Clomipramine
Also known as: Anafranil, Clomine, Ocifril
Important: This is informational content only. Always consult Dr. Ambrish Singal or your psychiatrist before starting, stopping, or changing any medication.
What is Clomipramine?
Clomipramine is the most serotonergic tricyclic antidepressant and is considered the gold standard for OCD treatment. It is effective when SSRIs fail and is also used for panic disorder and depression.
How It Works
Potent serotonin reuptake inhibitor with secondary norepinephrine reuptake inhibition. Its strong serotonergic effect makes it uniquely effective for OCD among tricyclics. Also blocks histamine, muscarinic, and alpha-adrenergic receptors.
Uses
How This Drug Starts Working
Effects typically begin within 1-4 weeks depending on the condition being treated. Full therapeutic effect usually takes 4-8 weeks.
Week-by-Week Timeline
Week 1: Medication reaching therapeutic blood levels. Some initial side effects may appear as body adjusts.
Week 2-3: Initial therapeutic effects beginning. Side effects often settling.
Week 4-6: Significant therapeutic benefit in most patients.
Week 8+: Full effect established. Treatment response can be properly assessed.
What Changes First?
Physical symptoms (sleep, appetite, energy) typically improve before emotional and cognitive symptoms. Others may notice improvement before you feel it yourself.
Why Does It Take Time?
Psychiatric medications work by gradually rebalancing brain chemistry and neural circuits. Unlike pain medications that block a sensation, these drugs help your brain rebuild healthy patterns — which requires time.
Complete Dosage Guide
How to Take
Take exactly as prescribed by your doctor. Maintain consistent timing each day.
Starting Dose
Your doctor will determine the appropriate starting dose based on your condition, age, weight, and other factors.
Dose Increases
Dose adjustments are made gradually based on your response and side effects. Follow your doctor's instructions for any changes.
Maximum Dose
Your doctor will not exceed safe maximum doses. Never take more than prescribed.
When to Take
Take at the same time daily for best results. Ask your doctor whether morning or evening is better for your specific medication.
If You Miss a Dose
If you miss a dose, take it as soon as you remember unless close to your next dose. Never double up. Contact your doctor if you miss multiple doses.
Food & Drink
Ask your doctor or pharmacist about specific food interactions for your medication.
How Long to Take
Duration of treatment varies by condition. Never stop medication without discussing with your doctor first — some medications require gradual tapering.
Dosage by Age Group
adult
OCD: Start 25mg/day. Increase gradually to 100-250mg/day. Maximum: 250mg/day.
child
Ages 10+: Start 25mg/day. Increase over 2 weeks to 3mg/kg or 100mg, whichever is less. Maximum: 200mg or 3mg/kg.
elderly
Start 10-25mg/day. Titrate slowly. Lower maximum doses.
Special Populations
Pregnancy
Category C. Neonatal withdrawal reported. Use only if clearly needed.
Kidney Conditions
Use with caution.
Liver Conditions
Reduce dose in hepatic impairment.
Side Effects
Common
- Dry mouth
- Constipation
- Drowsiness
- Weight gain
- Sexual dysfunction
- Tremor
- Sweating
- Dizziness
Serious
- Cardiac arrhythmias
- Seizures (dose-related)
- Serotonin syndrome
- Blood dyscrasias
- Hepatotoxicity
- Suicidal ideation
What You Should Know
Overdose Risks
DANGEROUS in overdose (like other TCAs). Fatal cardiac arrhythmias, seizures, hypotension, coma, and death. Lethal dose can be as low as 10x therapeutic dose.
Safe Discontinuation
Taper gradually over 4+ weeks. Abrupt withdrawal causes cholinergic rebound (nausea, sweating, headache) and discontinuation symptoms.