Anafranil

Brand Name

Anafranil

Common Name

clomipramine

In this drug factsheet:

• How does this medication work? What will it do for me?
• How should I use this medication?
• What form(s) does this medication come in?
• Who should NOT take this medication?
• What side effects are possible with this medication?
• Are there any other precautions or warnings for this medication?
• What other drugs could interact with this medication?

How does this medication work? What will it do for me?

Clomipramine belongs to the class of medications known as tricyclic antidepressants. It is used to treat depression and obsessive-compulsive disorders (OCD). These disorders are related to imbalances of certain brain chemicals. This medication helps to re-establish balance to these chemicals. It may take several days to a few weeks to see a significant benefit.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended adult dose of clomipramine ranges from 25 mg to 200 mg daily in divided doses, or as a single dose at bedtime. The dose depends on individual circumstances, but is usually started low and increased gradually as required and as prescribed by the doctor. Clomipramine may be taken with or without food. Taking it with food may decrease the chance of stomach upset.

Children and adolescents (10 to 17 years old) usually begin with a dose of 25 mg daily, increasing the dose by 25 mg every 3 to 4 days as prescribed by the doctor.

When discontinuing the medication, the dosage should be reduced gradually to prevent withdrawal effects.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

10 mg
Each pale yellow, triangular, biconvex, film-coated tablet, engraved with "10" on one side and "CP" on the other side, contains 10 mg of clomipramine. Nonmedicinal ingredients: carnauba wax, colloidal silicon dioxide, croscarmellose sodium, ferric oxide yellow, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

25 mg
Each pale yellow, round, biconvex, film-coated tablet, engraved with "25" on one side and "CP" on the other side, contains 25 mg of clomipramine. Nonmedicinal ingredients: carnauba wax, colloidal silicon dioxide, croscarmellose sodium, ferric oxide yellow, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

50 mg
Each white, round, biconvex, film-coated tablet, engraved with "CP" over "50" on one side, plain on the other side, contains 50 mg of clomipramine. Nonmedicinal ingredients: carnauba wax, colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

Who should NOT take this medication?

Do not take clomipramine if you:

• are allergic to clomipramine or any ingredients of the medication
• are taking linezolid or methylene blue
• have acute congestive heart failure
• have certain blood disorders
• have glaucoma
• have kidney or liver damage
• have recently had a heart attack
• have taken a MAO inhibitor such as moclobemide or phenelzine within 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• appetite changes (increase or decrease)
• constipation
• diarrhea
• dizziness
• drowsiness
• dryness of the mouth
• fatigue
• headache
• heartburn
• hot flashes
• irregular menstrual periods
• muscle spasms
• nausea
• sensitivity to sunlight
• nightmares
• sleepiness
• stomach pain or cramps
• sweating
• tiredness or weakness (mild)
• tremor
• trouble sleeping
• visual changes
• vomiting
• weight gain
• yawning

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• breast enlargement (men and women)
• confusion
• decreased sexual ability or interest
• dizziness when rising from a sitting or lying position
• hallucinations
• hair loss
• fainting
• fast or irregular heartbeat (pounding, racing, skipping)
• nervousness or restlessness
• numbness or pins and needles feeling in hands or feet
• problems with urinating
• shakiness or trembling
• signs of anemia (low red blood cells; e.g., dizziness,  pale skin, unusual tiredness or weakness, shortness of breath)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood,  bleeding gums, cuts that don’t stop bleeding)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of worsening depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• skin rash
• signs of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
• symptoms of low sodium in the blood (e.g., tiredness, weakness, confusion, achy, stiff or uncoordinated muscles)
• symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts
• unusual breast milk production
• withdrawal symptoms (e.g., nausea, vomiting, abdominal pain, diarrhea, trouble sleeping, headache, general feeling of being unwell)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• breathing problems (e.g., cough, chest tightness, shortness of breath, wheezing)
• seizures
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
• symptoms of DRESS (drug reaction with eosinophilia and systemic symptoms; e.g., fever, severe rash, swollen lymph glands, flu-like symptoms, feeling skin, shortness of breath, thirst urinating less often)
• symptoms of a severe allergic reaction (e.g., swelling of face and tongue, difficulty breathing, hives)
• symptoms of syndrome of inappropriate antidiuretic hormone secretion (SIADH; dark coloured urine, confusion, muscle cramps, seizures)
• symptoms of serotonin toxicity (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating uncontrolled muscle spasms and muscle rigidity)
• thoughts of suicide or self-harm
• uncontrolled movements, tremor or jerky movement

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Contact lens wearers: People who wear contact lenses should be cautious, as clomipramine may decrease tear production in the eye, thereby increasing the chance of eye damage for those wearing contact lenses.

