Clomipramine (Anafranil): How This TCA Works for OCD, Dosing, and When Telehealth Is Enough

Last updated: August 22, 2026

Clomipramine is a tricyclic antidepressant (TCA). The historic brand is Anafranil (clomipramine hydrochloride capsules). The FDA-approved use is obsessive-compulsive disorder (OCD) in people 10 years and older. It is a tertiary-amine TCA with strong serotonin-reuptake block compared with many other TCAs. It is not a controlled substance. A licensed telehealth clinician can often continue a stable course after a full history, but new starts need a cardiac and seizure-risk review, and overdose is a medical emergency.

This guide is educational. It is not a diagnosis and it is not a promise that any clinician will prescribe clomipramine.

Looking for OCD care online? Klarity Health has 2,000+ licensed providers. Many visits happen by video. Coverage varies by plan. Self-pay is also an option. See online OCD treatment options or browse conditions.

TLDR

• Clomipramine is a TCA. MedlinePlus a697002 (page current as of March 15, 2026) lists it for OCD. Historic brand: Anafranil.
• The Anafranil label on DailyMed (setid 4074b555, Rev 09/2024) lists capsules at 25 mg, 50 mg, and 75 mg. Indication: obsessions and compulsions in OCD. Pediatric approval is limited to OCD, not other psychiatric uses (DailyMed Anafranil).
• StatPearls clomipramine (NBK541006) (updated August 16, 2024) says it was the first FDA-approved OCD medicine (1989). Guidelines often still start with an SSRI because clomipramine has more anticholinergic, cardiac, and seizure burden. Off-label class uses include depression, anxiety, chronic pain, insomnia, panic, body dysmorphic disorder, and others.
• Adults (DailyMed): start 25 mg daily; raise as tolerated to about 100 mg during the first 2 weeks, in divided doses with meals. Then raise over later weeks to a maximum of 250 mg daily. After titration, many people take the full dose once at bedtime.
• Children and adolescents 10+ (DailyMed): start 25 mg daily; first 2 weeks max is 3 mg/kg or 100 mg, whichever is smaller. Later max is 3 mg/kg or 200 mg, whichever is smaller. After titration, once-daily bedtime dosing is common.
• Boxed warning: antidepressants raised suicidal thinking and behavior versus placebo in children, adolescents, and young adults in short-term studies. Clomipramine is not approved in pediatric patients except for OCD. Write the smallest practical quantity because TCA overdose can be fatal.
• Do not combine with an MAOI. Wait at least 14 days when you switch. Do not start during linezolid or IV methylene blue. Do not use in the acute recovery period after a myocardial infarction. Seizure risk rises with dose; the label and StatPearls flag toxicity more often above about 300 mg/day.
• Not a controlled substance. Telehealth can follow many stable adults. Chest pain, fainting, seizures, high fever, or any suspected overdose need emergency care. If you are in crisis, call or text 988.

Table of contents

• What clomipramine is
• How it works
• Approved and related uses
• Clomipramine dosage
• Side effects
• Warnings and who should not take it
• Interactions
• When telehealth is enough
• How a Klarity visit fits
• FAQ

What clomipramine is

Clomipramine hydrochloride is an oral capsule. DailyMed lists 25, 50, and 75 mg strengths. Product names are not interchangeable without a clinician and pharmacist check. DEA schedule: none.

Historic brand: Anafranil. Many pharmacies now dispense a generic. Related Klarity TCA and mood guides: amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil), desipramine (Norpramin), and doxepin (Silenor).

How it works

MedlinePlus says clomipramine raises serotonin, a natural brain chemical needed for mental balance. StatPearls describes it as a tertiary-amine dibenzazepine TCA with stronger serotonin-transporter affinity than many other TCAs. The active metabolite desmethylclomipramine leans more on norepinephrine.

Those extra receptor effects (muscarinic, histaminic, alpha-adrenergic) explain dry mouth, constipation, blurred vision, sedation, sexual side effects, and some blood-pressure change. StatPearls notes SSRIs are usually first-line for OCD because they tend to cause fewer of these effects, even when some analyses found clomipramine highly effective on OCD scales.

