Anafranil (Clomipramine) – Oral

Warning:

Like other antidepressants, Anafranil (clomipramine) carries a boxed warning due to the increased risk of suicidal thinking and behavior in children, adolescents, and young adults (18 to 24 years old). These risks are especially pronounced when starting antidepressant therapy or changing the dosage. A healthcare provider should advise you and your loved ones to watch for unusual changes in behavior, worsening depression, or suicidality.

What Is Anafranil?

Anafranil (clomipramine) is a prescription drug used to treat obsessive-compulsive disorder (OCD) and depression. It belongs to a drug class called tricyclic antidepressants. It is available in capsule form.

Clomipramine increases the concentrations of two brain chemicals (serotonin and norepinephrine). This increased availability may help improve mood, attention, and energy.

Drug Facts

Generic Name: Clomipramine

Brand Name(s): Anafranil

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antidepressant

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Clomipramine

Dosage Form(s): Capsule

What Is Anafranil Used For?

Anafranil (clomipramine) treats obsessive-compulsive disorder (OCD) in children 10 years and older, adolescents, and adults. It is given to help manage obsessions and compulsions that cause distress or significantly interfere with a person's day-to-day functioning.

In OCD, obsessions include recurrent, unwanted, intrusive thoughts, urges, or feelings. These episodes can be triggering and distressing for the person experiencing them. Compulsions involve repetitive, intentional behaviors the person uses in response to an obsession.

How to Take Anafranil

Take Anafranil with food daily in divided doses to prevent stomach upset. Once stable on your medicine, you may take the total daily amount at bedtime to lessen daytime sleepiness.

A severe side effect called serotonin syndrome may occur with this drug. To reduce the risk of serotonin syndrome, wait at least 14 days between starting a type of drug known as a monoamine oxidase inhibitor (MAOI) and stopping clomipramine, and vice versa. MAOIs are typically used to treat depression and Parkinson's disease.

Do not stop taking Anafranil, even if you feel better. If you and your healthcare provider are planning to discontinue clomipramine and you have been using it for at least six weeks, your provider will help you taper off the medication to reduce the risk of withdrawal symptoms. The symptoms may appear in various ways within three days of stopping the drug and linger for seven to 14 days.

Storage

Store Anafranil at room temperature (between 68 F and 77 degrees F) in a dry place. Do not store it in a bathroom. Keep the medication locked away and out of reach of children and pets.

Toss any unused and expired medication. Do not throw down the sink, toilet, or drain. Ask your pharmacist about the best ways to dispose of your medicine. Find out more about drug take-back programs in your area.

Off-Label Uses

Healthcare providers may prescribe clomipramine for off-label uses, meaning for conditions not specifically indicated by the Food and Drug Administration (FDA).

Off-label uses of clomipramine include:

This drug is not approved for use in children except for those over the age of 10 with OCD.

How Long Does Anafranil Take to Work?

This drug begins to work immediately. However, it may take about one to two weeks to see its effects. For people with obsessive-compulsive disorder, it may take up to 12 weeks.

What Are the Side Effects of Anafranil?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Anafranil include but are not limited to the following:

  • Sweating
  • Muscle pain
  • Flushing
  • Headache
  • Diarrhea
  • Stuffy nose
  • Nausea
  • Shakiness
  • Change in taste
  • Trouble sleeping
  • Dry mouth
  • Constipation
  • Cough
  • Passing gas
  • Nose or throat irritation
  • Stomach pain
  • Anxiety
  • Fatigue
  • Sore throat

Severe Side Effects

Anafranil can cause many side effects. Some may be life-threatening. Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Severe side effects include:

Serotonin syndrome risk increases if you take certain drugs or products like tramadol, lithium, Saint-John’s-wort, and fentanyl

All drugs used to treat depression increase the risk of suicidal thinking and behavior. Let your healthcare provider know if you have any thoughts of suicide.

Report Side Effects

Anafranil may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Anafranil Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (capsules):
    • For obsessive-compulsive disorder:
      • Adults—At first, 25 milligrams (mg) once a day at bedtime. Your doctor may adjust your dose as needed and tolerated. Higher doses may be given in evenly divided portions during the day. However, the dose is usually not more than 250 mg per day.
      • Children 10 years of age and older—At first, 25 mg once a day at bedtime. Your doctor may adjust your dose as needed and tolerated. Higher doses may be given in evenly divided portions during the day. However, the dose is usually not more than 200 mg per day.
      • Children younger than 10 years of age—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Anafranil:

Severe allergic reaction: Avoid using Anafranil if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: Withdrawal symptoms (jitteriness, seizures, and tremors) have been reported in newborns when the pregnant parent has taken Anafranil until delivery. Anafranil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Discuss with your healthcare provider if you plan to become pregnant or are pregnant, and weigh the benefits and risks of taking Anafranil during your pregnancy.

Breastfeeding: Talk with your healthcare provider if you plan to breastfeed, to weigh the benefits and risks of taking Anafranil while nursing and the other ways available to feed your baby.

