Quick Facts
Generic NameClomipramine
Brand NameAnafranil
Drug ClassTCA
FDA Approved1989
Starting Dose25mg/day
Typical Range100–250mg/day
Max Dose250mg/day
Half-Life19–37 hours
MetabolismCYP2D6, CYP1A2, CYP3A4
Generic Available1996
What Is Anafranil?
Clomipramine (brand name Anafranil) is a tricyclic antidepressant (TCA) prescribed for ocd, depression, and other psychiatric conditions. Most effective medication for OCD in some meta-analyses (superior to SSRIs). Most serotonergic TCA. Often reserved for SSRI-resistant OCD. Higher side effect burden than SSRIs limits first-line use. Seizure risk at doses >250mg. IV formulation used in some countries for severe OCD.
At Psychiatry Telemed, clomipramine is prescribed and monitored by board-certified psychiatrists who understand the nuances of TCA pharmacology — selecting the right dose, managing side effects, monitoring drug interactions, and optimizing your treatment through consistent monthly medication management appointments.
Clomipramine (Anafranil) — TCA medication for psychiatric care
ManufacturerVarious (originally Ciba-Geigy)
How Anafranil Affects Neurotransmitters
How Anafranil Works
Clomipramine is the most potently serotonergic TCA, making it particularly effective for OCD. It inhibits serotonin reuptake with potency comparable to SSRIs while also blocking norepinephrine reuptake (via its metabolite desmethylclomipramine). This dual mechanism with strong serotonergic predominance may explain its superior OCD efficacy.
Efficacy: Anafranil vs. Comparators
Efficacy Comparison
Response & remission rates vs. comparators (Cipriani et al. meta-analysis)
Data from published meta-analyses. Individual response may vary.
Conditions Treated with Anafranil
Considering Anafranil?
Board-certified psychiatrists can determine if clomipramine is right for you.
Dosage Information
| Indication | Starting Dose | Typical Range | Maximum |
|---|---|---|---|
| OCD | 25mg/day | 100–250mg/day | 250mg/day |
| Depression | 25mg/day | 100–250mg/day | 250mg/day |
Brain Regions Targeted by Anafranil
Side Effects
Like all medications, clomipramine has potential side effects. Most are mild, occur early in treatment, and resolve within 1–2 weeks. Your psychiatrist monitors at every appointment.
Common Side Effects
Dry MouthConstipationDrowsinessWeight GainSexual DysfunctionSweatingTremor
Less Common
Orthostatic HypotensionTachycardiaUrinary RetentionBlurred VisionCognitive Effects
Serious (Seek Immediate Help)
Seizures (dose-related)Cardiac ArrhythmiaSerotonin SyndromeSuicidal ThoughtsNMS (rare)
Side Effect Profile: Anafranil vs. Class Average
Side Effect Profile
Incidence rates from FDA prescribing information vs. class average
Percentages from clinical trial data. Actual experience may differ.
⚠️ FDA Black Box Warning
Antidepressants may increase suicidal thinking in young adults under 25. Seizure risk increases with dose.
Drug Interactions
Major Interactions
MAOIs (contraindicated), CYP2D6 inhibitors, serotonergic drugs, drugs lowering seizure threshold
CYP Metabolism
Substrate of CYP2D6, CYP1A2, CYP3A4. Complex metabolism. Blood level monitoring recommended.
Alcohol
Avoid alcohol during clomipramine treatment. Both affect the CNS, increasing sedation and impairing judgment.
Generic Versions & Cost
Generic clomipramine available since 1996. Approximate cost: $10–25/month. FDA-certified bioequivalent to brand-name Anafranil.
Starting Anafranil: What to Expect
First Weeks
Clomipramine is typically started at 25mg/day and increased gradually. Common initial side effects usually improve within 1–2 weeks. Full therapeutic benefit develops over 4–8 weeks.
When to Contact Your Psychiatrist
Contact your psychiatrist for: worsening depression/anxiety, thoughts of self-harm, unusual agitation, severe side effects, or any concerning changes.
Stopping Anafranil Safely
Never stop clomipramine abruptly. Your psychiatrist will develop a gradual tapering schedule to minimize discontinuation effects.
Timeline: When Anafranil Starts Working
Timeline to Effectiveness
Expected improvement trajectory over the first 8 weeks
Based on clinical trial data. Full therapeutic effects may take 6–8 weeks.
Get Anafranil from a Board-Certified Psychiatrist
At Psychiatry Telemed, clomipramine is prescribed following comprehensive evaluation. All Florida via HIPAA-compliant telepsychiatry. 1–3 days. $200 eval, $100 follow-up.
Frequently Asked Questions
Prescribed for ocd, depression.
Typically 2–4 weeks for initial improvement, 4–8 weeks for full benefit.
Common: dry mouth, constipation, drowsiness, weight gain, sexual dysfunction. Most resolve within 1–2 weeks.
No. Not habit-forming but should not be stopped abruptly — gradual tapering recommended.
Most effective medication for OCD in some meta-analyses (superior to SSRIs). Most serotonergic TCA. Often reserved for SSRI-resistant OCD. Higher side effect burden than SSRIs limits first-line use. S
Alcohol should be avoided — increases sedation, impairs judgment, and may worsen symptoms.
Resources
Medical Disclaimer: Educational only. Consult a psychiatrist before starting/stopping medication. Crisis: call 988 or 911.
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