Anafranil (clomipramine hydrochloride) is a tricyclic antidepressant (TCA) with potent serotonin reuptake inhibition, approved for the treatment of obsessive-compulsive disorder (OCD). It is recognized for its efficacy in cases where first-line treatments have proven insufficient. By modulating neurotransmitter activity in the central nervous system, Anafranil helps reduce the frequency and severity of obsessive thoughts and compulsive behaviors. Its well-established pharmacokinetic profile and decades of clinical use make it a cornerstone in psychiatric pharmacotherapy for severe OCD.

Features

• Active ingredient: Clomipramine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg oral capsules
• High affinity for serotonin reuptake inhibition
• Also exhibits noradrenergic reuptake blockade
• Long half-life (approximately 19–37 hours)
• Extensive hepatic metabolism via CYP450 enzymes

Benefits

• Significantly reduces obsessive-compulsive symptoms in clinically validated populations
• Improves overall daily functioning and quality of life for individuals with moderate to severe OCD
• Provides an alternative for patients unresponsive to SSRIs
• May alleviate associated depressive and anxiety symptoms
• Supported by long-term clinical data demonstrating sustained efficacy
• Can be used in both adult and pediatric populations (ages 10 and above)

Common use

Anafranil is primarily indicated for the treatment of obsessive-compulsive disorder. It is also used off-label for major depressive disorder, panic disorder, chronic pain syndromes such as neuropathic pain, and cataplexy associated with narcolepsy. Its use in depression, though less common today due to the advent of newer antidepressants, remains an option in treatment-resistant cases.

Dosage and direction

Initial dosing for OCD in adults typically begins at 25 mg daily, gradually increased to a therapeutic range of 100–250 mg per day, divided into two or three doses. Dose titration should be slow to minimize side effects. For pediatric patients (ages 10–17), starting dose is 25 mg daily, with gradual increases not exceeding 3 mg/kg or 200 mg daily, whichever is smaller. Administration with food may reduce gastrointestinal discomfort. Regular monitoring of plasma levels may be advised in certain clinical situations.

Precautions

Patients should be monitored for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, and hypomania. Use with caution in individuals with a history of seizures, cardiovascular disorders, glaucoma, or urinary retention. Elderly patients may be more sensitive to anticholinergic and cardiovascular effects. Abrupt discontinuation should be avoided; taper gradually under medical supervision.

Contraindications

Anafranil is contraindicated in patients with known hypersensitivity to clomipramine or other tricyclic antidepressants. It must not be used concomitantly with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Additional contraindications include recent myocardial infarction, uncompensated heart failure, and severe liver impairment.

Possible side effect

Common adverse reactions include dry mouth, constipation, blurred vision, dizziness, somnolence, weight gain, and orthostatic hypotension. Sexual dysfunction, including decreased libido and delayed ejaculation, may occur. Serious side effects include seizures, serotonin syndrome, increased intraocular pressure, and cardiac arrhythmias. Any unusual symptoms should be reported to a healthcare provider promptly.

Drug interaction

Anafranil interacts significantly with MAOIs, SSRIs, SNRIs, triptans, and other serotonergic drugs, increasing the risk of serotonin syndrome. It may potentiate the effects of CNS depressants including alcohol, benzodiazepines, and opioids. Concomitant use with drugs that prolong QT interval (e.g., antipsychotics, antiarrhythmics) should be avoided. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) may increase clomipramine levels.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one. Consistent daily dosing is important to maintain steady-state plasma concentrations.

Overdose

Symptoms of overdose may include severe drowsiness, confusion, agitation, tachycardia, hypotension, seizures, and coma. Cardiac arrhythmias and respiratory depression are life-threatening. Management includes gastric lavage, activated charcoal, and supportive care. ECG monitoring is essential. There is no specific antidote; treatment is symptomatic and supportive.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual response to medication may vary.

Reviews

Clinical studies and long-term use support the efficacy of Anafranil in reducing OCD symptoms, particularly in treatment-resistant cases. Many patients report significant improvement in daily functioning, though side effects may be a limiting factor for some. Physician reviews often highlight its role as a effective second-line option when SSRIs fail. Patient experiences vary, with some noting substantial symptom relief and others citing tolerability issues. Overall, it remains a valuable tool in psychiatric practice.