Children: The safety and effectiveness of Anafranil—other than for children with OCD—have not been established. This drug is not for use in children under the age of 10.

Missed Dose

If you accidentally forget your Anafranil dose, take it as soon as you remember. If it's already close to your next scheduled dose, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways that help you remember to keep your appointments and take your medication routinely. If you miss too many doses, Anafranil might be less effective at treating your condition.

Overdose: What Happens If I Take Too Much Anafranil?

Overdose symptoms include seizure, irregular heartbeat, low blood pressure and death.

What Happens If I Overdose on Anafranil?

If you think you or someone else may have overdosed on Anafranil, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Anafranil, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits to allow for changes in your dose and to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Clomipramine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some children, teenagers, and young adults to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, or your caregiver notice any of these side effects, tell your doctor right away. Let the doctor know if you, your child, or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not use clomipramine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid (Zyvox®), phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start using clomipramine during the 2 weeks after you stop an MAO inhibitor. Wait for 2 weeks after stopping clomipramine before you start using an MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or bowel symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions (seizures).

Clomipramine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use clomipramine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®). Check with your doctor first before taking any other medicines with clomipramine.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Check with your doctor right away if you have a fever, chills, cough, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be symptoms of a serious condition called drug reaction with eosinophilia and systemic symptoms (DRESS).

Clomipramine may lower the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with clomipramine may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may cause men to have problems with sex. Check with your doctor if you are having an abnormal ejaculation or decreased sexual performance or desire.

Weight changes may occur during treatment with this medicine. Talk with your doctor if this is a concern for you.

Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Taking clomipramine together with medicines used during surgery or emergency treatment may increase the risk of side effects.

Do not stop using this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent possible worsening of your condition and reduce the possibility of withdrawal symptoms such as dizziness, headache, nausea, vomiting, trouble sleeping, irritability, high fever, or a general feeling of discomfort or illness.

This medicine may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Anafranil?

Avoid taking Anafranil if you:

  • Are allergic to clomipramine, drugs in its class, or any part of its formulation
  • Are receiving intravenous methylene blue or taking Zyvox (linezolid)
  • Are healing from a heart attack
  • Are under the age of 10 years old
  • Have taken MAOIs for depression or Parkinson's disease in the last 14 days, including Zelapar (selegiline), Marplan (isocarboxazid), and Azilect (rasagiline)

What Other Medications Interact With Anafranil?

Certain medications interact with Anafranil and increase the risk of severe side effects, including anticholinergic side effects like dry mouth. Some of the drugs to avoid are:

  • Astepro (azelastine)
  • Multaq (dronedarone)
  • Cuvposa (glycopyrrolate)
  • Qbrexza (glycopyrronium)
  • Atrovent (Ipratropium)
  • Kratom (An herb)
  • Zyvox (linezolid)
  • Wakix (pitolisant)
  • K-Tab (potassium chloride)
  • Urocit-K (potassium citrate)
  • SymlinPen (pramlintide)
  • Azilect (rasagiline)
  • Zelapar (selegiline)
  • Thalomid (thalidomide)
  • Spiriva (tiotropium)
  • Incruse Ellipta (umeclidinium)

What Medications Are Similar?

Other drugs similar to Anafranil and used to treat obsessive-compulsive disorder (OCD) include:

Fluoxetine, paroxetine, sertraline, and fluvoxamine are in different drug classes than clomipramine. They are all selective serotonin reuptake inhibitors (SSRIs).

These drugs have little to no anticholinergic side effects. They also cause less drowsiness than clomipramine does. Therefore, healthcare providers commonly order them for OCD or depression rather than clomipramine.

The above is a list of drugs also prescribed to treat OCD. It is not a list of medicines recommended to take with clomipramine. You should not take these drugs together unless your healthcare provider tells you to. Ask your pharmacist or a healthcare practitioner any questions you may have.

Frequently Asked Questions

  • What is Anafranil used to treat?

    Anafranil treats obsessive-compulsive disorder (OCD) and depression.

  • What are the common side effects of Anafranil?

    Some common side effects include:

  • How long does it take Anafranil to work?

    Anafranil begins to work immediately. You may see results one to two weeks after starting it. However, it may take up to 12 weeks to see the effects of this drug in people with OCD.

When to Seek Emergency Help

If you think you may be in a position to harm yourself or someone else, call 911 or your local emergency number as soon as possible. If you have suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor.

Several treatment resources and support groups can also be sought through the Substance Abuse and Mental Health Service Administration (SAMHSA) National Hotline at 800-662-HELP (4357).

How Can I Stay Healthy While Taking Anafranil?

While Anafranil works well in treating people with OCD and depression, it may cause several side effects, including eye problems. If you experience eye pain, redness, or any change in your eyesight, do not assume it may just be due to stress or allergies. Tell your healthcare provider right away.

In addition to taking this medication, you can also try to get enough rest, stay hydrated, eat a healthy diet based on your individual needs, get enough movement weekly that makes you happy, and consume adequate fiber. These steps will help support you on your journey.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.