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Clomipramine is used to treat people with obsessive-compulsive disorder (a condition that causes repeated unwanted thoughts and the need to perform certain behaviors over and over). Clomipramine is in a group of medications called tricyclic antidepressants.

Anafranil (clomipramine) is an antidepressant predominantly used to treat Obsessive Compulsive Disorder (OCD). It also sees use as a treatment for chronic pain, depression, anxiety, panic attacks, and other physical and psychiatric disorders.

In studies Anafranil has shown to be more effective than other drugs in its class at treating OCD. It's even used in veterinary practices to treat OCD behaviors in animals, as well as to reduce anxiety-driven behaviors such as separation anxiety.

Taking Control of OCD

Anafranil reduces the frequency with which a patient with OCD is driven to perform repetitive behaviors or focus on unwanted thoughts. It is believed to work by restoring imbalances of serotonin and other substances in the brain to more appropriate levels.

This is a powerful medication which is effective if used properly but carries risk of serious adverse reactions if abused:

  • Both adult and juvenile patients should start with low doses of around 25 mg and gradually increase dosage strength over several weeks.
  • Maximum dose is typically 250 mg daily for adults and 200 mg daily for younger patients.
  • Daily doses are often split into two or more smaller doses at the beginning of treatment to reduce side effects; at later stages doses may be taken once daily.
  • Beginning doses should be taken with food; food is optional once maintenance doses are established.
  • Single, large doses are typically taken in the evening as the medication may cause drowsiness.
  • Abruptly stopping Anafranil treatment may result in psychological and physical withdrawal symptoms; treatment should be tapered down gradually.

Many patients notice improvements within days of starting treatment, but it may take several weeks before the full effects are realized. The condition may resurface if treatment is stopped.

Treating Younger Patients

For reasons not completely understood, patients under 24 years of age who take any antidepressant, including Anafranil, are at greater risk of developing some potentially dangerous side effects, including:

  • Worsening depression
  • Suicidal thoughts or behavior
  • Unreasonable anger or hostility
  • Impulsive actions
  • Loss of inhibition
  • Other personality changes

These side effects are rare, but more frequent in youthful patients. The risk is extremely slight in patients over 24, and almost unheard of in patients over 65.

Young patients -- particularly those with a history of mental illness or depression -- should be monitored closely for signs of developing problems. Any unexplained personality changes should be brought to the attention of a doctor; adjusting dosage strength may reduce symptoms.

Other Precautions & Side Effects

Because Anafranil is a powerful drug, it should always be used with caution and only after discussing risks with a doctor. There are a great many factors which could impact the medication's effectiveness and influence the severity of side effects:

  • Taking any other medication, particularly other antidepressants or sedatives (such as alcohol)
  • History of depression, mental illness or drug abuse
  • Pregnancy or breast-feeding
  • Any major medical condition, such as kidney or heart disease
  • Allergies to other medications or foods
  • Undergoing surgery or dental procedures

Anafranil can also produce a range of side effects even in patients with no other health issues. For the most part side effects are rare and mild, similar to those of any medication; headache, nausea, dry mouth, and so forth. Some side effects are potentially dangerous, however, and warrant medical attention:

  • Very high fever
  • Difficulty speaking
  • Changes in heart rhythm
  • Difficulty paying attention
  • Memory loss
  • Seizures or uncontrolled movements
  • Confusion or disorientation
  • Hallucinations or delusions
  • Persistent fatigue or drowsiness
  • Jaundice
  • Personality changes

If serious side effects do occur, dosage may be reduced or treatment stopped altogether if a dosage reduction does not bring about satisfactory improvement. Side effects usually reverse when treatment is stopped.


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Medicines have benefits and some have risks. Always read the label and use only as directed. If symptoms persist or you have side effects see your health professional.

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