Learn about Clomipramine side effects, from common issues like dry mouth and drowsiness to serious warnings. Know when to call your doctor.
Starting a new medication can be nerve-wracking, especially when the side effect list looks long. Clomipramine (brand name Anafranil) is a tricyclic antidepressant that's highly effective for OCD — but like all TCAs, it comes with side effects that you should understand before starting treatment.
The good news: most side effects are manageable and many improve over time. This guide helps you know what to expect, what's normal, and what warrants a call to your doctor.
Clomipramine is a tricyclic antidepressant (TCA) that's FDA-approved for treating obsessive-compulsive disorder (OCD) in patients aged 10 and older. It works by blocking the reuptake of serotonin in the brain, which helps reduce obsessive thoughts and compulsive behaviors. It's also used off-label for depression, anxiety, chronic pain, and other conditions.
These side effects are reported frequently and are usually most noticeable during the first few weeks of treatment or after a dose increase. Many improve as your body adjusts:
This is one of the most common complaints. Clomipramine blocks acetylcholine receptors, which reduces saliva production. Sipping water throughout the day, chewing sugar-free gum, and using a saliva substitute can help.
Feeling sleepy is very common, especially early on. This is why many doctors recommend taking Clomipramine at bedtime once you've finished the initial titration period. Avoid driving or operating heavy machinery until you know how the medication affects you.
Another anticholinergic side effect. Staying hydrated, eating high-fiber foods, and staying physically active can help keep things moving. Talk to your doctor if it becomes severe.
Some people gain weight on Clomipramine. This can happen due to increased appetite or metabolic changes. Monitoring your diet and staying active can help, but talk to your doctor if significant weight gain occurs.
You may feel lightheaded when standing up quickly (called orthostatic hypotension). Getting up slowly from sitting or lying positions can reduce this.
Decreased libido and difficulty with ejaculation or orgasm are common with Clomipramine. This side effect doesn't always go away on its own. If it's bothersome, talk to your doctor — there may be strategies to help.
These are less common but require immediate medical attention:
Clomipramine carries an FDA boxed warning about increased risk of suicidal thinking and behavior in children, adolescents, and young adults (up to age 24). This risk is highest during the first few months of treatment or after dose changes. Contact your doctor immediately if you or a loved one experiences new or worsening depression, agitation, panic attacks, or thoughts of self-harm.
Clomipramine lowers the seizure threshold, and the risk increases at higher doses (especially above 250 mg/day). If you experience a seizure, seek emergency medical care. Your doctor should keep the dose at or below the recommended maximum to minimize this risk.
This is a potentially life-threatening reaction that can occur when Clomipramine is combined with other serotonergic drugs. Symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle twitching, and high fever. This is a medical emergency — go to the ER immediately. Learn more about drug interactions that increase this risk.
Clomipramine can cause QT prolongation, which affects your heart's electrical activity. Symptoms may include fainting, irregular heartbeat, or palpitations. This is why your doctor may order an EKG before and during treatment.
In people with bipolar disorder (sometimes undiagnosed), Clomipramine can trigger a manic episode. Signs include racing thoughts, decreased need for sleep, unusual energy, and risky behavior. Contact your doctor right away if this happens.
Clomipramine is approved for OCD in children aged 10 and older. Side effects are similar to adults, but the suicidality risk requires especially close monitoring. The maximum dose for children is 200 mg/day or 3 mg/kg/day (whichever is less).
Elderly patients are more sensitive to anticholinergic effects (confusion, urinary retention, constipation) and orthostatic hypotension (dizziness, falls). Clomipramine is generally not recommended as a first-line treatment in older adults.
Clomipramine is classified as Pregnancy Category C, meaning risk cannot be ruled out. It does pass into breast milk. If you're pregnant, planning to become pregnant, or breastfeeding, discuss the risks and benefits with your doctor before starting or continuing Clomipramine.
Here are practical strategies that can help:
Clomipramine is one of the most effective medications available for OCD, but it does come with a meaningful side effect profile. Understanding what to expect — and knowing the warning signs that need immediate attention — puts you in a much better position to manage your treatment successfully.
If you're just starting Clomipramine, stay in close contact with your doctor during the first few weeks. Most side effects are temporary, but some require dose adjustments or additional management. And if you're having trouble finding Clomipramine in stock, Medfinder can help you locate a pharmacy that has it.
You focus on staying healthy. We'll handle the rest.
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