Clomipramine: A Complete Overview for Patients

Clomipramine (brand name Anafranil) is a tricyclic antidepressant (TCA) and the only medication in its class that is FDA-approved for treating obsessive-compulsive disorder (OCD). It is one of the most effective medications available for OCD and has been used since the 1960s. It is available as a generic in 25 mg, 50 mg, and 75 mg oral capsules.

Whether your doctor just mentioned Clomipramine or you're doing your own research, this guide covers what you need to know — from how it works to what it costs in 2026.

What Is Clomipramine?

Clomipramine is a prescription medication that belongs to a class of drugs called tricyclic antidepressants. Unlike newer antidepressants like SSRIs, TCAs have been around for decades and affect multiple brain chemicals at once.

What makes Clomipramine unique among TCAs is its exceptionally strong effect on serotonin. It has the highest affinity for the serotonin transporter of any TCA, which is why it's particularly effective for OCD — a condition closely linked to serotonin function. You can learn more about how Clomipramine works in your body in our detailed explainer.

Clomipramine is not a controlled substance and is available as a generic, though it can sometimes be difficult to find in stock.

What Is Clomipramine Used For?

FDA-Approved Use

Obsessive-Compulsive Disorder (OCD) — Clomipramine is approved for OCD in patients aged 10 and older. It's often considered after SSRIs haven't provided enough relief, and some studies suggest it may be more effective than SSRIs for severe OCD.

Off-Label Uses

Doctors sometimes prescribe Clomipramine for conditions beyond its FDA approval, including:

• Depression and treatment-resistant depression
• Anxiety disorders and panic disorder
• Neuropathic pain and chronic pain
• Cataplexy (sudden muscle weakness associated with narcolepsy)
• Body dysmorphic disorder
• Premature ejaculation
• Trichotillomania (hair-pulling disorder)
• Pediatric nocturnal enuresis (bedwetting)

Off-label use is legal and common in medicine, but your doctor should explain why Clomipramine is being recommended for your specific situation.

How Is Clomipramine Taken?

Clomipramine comes in oral capsules in three strengths: 25 mg, 50 mg, and 75 mg.

Here's what a typical dosing plan looks like:

• Starting dose: 25 mg per day, usually taken with food
• Dose increases: Your doctor will gradually increase the dose by 25 mg every 4-7 days
• Target dose: Most adults reach 100-250 mg per day
• Maximum dose: 250 mg/day for adults; 200 mg/day or 3 mg/kg/day for children and adolescents (whichever is less)

During the titration phase, Clomipramine is often taken in divided doses (2-3 times per day) with meals. Once your dose is stable, many doctors consolidate it to a single bedtime dose to reduce daytime drowsiness.

If you have trouble swallowing capsules, they can be opened and mixed with soft food like applesauce or pudding.

Important: Never stop Clomipramine suddenly. Abrupt discontinuation can cause withdrawal symptoms including nausea, headache, and irritability. Always taper off under your doctor's supervision.

Who Should Not Take Clomipramine?

Clomipramine is not safe for everyone. You should not take it if you:

• Are allergic to Clomipramine or other tricyclic antidepressants
• Have taken an MAO inhibitor in the last 14 days
• Are currently taking linezolid or intravenous methylene blue
• Have had a recent heart attack

Your doctor should also use caution if you:

• Have a history of seizures
• Have heart disease or abnormal heart rhythms
• Have liver or kidney problems
• Have bipolar disorder
• Are pregnant or breastfeeding
• Are a CYP2D6 poor metabolizer (a genetic factor that affects how you process the drug)

Be sure to tell your doctor about all medications and supplements you take, as Clomipramine has several important drug interactions. For a complete overview of side effects, see our dedicated guide.

How Much Does Clomipramine Cost?

Cost depends on your dose, pharmacy, and insurance coverage:

• Without insurance: $30 to $150 for a 30-day supply, depending on dose and pharmacy
• With a discount coupon: Approximately $15 to $60 for generic Clomipramine
• With insurance: Generic Clomipramine is covered by most plans, though some insurers require prior authorization or step therapy (trying an SSRI first)

Brand-name Anafranil is largely discontinued in the U.S. market, so most patients take the generic version.

There's no current manufacturer savings card for Clomipramine, but patient assistance programs exist through organizations like NeedyMeds and RxAssist. For more money-saving strategies, read our guide on how to save money on Clomipramine.

If you're having trouble finding Clomipramine at your pharmacy, Medfinder can help you check which pharmacies have it in stock.

Final Thoughts

Clomipramine remains one of the most powerful tools available for treating OCD, even decades after it was first introduced. It's not always the first medication doctors try — SSRIs are typically used first — but for many patients, Clomipramine makes a significant difference when other treatments fall short.

If you and your doctor decide Clomipramine is right for you, understanding how it works, how to take it, and what to watch for will help you get the most out of your treatment. And if you need help finding a doctor who prescribes it or finding it in stock, we've got guides for that too.