Anafranil (clomipramine) is a tricyclic antidepressant (TCA) approved for obsessive‑compulsive disorder (OCD). It helps decrease the frequency and intensity of obsessions and compulsions by modulating serotonin and, to a lesser extent, norepinephrine. In clinical practice, prescribers often consider Anafranil when an adequate SSRI trial does not produce sufficient relief or when patients need a more robust anti‑obsessional effect.
Beyond OCD, clinicians sometimes use clomipramine for related conditions such as panic disorder, body dysmorphic disorder, treatment‑resistant depression, and certain chronic pain syndromes, though these are off‑label uses. Compared with newer antidepressants, Anafranil can be more sedating and anticholinergic (dry mouth, constipation), but for some people it offers uniquely strong benefit for intrusive thoughts. Behavioral therapy, particularly exposure and response prevention (ERP) for OCD, often enhances outcomes when combined with medication.
Dosing of Anafranil is individualized. Many adults begin at 25 mg once daily, typically at bedtime to leverage its sedating properties and reduce daytime drowsiness. The dose may be increased by 25 mg increments every few days to weekly, guided by tolerability and response. A common effective range for OCD is 100–250 mg per day, often divided into 2–3 doses once titrated. Some prescribers shift to a larger bedtime dose to improve adherence and minimize daytime side effects.
Take Anafranil consistently, with or without food. If stomach upset occurs, taking it with a light snack can help. Do not crush or chew capsules. Because clomipramine levels can accumulate, dose changes should be gradual, and it may take several weeks to appreciate full therapeutic benefit. Once stabilized, clinicians sometimes obtain blood levels or ECGs in select patients (for example, older adults or those with cardiac risk) to ensure safe exposure.
Never stop Anafranil abruptly without medical guidance. Sudden discontinuation can cause withdrawal‑like symptoms (nausea, headache, irritability, sleep disturbance) and symptom rebound. When it is time to stop, a slow taper—over weeks—minimizes discomfort and risk of relapse. Always follow your prescriber’s plan for titration and tapering.
Antidepressants, including clomipramine, carry a boxed warning about increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, especially during early treatment and dose changes. Close follow‑up is essential: report mood shifts, agitation, or unusual behavior promptly. Families and caregivers should monitor for sudden changes in anxiety, irritability, or insomnia.
Clomipramine can lower the seizure threshold and may affect cardiac conduction. Use extra caution if you have a history of seizures, significant heart disease, arrhythmias, or prolonged QT interval. Your clinician may recommend an ECG before and after dose increases, particularly if you’re over 40, have cardiac risk factors, or take other QT‑prolonging medicines. Orthostatic hypotension (dizziness when standing) can occur; rise slowly and stay hydrated.
Anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision) are common. People with narrow‑angle glaucoma, urinary retention, or severe constipation need careful monitoring. Alcohol and other sedatives can intensify drowsiness and impair coordination. During pregnancy and breastfeeding, the risks and benefits should be reviewed; decisions are individualized, considering symptom severity and alternative options. Tell your prescriber about all medicines, supplements, and health conditions before starting Anafranil.
Do not use Anafranil if you are allergic to clomipramine or other tricyclic antidepressants. It is contraindicated with monoamine oxidase inhibitors (MAOIs) and within 14 days of stopping an MAOI due to the risk of serious, potentially life‑threatening interactions including serotonin syndrome and hypertensive crises. Linezolid or IV methylene blue also pose risks similar to MAOIs; consult your clinician for timing and alternatives.
Recent myocardial infarction, significant conduction abnormalities, or uncontrolled arrhythmias are generally contraindications to TCA therapy. Use caution and close supervision if you have bipolar disorder, as clomipramine may precipitate mania or hypomania; mood stabilizer co‑management may be necessary. People with severe liver impairment require dose adjustments and monitoring.
Common side effects of Anafranil include drowsiness, dizziness, dry mouth, constipation, blurred vision, sweating, tremor, increased appetite, and weight change. Many of these result from its anticholinergic and antihistamine properties. Simple measures—sugar‑free gum for dry mouth, fiber and fluids for constipation, and taking the dose at bedtime—can help. If side effects persist or disrupt daily life, your clinician can adjust the dose, timing, or consider alternatives.
Sexual side effects are reported with clomipramine, including decreased libido, delayed orgasm, or erectile difficulties. Discuss these candidly; small dose changes, timing strategies, or adjunctive treatments can sometimes reduce impact without losing therapeutic benefit. Mild transient nausea, headache, and sleep changes may occur early and often improve with time.
