For many people with obsessive-compulsive disorder (OCD), taking medication is a significant step in allowing them to improve their mental health. One common medication often used to treat OCD is clomipramine, often known by the trade name Anafranil. This page outlines some important information about clomipramine.

What is clomipramine?

What is clomipramine? How does it work?

Clomipramine is an antidepressant medication approved to treat conditions such as Obsessive-Compulsive Disorder. Clomipramine sometimes may be used off-label to treat depression, anxiety, insomnia, cataplexy syndrome, neuropathic pain, chronic pain, Body Dysmorphic Disorder, Panic Disorder, treatment-resistant depression, premature ejaculation, pediatric nocturnal enuresis, and trichotillomania.

Clomipramine belongs to a class of medications called tricyclic antidepressants. Tricyclic antidepressants help with ensuring the balance of certain chemical messengers called neurotransmitters in the brain. Clomipramine specifically increases the level of the neurotransmitters serotonin and norepinephrine to improve concentration and mood. 

How is clomipramine typically used?

The usual recommended starting dose for clomipramine is 25mg orally once daily. Many doctors will start patients off with lower dosages, increasing it to as much as 100mg over time depending on what’s best for the patient. 

Clomipramine usually should be taken at bedtime as it could make you drowsy.

Do not stop taking clomipramine without talking with your doctor. If you need to stop taking clomipramine, your doctor would lower your dose over some weeks to help prevent any negative reactions from stopping the medication suddenly. 

What are some possible side effects?

Some common side effects(also known as adverse effects) of clomipramine may include:

• Drowsiness
• Dry mouth
• Nausea and vomiting
• Diarrhea
• Constipation
• Impaired sexual functioning

Some serious(but uncommon side effects) may include:

• Difficulty breathing or rapid breathing
• Uncontrollable shaking of a part of the body 
• Rapid, irregular, or pounding heartbeat
• Difficulty urinating or loss of bladder control
• Hallucinations 
• Severe muscle stiffness

Call 911 or seek emergency care if you notice any severe side effects.  See a more comprehensive list of possible side effects here. 

Why do these side effects occur? 

Any medication can potentially lead to side effects. A person’s likelihood of having side effects depends on many factors including genetics, age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. 

Clomipramine produces its effects by increasing the levels of the neurotransmitters serotonin and norepinephrine in the brain. Serotonin and norepinephrine are chemical messengers which are important regulators of mood and emotions. These neurotransmitters are also involved in some other activities of the body(e.g. breathing, movement, concentration, etc.) and increasing the levels of these chemicals can affect some of these other activities leading to side effects.  

Many non-serious side effects of mental health medications such as clomipramine go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. Your doctor may then recommend a dose adjustment or change of medication.

How do your genes relate to clomipramine? 

Genetics can affect your body’s response to medication. Some people with a certain variation of the CYP2D6 gene might not be able to break down clomipramine rapidly. This is called being a slow metabolizer. Being a slow metabolizer means that your body breaks down the medication more slowly than other people do, which means that the drug sticks around in your body for longer than average and may lead to increased side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to help predict whether you will have a negative reaction while taking clomipramine is by taking a DNA test to determine what genetic variations you have and how they may affect medication metabolism. Your genetic(DNA) test results can help your doctor avoid less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• Inform your doctor if you have any history of allergies with this or any other medication. You should also notify your doctor of any other allergies e.g. food, animals etc. 
• Notify your doctor if you have any kidney or liver conditions as it might require some dose adjustment. 
• Ensure that your doctor is aware of any other medications you might be taking alongside clomipramine, to avoid possible drug interactions. 

If you show signs of an allergic reaction to clomipramine (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how clomipramine works. Make sure to tell your doctor about all other medications you are taking before starting clomipramine, to avoid negative drug interactions. For full details, see the FDA’s full list of precautions. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.