journal of Affective Disorders, 14(2), 123–127. Retrieved from https://doi.org/10.1016/0165-0327(88)90054-7
  10. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of Anxiety Disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. Retrieved from https://doi.org/10.31887/DCNS.2017.19.2/bbandelow