MedlinePlus notes it may take several weeks or longer to feel the full benefit. StatPearls puts typical OCD onset at 6 to 12 weeks. Keep taking it unless your clinician changes the plan. Sudden stops can bring dizziness, nausea, headache, sleep change, fever, and irritability.

Approved and related uses

DailyMed indication: treatment of obsessions and compulsions in OCD when those symptoms cause marked distress, take substantial time, or interfere with work or social life. Adult trials were 10 weeks; the child/adolescent trial was 8 weeks in ages 10 to 17. Mean Y-BOCS improvement was about 35% to 42% in adults and 37% in youth versus little change on placebo. Adult trial max was usually 250 mg/day. Youth trial max was 3 mg/kg/day up to 200 mg.

StatPearls off-label list includes depression, anxiety, neuropathic and chronic pain, treatment-resistant depression, cataplexy, insomnia, body dysmorphic disorder, panic, premature ejaculation, pediatric nocturnal enuresis, and trichotillomania. Off-label use still needs a clinician who owns the risk-benefit call. This article does not recommend any off-label start.

For OCD care more broadly, see Klarity’s online OCD treatment page and the adult OCD symptoms checklist. Exposure and response prevention (ERP) remains a core therapy option alongside medicine.

Clomipramine dosage

Only your prescriber sets your dose. The figures below come from the Anafranil DailyMed label and StatPearls, not from a Klarity protocol.

• Adults: 25 mg daily to start. Raise toward about 100 mg over the first 2 weeks, split with meals. Then raise over later weeks to a max of 250 mg/day. After titration, once daily at bedtime is common.
• Children and adolescents (10+): 25 mg daily to start. First 2 weeks: do not exceed 3 mg/kg or 100 mg, whichever is smaller. Later: do not exceed 3 mg/kg or 200 mg, whichever is smaller.
• Steady state: DailyMed notes CMI and its metabolite DMI have long half-lives. Plasma levels may not settle for 2 to 3 weeks after a change. After the first titration, waiting 2 to 3 weeks between further increases is often reasonable.
• Off-label bedtime ranges in StatPearls are often 25 to 100 mg, depending on the target. That is not an FDA OCD schedule.
• Taper: StatPearls describes cutting the dose by about 50% every 3 days down to 25 mg, then stopping. Do not stop on your own.

StatPearls also notes capsules can be opened and mixed with soft food such as applesauce if you swallow the mix without chewing. Confirm that plan with your pharmacist for your specific product.

Side effects

MedlinePlus common effects include drowsiness, dry mouth, nausea, and other anticholinergic symptoms. StatPearls adds weight gain, increased appetite, constipation, urinary retention, blurred vision, headache, dizziness, fatigue, low blood pressure, anxiety, restlessness, sweating, sexual dysfunction, and rare blue-green urine.

Serious effects that need urgent care: arrhythmia or very fast heartbeat, seizures, fainting, high fever, severe constipation or no urine, yellowing of skin or eyes, eye pain (possible angle-closure glaucoma), mania, or new or worsening suicidal thoughts. Overdose can cause seizures, heart-rhythm collapse, coma, and death. Sodium bicarbonate and ICU support are the usual hospital approach for TCA overdose. Call 911 for suspected overdose. Call or text 988 for a mental-health crisis.

Warnings and who should not take it

DailyMed contraindications: hypersensitivity to clomipramine or other TCAs; MAOI use or a 14-day window either direction; start while on linezolid or IV methylene blue; acute recovery after myocardial infarction.

Use extra caution with heart block, long QTc, arrhythmia, heart failure, mania or bipolar risk, liver disease, narrow-angle glaucoma, urinary retention, seizure history, and older adults. The 2023 AGS Beers Criteria (cited in StatPearls) generally advise against TCAs in older adults because of anticholinergic load, sedation, and orthostasis.

