Anafranil (Clomipramine): Uses, Side Effects, Dosage, & More

What Is Anafranil (Clomipramine)?

Anafranil (clomipramine) is part of the drug class of tricyclic antidepressants.¹ It is FDA-approved for the treatment of obsessive-compulsive disorder (OCD). FDA approval means the medication has undergone rigorous testing and evaluation, showing its safety and efficacy for a specific disorder.

Anafrinil primarily works by affecting serotonin levels in the brain.² Serotonin is a chemical that plays a major role in mood regulation. By increasing the levels of serotonin, individuals can experience a reduction or elimination of OCD symptoms. These symptoms of OCD include repeated unwanted thoughts and behaviors.

Is Anafranil Available as a Generic Medication?

Anafranil is available as a generic medication called clomipramine. Generic versions contain the same active ingredient as the brand-name drug but are often available at a much lower price.

Is Anafranil Used for Anxiety?

Anafranil is sometimes used off-label for the treatment of anxiety disorders, although it is not FDA-approved for this use. However, the way that clomipramine works is similar to other medications that are FDA-approved for the treatment of anxiety. Individual responses vary to different medications, and a healthcare provider can determine the most appropriate treatment for each individual.

Is Anafranil the Same as Prozac?

Anafranil and Prozac are different medications and work differently in the brain. However, both medication’s primary function is to increase serotonin. Anafranil is a tricyclic antidepressant used to treat OCD. Prozac is a selective serotonin reuptake inhibitor used to treat various mood disorders, including depression and anxiety.

How Does Anafranil Work?

Anafranil works by improving the balance of chemicals in the brain. When someone has OCD, the brain might struggle to regulate certain chemicals, leading to intrusive thoughts and repetitive behaviors. Anafranil works by increasing serotonin in the brain, causing improvement in OCD symptoms.

What Is Anafranil Used to Treat?

Anafranil (clomipramine) is FDA-approved to treat obsessive-compulsive disorder (OCD), a mental health condition that causes intrusive thoughts and repetitive behaviors. FDA approval means the medication has undergone rigorous testing to demonstrate its effectiveness and safety.

While Anafranil is most often used to treat OCD symptoms, it has also been used off-label to treat other disorders. Off-label means the medication is being used to treat a condition not approved by the FDA. A healthcare provider may choose to prescribe a medication off-label if, in their professional judgment, they believe the medication will still benefit a patient. Off-label uses of Anafranil include severe and treatment-resistant depression, cataplexy syndrome, anxiety, insomnia, and neuropathic/chronic pain.³

Common Side Effects of Anafranil

When taking Anafranil, some individuals may experience side effects. The side effects of this medication can vary in severity. Many side effects are mild and resolve over time as the body adjusts to the medication. However, some side effects can be severe or persistent, requiring medical care.

Common side effects of Anafranil:^1,2

• Dry mouth
• Constipation
• Nausea
• Changes in appetite
• Drowsiness
• Dizziness
• Fatigue
• Decreased libido

*All medications, including Anafranil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Anafranil

While most side effects of Anafranil are mild, some side effects can be severe and require immediate medical attention. These severe side effects may include allergic reactions, severe changes in mood, heart problems, and seizures. If these symptoms occur, it’s imperative to seek immediate medical attention.

Serious side effects of Anafranil include:^1,2

• Seizures
• Swelling of the face, mouth, and tongue
• Chest pain
• Irregular heart rate
• Difficulty breathing
• Fainting
• Loss of bladder control
• Hallucinations
• Agitation

*All medications, including Anafranil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Anafranil Warnings & Precautions

Before taking Anafranil, individuals should be aware of the important warnings and precautions associated with the medication. Some individuals may be at a higher risk for severe side effects, and it is important to discuss this possibility with a healthcare provider before starting the medication.

You may need to avoid or take precautions with Anafranil if you:^1,2

• Have a history of seizures: Anafranil should be used cautiously in individuals with a history of seizures as the medication can increase this risk.
• Have a history of allergic reactions to Anafranil or similar medications: Individuals who have experienced allergic reactions to this medication should avoid it. Symptoms may include rash, difficulty breathing, and swelling of the face.
• Have a history of suicidal thoughts/behaviors: Anafranil may worsen depression symptoms, leading to an increased risk for suicidal thoughts and behaviors.
• Have cardiovascular problems: Anafranil has been associated with decreased blood pressure and elevated heart rate when standing. This medication should be used cautiously in individuals with cardiovascular disease.
• Have liver problems: Anafranil can raise markers for liver disease and should be monitored for individuals with liver problems.
• Are receiving electroconvulsive therapy: Taking Anafranil while receiving electroconvulsive therapy may increase the risks of this type of therapy.

Anafranil Dosages for FDA-Approved Treatment

Anafranil dosages vary based on individual factors, such as age, medical history, use of other medications, and response to treatment. The typical dosage range for Anafranil is 100-200 mg per day. Healthcare providers will often start the medication at the lowest effective dose and make increases based on individual responses.

