Anafranil (clomipramine hydrochloride) is a tricyclic antidepressant (TCA) approved for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD). It works by increasing the activity of serotonin, a neurotransmitter in the brain that helps regulate mood, anxiety, and repetitive behaviors. This medication is recognized for its robust efficacy in significantly reducing the frequency and severity of OCD symptoms, enabling improved daily functioning and quality of life. Treatment should be initiated and monitored under the supervision of a qualified healthcare professional.

Features

• Active ingredient: Clomipramine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg oral capsules
• Prescription-only medication
• Belongs to the tricyclic antidepressant (TCA) class
• Serotonin reuptake inhibitor with secondary effects on norepinephrine
• Bioavailability of approximately 50% following oral administration
• Peak plasma concentrations reached within 2–6 hours post-dose
• Metabolized hepatically via cytochrome P450 enzymes (primarily CYP2D6, CYP3A4, and CYP1A2)

Benefits

• Significantly reduces the frequency and intensity of obsessive thoughts and compulsive rituals
• Helps restore normal daily functioning and social interactions impaired by OCD
• Provides long-term symptom control with consistent use under medical supervision
• May also be effective off-label for certain anxiety disorders, depression with obsessive features, and chronic pain conditions
• Supported by extensive clinical evidence and decades of therapeutic use
• Can be part of a comprehensive treatment plan including psychotherapy

Common use

Anafranil is primarily indicated for the treatment of obsessions and compulsions in patients diagnosed with Obsessive-Compulsive Disorder. It is also used off-label for conditions such as panic disorder, major depressive disorder (particularly with obsessive features), cataplexy associated with narcolepsy, chronic pain syndromes (e.g., neuropathic pain), and treatment-resistant depression. Its use should always be based on a thorough psychiatric or medical evaluation.

Dosage and direction

Dosage must be individualized under medical supervision. For OCD in adults, initial dose is typically 25 mg daily, gradually increased to a therapeutic range of 100–250 mg per day, divided into two or three doses. Maximum daily dose should not exceed 250 mg. For elderly or debilitated patients, initial dose is often lower (10–25 mg daily) with careful titration. Dose adjustments should be made at intervals of several days to weeks. Take with food to minimize gastrointestinal upset. Do not abruptly discontinue.

Precautions

Use with caution in patients with cardiovascular disease, history of seizures, glaucoma, urinary retention, hyperthyroidism, or hepatic impairment. May impair mental or physical abilities required for hazardous tasks (e.g., driving). Monitor for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, or suicidality, especially during initial treatment or dose changes. Regular monitoring of blood pressure, heart rate, and ECG may be advised. Not recommended during pregnancy unless potential benefit justifies potential risk.

Contraindications

Hypersensitivity to clomipramine or other tricyclic antidepressants. Should not be used concomitantly with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Contraindicated in patients during the acute recovery phase after myocardial infarction. Do not use in those with uncontrolled narrow-angle glaucoma or severe urinary retention.

Possible side effect

Common: dry mouth, constipation, blurred vision, drowsiness, dizziness, weight gain, sweating, nausea. Less common: orthostatic hypotension, tachycardia, sexual dysfunction, tremor, fatigue, headache. Rare but serious: seizures, serotonin syndrome, neuroleptic malignant syndrome, agranulocytosis, hyponatremia, hepatotoxicity, arrhythmias. Report any persistent or severe side effects to a healthcare provider immediately.

Drug interaction

Interacts strongly with MAOIs (risk of serotonin syndrome). Use with SSRIs, SNRIs, triptans, tramadol, lithium, or St. John’s wort may increase serotonin activity. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) may increase clomipramine levels. May potentiate effects of CNS depressants (alcohol, benzodiazepines, opioids). Anticholinergic effects may be additive with other anticholinergic drugs. Use with sympathomimetics may increase cardiovascular effects. Caution with anticoagulants (may affect metabolism).

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. Maintain regular dosing schedule to ensure stable plasma concentrations. Consult a healthcare provider if multiple doses are missed or if unsure.

Overdose

Symptoms may include severe drowsiness, agitation, confusion, tachycardia, hypotension, dilated pupils, dry mouth, seizures, coma, cardiac arrhythmias, and respiratory depression. Overdose is a medical emergency—seek immediate medical attention or contact a poison control center. Treatment is supportive and may include gastric lavage, activated charcoal, ECG monitoring, and management of symptoms.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after expiration date. Dispose of unused medication properly according to local guidelines; do not flush.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

Clinical studies and long-term use support the efficacy of Anafranil in reducing OCD symptoms. Many patients report significant improvement in quality of life with appropriate dosing and monitoring. Individual responses may vary. Discuss treatment experience and outcomes with your healthcare provider.