Seizure risk is dose-related. StatPearls links toxicity more often with doses over 300 mg/day. Stay inside the labeled maximum unless a specialist has a documented reason and monitoring plan.

Pregnancy and lactation: StatPearls notes placental transfer, possible neonatal lethargy, heart defects, and withdrawal, plus presence in breast milk. Decisions belong with obstetric and psychiatric clinicians together.

Interactions

Key interaction themes from DailyMed and StatPearls:

• MAOIs, linezolid, IV methylene blue: contraindicated (serotonin syndrome).
• Other serotonergic drugs (many SSRIs, SNRIs, triptans, tramadol, St. John’s wort): higher serotonin-syndrome risk. Fluoxetine needs a long washout (StatPearls: at least 5 weeks) before a TCA start.
• CYP2D6 inhibitors (fluoxetine, quinidine, cimetidine, and others) can raise clomipramine levels. About 7% of people are CYP2D6 poor metabolizers; levels can vary widely.
• CYP1A2 matters for conversion to desmethylclomipramine. Fluvoxamine can block that step. Some specialists combine the two in refractory OCD; that is specialist care, not a DIY stack.
• Enzyme inducers (barbiturates, phenytoin) can lower levels.
• Highly protein-bound drugs such as warfarin or digoxin may need extra monitoring.
• Alcohol and other CNS depressants add sedation.

When telehealth is enough

Clomipramine is not a controlled substance, so Ryan Haight in-person rules for controlled drugs do not apply the same way. Video psychiatry can still be a good fit when:

• You already take a stable dose, know your side effects, and can get labs or an ECG locally if the clinician asks.
• OCD symptoms are impairing but you are not in acute medical crisis.
• You can use a reliable video connection and a local pharmacy.

In-person or emergency care is the better path for new chest pain, fainting, a first seizure, suspected overdose, severe agitation or mania, or inability to keep down fluids. Depot or IV clomipramine is not a typical telehealth product. Pediatric starts belong with clinicians experienced in youth OCD.

How a Klarity visit fits

Klarity Health connects people with 2,000+ licensed providers for video visits. A visit may include history, medication review, and a plan that could include an SSRI, clomipramine, therapy referral, or no medicine. No one can promise a specific prescription before the exam.

Insurance may help pay for a visit or a fill. Coverage varies by plan, state, and formulary. Prior authorization is common for TCAs used after SSRI trials. Verify benefits before you book. Self-pay is also an option.

See if you may qualify for online OCD care or review online depression treatment if mood symptoms are the main issue.

FAQ

Is clomipramine the same as Anafranil?

Anafranil is the historic brand of clomipramine hydrochloride capsules. Many fills today are generic clomipramine. Strengths on the Anafranil label are 25, 50, and 75 mg.

Is clomipramine used for depression?

The FDA-approved human use on the U.S. label is OCD. StatPearls lists depression and several other conditions as off-label. Your clinician decides whether that tradeoff makes sense versus an SSRI or another TCA.

How long does clomipramine take to work for OCD?

StatPearls typically cites 6 to 12 weeks for OCD benefit. Anxiety or sleep change can show up sooner. MedlinePlus says several weeks or longer.

Can a telehealth doctor prescribe clomipramine?

Often yes, because it is not scheduled. The clinician still needs an appropriate exam, a cardiac and seizure-risk review, and a plan for follow-up. They may decline a start if risk is high or records are missing.

What if I miss a dose?

MedlinePlus generally advises taking a missed dose when you remember, unless it is almost time for the next one. Do not double up. Confirm with your own label and pharmacist.

Disclaimer

This article is for education. It does not diagnose, treat, or replace a licensed clinician. Medicine names, doses, and interaction lists can change. Check DailyMed, your pharmacist, and your prescriber for the product in your bottle. Insurance coverage varies by plan. Verify benefits before you book or fill. If you are in crisis, call or text 988. If you think someone has overdosed, call 911.

Sources: MedlinePlus clomipramine; DailyMed Anafranil setid 4074b555; StatPearls NBK541006.