Anafranil (clomipramine hydrochloride) is a tricyclic antidepressant (TCA) approved for the treatment of obsessive-compulsive disorder (OCD). It functions primarily as a potent serotonin reuptake inhibitor, increasing serotonin levels in the brain, which is crucial for regulating mood, anxiety, and obsessive thoughts. This medication is recognized for its established efficacy in reducing the frequency and severity of obsessions and compulsions, helping patients achieve better daily functioning and improved quality of life. It is typically prescribed when first-line treatments like SSRIs are ineffective or not tolerated.

Features

• Active ingredient: Clomipramine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg oral capsules
• Potent serotonin reuptake inhibition with secondary noradrenergic effects
• FDA-approved for the treatment of obsessive-compulsive disorder (OCD)
• Also used off-label for major depressive disorder, panic disorder, and chronic pain
• Requires gradual titration to minimize side effects
• Generic versions available, offering cost-effective alternatives

Benefits

• Significantly reduces the frequency and intensity of obsessive thoughts and compulsive behaviors.
• Helps restore normal daily functioning and improves overall quality of life for individuals with OCD.
• Provides long-term stability in mood and anxiety management with consistent use.
• May alleviate associated symptoms of depression and panic attacks.
• Supports cognitive-behavioral therapy (CBT) outcomes by reducing baseline anxiety.
• Offers a therapeutic option for treatment-resistant cases where SSRIs have failed.

Common use

Anafranil is primarily indicated for the treatment of obsessive-compulsive disorder (OCD). It is also used off-label for major depressive disorder, panic disorder, cataplexy associated with narcolepsy, and chronic pain syndromes such as neuropathic pain. Its use in pediatric populations for OCD is supported under careful supervision, though it is more commonly prescribed to adults due to its side effect profile.

Dosage and direction

Dosage must be individualized based on patient response and tolerance. For adults with OCD, the initial dose is typically 25 mg daily, gradually increased to a therapeutic range of 100–250 mg per day, divided into two or three doses. Maximum daily dose should not exceed 250 mg. For elderly or debilitated patients, start with lower doses (e.g., 10–20 mg daily). Always take with food to minimize gastrointestinal upset. Dosage adjustments should be made under strict medical supervision; abrupt discontinuation is not recommended.

Precautions

• Regular monitoring of blood pressure and heart rate is advised due to potential cardiovascular effects.
• Use with caution in patients with a history of seizures, cardiovascular disease, glaucoma, or urinary retention.
• May cause drowsiness or dizziness; avoid driving or operating machinery until response is known.
• Alcohol and CNS depressants should be avoided as they may enhance sedation.
• Not recommended during pregnancy unless potential benefits outweigh risks; discuss with healthcare provider.
• Periodic liver function tests and complete blood counts are recommended during long-term therapy.

Contraindications

• Hypersensitivity to clomipramine or other tricyclic antidepressants.
• Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy.
• Recent myocardial infarction.
• History of severe liver or kidney impairment.
• Narrow-angle glaucoma.
• Pre-existing cardiac conduction abnormalities.

Possible side effect

Common side effects include dry mouth, constipation, blurred vision, dizziness, drowsiness, weight gain, sweating, and orthostatic hypotension. Less frequently, patients may experience tachycardia, urinary retention, sexual dysfunction, or confusion. Serious but rare adverse effects include seizures, agranulocytosis, and hepatotoxicity. Any unusual or severe symptoms should be reported to a healthcare provider immediately.

Drug interaction

Anafranil interacts with numerous medications. Significant interactions include:

• MAOIs: Risk of serotonin syndrome; avoid concomitant use.
• SSRIs, SNRIs, tramadol: Increased risk of serotonin syndrome.
• Anticholinergic drugs: Enhanced anticholinergic effects.
• Antihypertensives: Potentiated hypotension.
• CNS depressants (e.g., benzodiazepines, alcohol): Additive sedation.
• Warfarin: Altered anticoagulant effect; monitor INR.
• CYP2D6 inhibitors (e.g., fluoxetine, quinidine): Increased clomipramine levels.

Missed dose

If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose. Do not double the dose to catch up. Consistent daily dosing is important for maintaining therapeutic levels; irregular dosing may reduce efficacy or increase side effects.

Overdose

Overdose symptoms may include severe drowsiness, confusion, agitation, tachycardia, hypotension, seizures, and coma. Cardiac arrhythmias and respiratory depression are life-threatening. Immediate medical attention is required. Treatment is supportive and may include gastric lavage, activated charcoal, and monitoring of vital signs. ECG monitoring is essential due to risk of QT prolongation.

Storage

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

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis, treatment decisions, and personalized medical guidance. Do not initiate, adjust, or discontinue medication without professional supervision.

Reviews

Clinical studies and patient reports consistently highlight Anafranil’s efficacy in reducing OCD symptoms, particularly in treatment-resistant cases. Many users note significant improvement in compulsions and anxiety over several weeks of use. Common criticisms include side effects such as weight gain and dry mouth, though these often diminish with time. Overall, it is regarded as a potent option for severe OCD when other treatments fail.