Anafranil® (Clomipramine Hydrochloride)
Compared with: Blackmores Conceive Well Gold 28 Tablets + 28 Capsules
Anafranil (Clomipramine) is a tricyclic antidepressant indicated for obsessive‑compulsive disorder (OCD) and major depressive disorder. It increases synaptic concentrations of serotonin and norepinephrine by inhibiting their reuptake, providing relief from intrusive thoughts and depressive symptoms. Anafranil is effective when selective serotonin reuptake inhibitors are insufficient or not tolerated.
Clomipramine Hydrochloride – available in 25 mg and 50 mg capsules.

Other Popular and Common Names
Clomipramine
TCA Antidepressant
Clomipramine HCl
Anafranil® Capsules
Tricyclic Serotonin/Norepinephrine Reuptake Inhibitor
Clomipramine binds to presynaptic transporters, inhibiting reuptake of serotonin (5‑HT) and to a lesser extent norepinephrine (NE). This enhances neurotransmitter levels in the synaptic cleft, normalizing mood and reducing anxiety and compulsive behaviors. Its additional antagonism of histamine H₁ and muscarinic receptors contributes to sedative and anticholinergic effects.
Obsessive‑Compulsive Disorder (OCD): First‑line or second‑line when SSRIs fail.

Major Depressive Disorder: Particularly in patients with prominent psychomotor retardation or melancholic features.

Off‑Label Uses: Chronic pain syndromes, panic disorder, and treatment‑resistant depression.
Indication Initial Dose Titration Maintenance Maximum Dose
OCD (Adults) 25 mg at bedtime Increase by 25 mg weekly 100–150 mg/day in divided doses 250 mg/day
Depression (Adults) 25 mg once or twice daily Increase by 25 mg every 3–7 days 100–200 mg/day divided 250 mg/day
Elderly / Hepatic Impairment 10–25 mg once daily Slower titration recommended Lowest effective dose 150 mg/day
Administration: Capsules swallowed whole with water; may be taken with food to reduce gastrointestinal upset.
Tapering: Gradual dose reduction over 2–4 weeks to discontinue and avoid withdrawal.
Prescribing Information
Form: Hard gelatin capsules

Strengths: 25 mg, 50 mg
Route: Oral
Legal Status: Prescription Only Medicine
Pregnancy: Category C – Use only if benefit outweighs risk; neonatal adaptation syndrome reported.

Breastfeeding: Minimal excretion in breast milk; monitor infant for sedation or irritability.

Children <10 years: Safety and efficacy not established.

Elderly: Increased sensitivity to anticholinergic and orthostatic hypotension; start low and titrate slowly.
Dry mouth, constipation, urinary retention (anticholinergic)

Sedation, drowsiness (H₁ antagonism)
Weight gain
Orthostatic hypotension
Dizziness
Cardiac arrhythmias (QT prolongation)
Seizures at high doses
Severe anticholinergic effects (confusion, delirium)
Suicidal ideation in young adults

Blood dyscrasias (rare agranulocytosis)

Cardiovascular Risk: Baseline ECG recommended in patients with cardiac disease or elderly; monitor for QT prolongation.

Suicide Risk: Monitor mood and behavior, especially at treatment initiation or dose changes.

Anticholinergic Toxicity: Caution in glaucoma, prostatic hypertrophy, or ileus.

Seizure Threshold: Lowered by clomipramine; use caution in patients with epilepsy.

Drug Withdrawal: Abrupt cessation may cause cholinergic rebound (nausea, headache, malaise); taper gradually.
Therapeutic Class: Antidepressant

Pharmacologic Class: Tricyclic Antidepressant (TCA) – Serotonin and Norepinephrine Reuptake Inhibitor

Legal Category: Prescription Only

Drug Interactions
MAO Inhibitors: Contraindicated – risk of serotonin syndrome.

SSRIs/SNRIs/Triptans: Increased serotonin syndrome risk; observe for agitation, hyperreflexia.

Anticholinergics: Additive effects – risk of severe anticholinergic toxicity.

Antiarrhythmics: QT‑prolonging agents (e.g., amiodarone) – additive cardiac risk.

Cimetidine: May decrease clomipramine metabolism, increasing toxicity.

A multicenter trial demonstrated clomipramine’s superiority over placebo in reducing Yale–Brown Obsessive Compulsive Scale scores by 40 % after 12 weeks (Goodman et al., Am J Psychiatry, 1989).

Comparative studies show similar antidepressant efficacy to imipramine with greater anti‑obsessional benefit.

FAQs – Anafranil (Clomipramine)
Q1. How long until Anafranil works?
A: Anticholinergic and sedative effects appear within hours; antidepressant and anti‑obsessional effects require 4–6 weeks of continuous treatment.

Q2. Can Anafranil cause weight gain?
A: Yes. Monitor weight and implement dietary measures if necessary.

Q3. Is Anafranil addictive?
A: It is not a controlled substance, but withdrawal symptoms can occur if stopped abruptly.

Q4. Can I drive while taking Anafranil?
A: Caution advised until you know how it affects you; sedation and orthostatic hypotension may impair performance.

Q5. What if I miss a dose?
A: Take as soon as remembered unless it’s within 6 hours of the next dose. Do not double the dose.

Q6. Can Anafranil be used in children with OCD?
A: Off‑label use in adolescents has been studied; specialist supervision required. Safety profile differs in this population.

Q7. How should I stop taking Anafranil?
A: Gradually taper over 2–4 weeks under medical guidance to minimize withdrawal effects.
Goodman et al., Am J Psychiatry, 1989: Established efficacy in OCD with significant Y‑BOCS score reduction.

Meta‑Analysis (1998): Confirmed clomipramine’s superior anti‑obsessional effect versus SSRIs in partial responders.

Guidelines: Australian and European psychiatric guidelines include Anafranil as first‑ or second‑line for OCD.
Anafranil, Clomipramine, Tricyclic Antidepressant, OCD Treatment, Serotonin Reuptake Inhibitor, TCA Antidepressant, Major Depression, EZ Chemist, Anti‑obsessional Therapy, Mental Health Medication