The starting dose is usually 25 mg daily. This dose is gradually increased to 100 mg over the first two weeks. It can then be gradually increased to the maximum daily dose of 250 mg if needed. The medication can be taken 1-3 times per day depending on factors such as the individual’s weight, age, response to medication, other medications, underlying health conditions, and side effects.

Anafranil Forms & Strengths

Anafranil is available in capsule form, ranging from 25-75 mg. The strength of the medication is based on individual needs and should be decided by a healthcare provider.

Anafranil is available in the following forms and strengths:²

• 25 milligram (mg) capsule
• 50 mg capsule
• 75 mg capsule

How Should I Take Anafranil?

Anafranil can be taken with or without food, but taking it with food when beginning the treatment may help prevent side effects.⁴ The capsule can be swallowed whole. However, for individuals with trouble swallowing, the capsule can be opened and mixed with soft foods.⁵

What Happens If I Miss a Dose of Anafranil?

If you forget to take the Anafranil, take the medication as soon as you remember it. However, if it is almost time for the next dose, skip the previous dose and resume your regular dosing schedule. Never double your dose to make up for a missed one.

If you have missed a dose and aren’t sure if you should take it, contact your pharmacist or healthcare professional.

Can You Overdose on Anafranil?

Overdose is possible if too much Anafranil is taken at one time. The symptoms and severity of overdose are dependent on several factors, including the age of the individual, the amount of drug taken, and the time since the ingestion. Symptoms may include severe drowsiness, agitation, muscle stiffness, rapid heart rate, heart failure, and coma. Deaths from Anafranil overdose have occurred.

What Should You Do If You Take Too Much Anafranil?

If you have taken too much of Anafranil, call the poison control helpline at 1-800-22-1222. Seek immediate medical attention if severe symptoms occur, such as seizures, difficulty breathing, or coma.

What to Avoid When Taking Anafranil

Anafranil may interact with other medications, substances, and herbs. This can lead to an increased risk of side effects from the medication. It is important to inform your healthcare provider of all medications, substances, and herbs you are taking to prevent this risk.

Seven substances you should avoid while taking Anafranil include:^1,2,3

• Tramadol: Taking tramadol with tricyclic antidepressants such as Anafranil can increase the risk of seizures.
• Monoamine oxidase inhibitors (MAOIs): Taking Anafranil with MAOIs can lead to a serious side effect called serotonin syndrome. Examples of MAOIs include selegiline, isocarboxazid, and phenelzine.
• Antidepressants: Some antidepressants may increase the concentration of Anafranil in the body, leading to an increased risk of side effects. These antidepressants include fluoxetine, paroxetine, bupropion, and duloxetine.
• Cimetidine: Cimetidine, a medication used for stomach ulcers, can increase the concentration of Anafranil in the body, leading to an increased risk of side effects.
• Antihypertensive medications: Anafranil may impact the effects of antihypertensive medications.
• Fluvoxamine: Taking Anafranil with Fluvoxamine, another medication used to treat OCD, can increase the concentration of Anafranil in the body. This can lead to an increased risk of side effects.
• Alcohol: Anafranil may exaggerate an individual’s response to alcohol, leading to worsening drowsiness and impairment.

Risks of Sudden Discontinuation of Anafranil

Abruptly stopping Anafranil can lead to symptoms of withdrawal. These symptoms may include dizziness, nausea, vomiting, hyperthermia, and irritability. ¹ To prevent withdrawal symptoms, it is recommended to work with a healthcare provider to taper off the medication slowly.

How to Get a Prescription for Anafranil

Obtaining a prescription for Anafranil involves consultation with a healthcare professional, typically a psychiatrist or primary care physician. Anafranil is only available as a prescription and cannot be obtained without a doctor’s order. The process usually begins with a comprehensive medication evaluation by a healthcare provider to best determine an individual’s needs.

How Much Does Anafranil Cost?

The cost of Anafranil can vary widely based on factors such as the pharmacy, location, insurance coverage, and use of the brand-name or generic version. The generic formulation is typically more affordable than the brand-name medication. For those whose costs are still too high, there are other cost-saving options that exist, including prescription discount cards and manufacturer coupons. Consult your pharmacist, insurance company, and healthcare provider to explore options to lower out-of-pocket costs.

Questions to Ask Your Healthcare Provider About Anafranil

If you are considering Anafranil as a treatment option, it’s important to have an open discussion with your doctor, psychiatrist, and therapist. You may want to ask about the suitability of Anafranil for you based on your medical history. You may also want to ask about the risks and benefits of this medication over alternative treatment options. If you are searching for a new healthcare provider, online psychiatry services are another option to consider.

Questions to ask your care team about Anafranil include:

• How safe is Anafranil?
• How long will it take for me to adjust to taking Anafranil?
• Am I at risk for more serious symptoms if I am already taking other medications?
• What is the best dosage to ensure fewer side effects?
• What should I do if I experience side effects?
• Are there any lifestyle or dietary changes to consider while taking Anafranil?
• How often will I need to follow up to monitor my progress?
• Are there any symptoms or side effects I should report immediately?
• How will taking Anafranil affect me long-term?