Clomipramine: what it treats, how to take it, side effects
Last updated September 3, 2026.
Clomipramine is a tricyclic antidepressant - the oldest proven medication for obsessive-compulsive disorder, still prescribed when newer options have not done enough. You may know it as Anafranil. It increases serotonin in the brain, and it demands more respect than the newer drugs: the side-effect list is longer and the margin narrower.
What does it treat?
Obsessive-compulsive disorder - repeated unwanted thoughts and the need to perform certain behaviors over and over. It carries the class boxed warning about increased suicidal thoughts and actions in children, teenagers, and young adults under 24, most likely in the first months and after dose increases: new or worsening depression, self-harm thoughts, agitation, panic, sleep changes, or restlessness mean calling your doctor right away, and family should know the list so they can call if you cannot.
How do you take it?
Capsules once a day at bedtime or in divided doses as prescribed - your doctor starts low and increases gradually over weeks. Take it exactly as directed: tricyclics have a narrower safety margin than newer antidepressants, so the prescribed dose is a real boundary, not a suggestion. Never stop suddenly. Missed dose: take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: drowsiness, dry mouth, nausea, vomiting, diarrhea, constipation, nervousness, decreased sexual ability, memory or concentration trouble, headache, stuffy nose, and appetite or weight changes.
- Serious - call your doctor immediately or get emergency care: uncontrollable shaking of a body part; seizures; fast, irregular, or pounding heartbeat; difficulty urinating or loss of bladder control; believing things that are not true; hallucinations; shakiness; difficulty or fast breathing; severe muscle stiffness; unusual tiredness or weakness; and sore throat, fever, or other signs of infection.
Who should not take it?
Anyone on an MAOI or within its washout window, and anyone who recently had a heart attack. Flag heart disease, glaucoma, urinary retention or prostate problems, seizures, thyroid disease, and liver disease - the tricyclic profile touches all of them. Alcohol compounds the sedation. If you become pregnant, call your doctor.
When is it an emergency?
Any thought of suicide or self-harm - call or text 988, the Suicide and Crisis Lifeline, any time. A seizure, irregular pounding heartbeat, or hallucinations is the physical emergency. For an overdose - more dangerous with tricyclics than with newer drugs - call Poison Control at 1-800-222-1222 immediately. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Why did my doctor choose a tricyclic instead of a newer drug?
Usually because the newer options - SSRIs - were tried first and did not go far enough. Clomipramine is the longest-proven OCD medication and often the most effective per milligram of effort; the trade is a wider side-effect net - dry mouth, drowsiness, constipation, urinary and cardiac cautions - and a narrower safety margin. It is the drug you take with respect, exactly as written.
Why does clomipramine need a heart history before starting?
Tricyclics affect cardiac conduction - fast, irregular, or pounding heartbeat is on the call-immediately list - so heart disease and recent heart attack are decision-shaping flags. Many prescribers check an ECG before and during treatment. This is the main way clomipramine differs in risk from the SSRIs, and it is why the dose boundary is real.
Why is the overdose warning stronger for this drug?
Tricyclics are more dangerous in overdose than newer antidepressants - the same cardiac and seizure effects, amplified. So the rules are stricter: exact doses, no doubling after a missed one, and any suspected overdose goes straight to Poison Control at 1-800-222-1222 or emergency services, no waiting to see. Keep the bottle out of reach of anyone it is not prescribed to.
Why do I have a constant dry mouth - and what helps?
Anticholinergic effect - clomipramine dampens the nerve signals that run saliva, sweat, and gut motility, which is why dry mouth, constipation, and urinary hesitancy cluster together. Water, sugar-free gum, and hydration help the mouth; fiber and fluids help the rest. Difficulty urinating or loss of bladder control crosses from nuisance to call-your-doctor-immediately.
Why does clomipramine carry a suicide warning if it treats OCD?
It is still an antidepressant, and the class boxed warning applies: increased risk of suicidal thoughts and actions in children, teenagers, and young adults under 24, most likely early in treatment and after dose increases. Everyone around you should know the watch-list - worsening depression, self-harm thoughts, agitation, panic, sleep changes - and any thought of self-harm means 988, immediately.
What happens if I miss a dose of clomipramine?
Take it as soon as you remember, unless it is almost time for the next one - then skip it and never double up. Doubling a tricyclic stacks the cardiac and seizure risks, which is why this drug's no-double rule matters more than most. Bedtime dosing anchored to brushing your teeth keeps misses rare.