Dental effects: Lengthy treatment with clomipramine may lead to more dental cavities as a result of dry mouth. You should have regular dental checkups and practice good dental hygiene while taking this medication.

Drug reaction with eosinophilia and systemic symptoms: In rare cases, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome) may occur. This reaction involves including fever, swollen glands, yellowing of the skin or eyes, flu-like symptoms with skin rash or blistering or other organ involvement. These reactions are medical emergencies. Get immediate medical attention if you have symptoms of a severe allergic reaction. If you experience any unusual symptoms, contact your doctor.

Drowsiness/reduced alertness: Since clomipramine may cause drowsiness, especially at the beginning of treatment, be careful when engaging in activities requiring mental alertness, judgment, and physical coordination such as driving or operating machinery.

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Grapefruit juice: Grapefruit, grapefruit juice, and cranberry juice can affect how clomipramine is removed from the body and may cause too much of the medication to build up in the body and cause possibly harmful side effects. Avoid these foods while taking clomipramine.

Heart disease: People who are at risk of heart attack or stroke may be more likely to experience heart problems when taking clomipramine. If you have been told that you have an increased risk of heart attack or stroke, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart rhythm: Clomipramine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Lactose: Some formulations of this medication contain lactose. If you have hereditary problems of galactose intolerance, lactase deficiency, or glucose-galactose malabsorption, talk to your doctor about whether this medication is appropriate for you.

Low sodium: Clomipramine can cause to much sodium to be removed from the body. Too little sodium in the blood can quickly become a medical emergency. Older adults and people taking diuretics (water pills) may be more likely to experience this effect. If you experience headache, trouble concentrating or remembering, or decreased coordination, contact your doctor immediately.

Neuroleptic malignant syndrome (NMS): Clomipramine may contribute to a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS), when it is taken in combination with certain other medications. If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Orthostatic hypotension (dizziness upon arising): Move slowly when rising from a sitting or lying down position, as clomipramine can cause sudden temporary low blood pressure resulting in dizziness.

Seizures: There have been occasional reports of seizures occurring with clomipramine. Seizures are more likely to occur when higher doses of this medication are taken. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin toxicity: Severe reactions are possible when clomipramine is combined with other medications that act on serotonin, such as other medications used to treat depression and certain medications to treat migraine. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible. Discuss with your doctor how this medication may affect other medications that you may be taking and whether any special monitoring is needed.

Suicidal or agitated behaviour: People taking antidepressants such as clomipramine may feel agitated (restless, anxious, aggressive, emotional, trouble sleeping, and feeling not like themselves), or they may want to hurt themselves or others. If you notice any changes in mood, behaviours, thoughts, or feelings in yourself or someone who is taking this medication, contact a doctor immediately. Your doctor will monitor you closely for behaviour changes, especially at start of treatment or when your dose is increased or decreased.

Surgery: Tell your doctor as soon as possible if you are taking clomipramine before any planned surgeries. It may need to be stopped to prevent heart problems during surgery.

Thyroid disease: People who have an overactive thyroid gland are at an increased risk of developing an irregular heartbeat while taking this medication. If you have been diagnosed as having an overactive thyroid, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary problems: This medication may cause urinary retention (difficulty urinating). If you have urinary tract problems, these symptoms may become worse. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Withdrawal: Withdrawal symptoms such as dizziness, nausea, headache, and sleep disturbance have occurred when clomipramine is stopped suddenly. This is not a sign of addiction. Do not suddenly stop taking this medication. If you are supposed to stop taking this medication, contact your doctor, who will advise you on how to gradually reduce the dose.

Pregnancy: The safety of this medication for use during pregnancy has not been established. It should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are breast-feeding and are taking clomipramine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding, or whether you should gradually withdraw the medication.

Children: Clomipramine has not been studied for use by people under 10 years of age, and specific recommendations for its use by this age group cannot be provided. The long-term effects of clomipramine on childhood growth and development have not been determined.

Seniors: Seniors are more likely to experience side effects of clomipramine and require lower doses than younger adults.

What other drugs could interact with this medication?

For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.

If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2025. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Anafranil