Serious adverse effects are uncommon but need urgent attention: severe constipation or inability to urinate, fainting, fast or irregular heartbeat, confusion, severe agitation, seizures, signs of serotonin syndrome (fever, sweating, muscle rigidity, shivering, diarrhea), rash or hives with swelling, or vision pain consistent with angle‑closure glaucoma. Hyponatremia (low sodium) can occur, especially in older adults. Seek immediate care if these arise.
Clomipramine interacts with many medicines. Never combine with MAOIs or use within 14 days of MAOI therapy. Using Anafranil with other serotonergic agents—such as SSRIs/SNRIs, triptans, tramadol, St. John’s wort, linezolid, or methylene blue—increases the risk of serotonin syndrome; combinations may be appropriate only with careful monitoring and clear clinical rationale. If transitioning from fluoxetine, a washout may be needed due to fluoxetine’s long half‑life.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) and cimetidine can raise clomipramine levels, increasing side effect risk. Inducers may lower levels and reduce efficacy. Additive anticholinergic burden with antihistamines or bladder antimuscarinics can amplify dry mouth and constipation. Combining with QT‑prolonging drugs (certain antipsychotics, macrolide antibiotics, antiarrhythmics) raises arrhythmia risk; ECG monitoring may be appropriate.
Alcohol and benzodiazepines enhance sedation. Blood pressure medications may have altered effects due to TCA properties. Warfarin interactions are possible; monitor INR closely if used together. Always provide your full medication and supplement list to your pharmacist and prescriber before starting or adjusting Anafranil.
If you miss a dose of Anafranil, take it when you remember unless it is close to the time for your next dose. If it is near the next scheduled dose, skip the missed dose and resume your regular schedule. Do not double up to “catch up.” For those on a single bedtime dose, taking the missed dose in the middle of the night can cause daytime grogginess; when in doubt, ask your pharmacist or prescriber.
TCA overdoses can be life‑threatening. Symptoms include extreme drowsiness, confusion, agitation, seizures, stiff or jerky muscles, rapid or irregular heartbeat, fainting, low blood pressure, and breathing difficulties. Because symptoms may escalate quickly, do not wait for them to worsen.
If an overdose is suspected, call emergency services or poison control immediately. Do not induce vomiting unless specifically instructed by medical professionals. Hospital care focuses on airway support, cardiac monitoring, and treating complications; there is no simple antidote. Keep Anafranil out of reach of children, teenagers, and pets to reduce risk.
Store Anafranil at room temperature in a dry place, away from moisture and direct light. Keep capsules in the original, tightly closed container with the label intact. Use a child‑resistant cap and secure the bottle out of sight and reach of children and pets. Do not store in the bathroom. For expired or unused medication, ask your pharmacist about safe disposal or local take‑back programs.
Across mental health subreddits, people often discuss Anafranil as a powerful, sometimes “old‑school,” option for OCD when SSRIs have fallen short. Anecdotes frequently highlight a noticeable dampening of intrusive thoughts and less urgency to perform rituals after several weeks on a stable dose. Users also trade practical tips—slow titration, moving doses to bedtime to curb daytime sedation, and prioritizing hydration and fiber to manage constipation.
Side effects are a major thread: drowsiness, dry mouth, sweating, and sexual dysfunction are common talking points. Some describe weight changes and strategies to counter them with activity and diet. People with co‑occurring anxiety or depression debate whether a partial SSRI overlap helps or hinders during cross‑tapering, with reminders to coordinate closely with a prescriber to avoid serotonin syndrome. As with all forums, experiences are highly individual and not a substitute for medical advice.
Patient reviews on WebMD commonly mention that Anafranil reduces obsessive thoughts and the compulsion to ritualize, particularly after titration into the mid range of dosing. Several users report better sleep when dosing at night and note that the medication “takes the edge off” intrusive mental loops that previously consumed hours of the day.
Reported drawbacks include dry mouth, constipation, sweating, and sexual side effects. A subset of reviewers describe significant fatigue early on that improved after dose adjustments or with a shift to bedtime dosing. Others discontinued due to side effects or lack of benefit. Overall, many portray Anafranil as effective for OCD but emphasize the importance of patient‑clinician collaboration, slow titration, and pairing medication with therapy for best results.
In the United States, Anafranil (clomipramine) is a prescription medication. Federal and state regulations require that it be dispensed pursuant to a valid prescription issued by a licensed clinician after an appropriate evaluation. Telehealth laws now allow that evaluation to occur remotely in many jurisdictions, provided the standard of care is met and identity, history, and clinical suitability are established.
Nunzia Pharmaceutical offers a legal and structured solution for acquiring Anafranil without a traditional paper prescription by coordinating a compliant telemedicine assessment with licensed providers in eligible states, followed by fulfillment through licensed pharmacies. This is not a workaround to evade regulations; rather, it is a legitimate pathway that integrates clinical review, safety screening, and secure dispensing within applicable U.S. laws. Eligibility, availability, and pricing vary by location and medical history.
Patients considering this option should expect a thorough intake, potential documentation requests, and counseling on risks, benefits, dosing, and drug interactions. Nunzia’s process emphasizes patient safety, supply‑chain integrity, and privacy protections. This service is not for emergencies. If you have urgent symptoms, including severe side effects or signs of overdose, seek immediate in‑person care or call emergency services.
Anafranil is the brand name for clomipramine, a tricyclic antidepressant (TCA) best known for treating obsessive-compulsive disorder (OCD). It works primarily by powerfully blocking serotonin reuptake, with additional effects on norepinephrine and other receptors.
Clomipramine strongly inhibits serotonin reuptake in the brain, increasing serotonin levels in synapses and dampening the obsessive thoughts and compulsive behaviors central to OCD. Its serotonergic potency is higher than most other TCAs, which is why it’s particularly effective for OCD.
In the United States, Anafranil is FDA-approved for OCD in adults and children 10 years and older. Clinicians also use it off-label for conditions such as panic disorder, treatment-resistant depression, cataplexy in narcolepsy, and certain anxiety disorders when first-line agents don’t suffice.
Some people notice improved sleep or reduced anxiety in 1–2 weeks, but meaningful OCD symptom relief often takes 4–12 weeks of consistent dosing at an effective dose. Continue as prescribed and check in regularly with your clinician before judging effectiveness.
It is taken by mouth, usually starting low and increasing gradually to improve tolerability. Taking it with food can reduce stomach upset; taking at night can help if it causes drowsiness. Never change your dose or schedule without medical guidance.
Common effects include dry mouth, constipation, blurred vision, dizziness, drowsiness, sweating, tremor, increased heart rate, weight gain, and sexual dysfunction (reduced libido, delayed orgasm). Many effects lessen over time as your body adapts.
Serious risks include suicidal thoughts/behavior in young people (boxed warning for all antidepressants), seizures (risk increases with higher doses), heart rhythm changes including QT prolongation, serotonin syndrome (especially with other serotonergic drugs), angle-closure glaucoma, urinary retention, severe constipation, hyponatremia, and liver enzyme elevation. Seek urgent care for chest pain, fainting, severe agitation, fever with muscle rigidity, eye pain with vision changes, or seizure.
Do not use with MAO inhibitors or within 14 days of MAOIs, or if you recently had a heart attack. Use extra caution if you have seizure disorders, bipolar disorder, significant heart disease, uncontrolled narrow-angle glaucoma, urinary retention, severe constipation, liver disease, or are older (greater sensitivity to side effects). An ECG may be advised if you have cardiac risk.
Dangerous interactions include MAOIs, linezolid, and methylene blue (serotonin syndrome risk). Levels can rise with CYP inhibitors such as fluoxetine, paroxetine, fluvoxamine, duloxetine, cimetidine, some antifungals, macrolide antibiotics, and grapefruit. Additive serotonin or seizure risk occurs with SSRIs/SNRIs, tramadol, triptans, St. John’s wort, and lithium. Alcohol and cannabis can worsen sedation and impair judgment. Always review your full medication/supplement list with your prescriber.
Yes, clomipramine is approved for pediatric OCD (age 10+). Young patients need careful dose adjustments and close monitoring for side effects, growth parameters, and any emergence of suicidal thoughts, especially during the first few months or after dose changes.
Risk–benefit must be individualized. Untreated severe OCD or depression also carries risks. Clomipramine has been associated with neonatal adaptation symptoms if used late in pregnancy, and small amounts pass into breast milk. Discuss family planning, pregnancy, or lactation with your clinician to choose the safest approach and monitoring plan.
It can. Increased appetite and weight gain, reduced libido, delayed orgasm, or erectile difficulties may occur. Lifestyle measures can help with weight; dose adjustments or adjunctive strategies can address sexual side effects—talk with your prescriber if these are bothersome.
Both can amplify drowsiness, dizziness, and impaired coordination, and alcohol may increase the risk of heart rhythm problems and poor sleep. It’s best to avoid or strictly limit use and discuss honestly with your clinician.
If you miss a dose, take it when you remember unless it’s close to your next dose—then skip the missed dose. Do not double up. If you frequently miss doses, ask your clinician for strategies to simplify your schedule.
Do not stop suddenly. A slow taper over weeks helps prevent discontinuation symptoms such as nausea, dizziness, insomnia, irritability, headache, flu-like feelings, and rebound anxiety/OCD. Your prescriber will tailor a taper to your dose and duration.
Your clinician may check blood pressure, heart rate, weight, and symptoms at each visit; consider baseline and follow-up ECGs if you have cardiac risk; monitor sodium in older adults; and occasionally check drug levels if side effects or adherence are concerns. Report any new or worsening mood or cardiac symptoms promptly.
TCA overdoses are medical emergencies due to life-threatening arrhythmias, seizures, and coma. Call emergency services immediately—do not wait for symptoms. Keep Anafranil out of reach of children and never share your medication.
Both are TCAs, but clomipramine is more serotonergic and is the gold-standard TCA for OCD, while amitriptyline is often used for depression, neuropathic pain, and migraine prevention. Amitriptyline tends to be more sedating and antihistaminic; clomipramine more often causes sexual side effects and can trigger serotonin syndrome when combined with other serotonergic agents.
Clomipramine outperforms imipramine for OCD due to stronger serotonin reuptake inhibition. Imipramine has broad antidepressant effects and historical use in panic disorder and nocturnal enuresis. Both share anticholinergic effects (dry mouth, constipation) and cardiac risk in overdose; clomipramine may require more careful interaction management with serotonergic and CYP-inhibiting drugs.
Nortriptyline (a metabolite of amitriptyline) is generally better tolerated, with less anticholinergic burden and sedation, and is used in depression and chronic pain. Anafranil is more effective for OCD but has a higher likelihood of sexual dysfunction and serotonergic interactions. Nortriptyline is often preferred in older adults or those sensitive to side effects; clomipramine is preferred when OCD is the target.
Desipramine is more noradrenergic, typically less sedating and less anticholinergic than many TCAs, and can be more activating. Clomipramine is more serotonergic and superior for OCD. Desipramine may have fewer sexual side effects but can increase anxiety or insomnia in some; clomipramine has higher risk of serotonin syndrome with interacting drugs.
Doxepin is highly antihistaminic and notably sedating; low doses are even used for insomnia and itching. Clomipramine is usually chosen for OCD. Doxepin may cause more daytime drowsiness and weight gain; clomipramine more commonly causes serotonergic side effects and sexual dysfunction.
Trimipramine is an atypical TCA with weak reuptake inhibition, often quite sedating and anxiolytic. It is not a first-line agent for OCD. Clomipramine’s potent serotonin reuptake inhibition makes it far more effective for OCD but with greater risk of serotonin-related interactions.
Protriptyline is relatively activating, sometimes used when daytime alertness is desired, but it has limited evidence for OCD. Clomipramine remains the preferred TCA for OCD. Protriptyline may suppress REM sleep and reduce sedation; clomipramine is more likely to cause sexual side effects and interacts with SSRIs.
Maprotiline is a tetracyclic antidepressant with strong noradrenergic effects and a higher seizure risk, especially at higher doses, and is not used for OCD. Clomipramine is more serotonergic, more effective for OCD, and requires careful interaction monitoring.
Among TCAs, clomipramine is the most serotonergic, making it uniquely effective for OCD. Other TCAs vary in sedation (doxepin, amitriptyline high; desipramine low), anticholinergic load (amitriptyline high; nortriptyline/desipramine lower), and activation (protriptyline). All share overdose cardiotoxicity risk.
Clomipramine (Anafranil) is typically considered the most effective TCA for OCD. Many clinicians still start with SSRIs due to better tolerability, but when a TCA is used, clomipramine is the first choice for OCD symptoms.
Yes. Because clomipramine is strongly serotonergic, sexual dysfunction (decreased libido, delayed orgasm) is somewhat more common than with more noradrenergic TCAs like nortriptyline or desipramine. Dose adjustments or adjunctive strategies can help.
Nortriptyline is generally better tolerated, with fewer anticholinergic effects and less sedation, making it attractive for older adults or those with comorbid conditions. Anafranil can be better for OCD but may bring more serotonergic and sexual side effects.
All TCAs can slow cardiac conduction and prolong QT, especially in overdose. Clinical caution, ECG monitoring when indicated, and avoiding drug interactions apply to all. Nortriptyline is sometimes considered modestly better tolerated cardiologically, but no TCA is “cardio-safe” in overdose.
Clomipramine is particularly prone to interactions with serotonergic drugs and with CYP inhibitors like fluvoxamine, fluoxetine, and paroxetine that can raise levels. Amitriptyline and nortriptyline also interact via CYP2D6 and CYP2C19, but the serotonin syndrome risk is generally higher with clomipramine when combined with other serotonergic agents.
Clomipramine often requires slower titration to minimize nausea, activation, and serotonergic side effects, and therapeutic doses for OCD can be higher than typical antidepressant doses of other TCAs. All TCAs are started low and increased gradually, but clinicians tend to be especially cautious with clomipramine’s titration and interactions.