Tricyclic antidepressant Pregnancy: Not recommended during pregnancy and in women of childbearing potential not using contraception. First-trimester data suggest increased risk of cardiac defects (2/100 vs 1/100). Neonatal effects (dyspnoea, lethargy, irritability, tremor) reported after use up to delivery. Breast-feeding: passes into breast milk in small quantities — withdraw medication or cease breast-feeding.

Clomipramine hydrochloride

Brand names: Anafranil

Clomipramine is a tricyclic antidepressant used for depression, obsessive-compulsive disorder and phobic and panic disorders.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg/day initially, increasing gradually to 30-150 mg/day if required

Route: Oral

Frequency: In divided doses throughout the day or as a single dose at bedtime

Max: 250 mg per day (severe cases)

Depression: many patients adequately maintained on 30-50 mg/day; after distinct improvement, adjust to maintenance ~50-100 mg. Elderly: start 10 mg/day, increase cautiously under close supervision to 30-75 mg daily (reached after ~10 days). Obsessional/phobic states: build up to 100-150 mg daily over ~2 weeks starting with 25 mg daily (elderly/TCA-sensitive start 10 mg daily). Adjunctive treatment of cataplexy with narcolepsy: 10-75 mg daily, commencing at 10 mg daily. Treat hypokalaemia before initiating. Avoid abrupt discontinuation (withdrawal symptoms) — taper gradually. Give with caution in renal or hepatic impairment. Paediatric population: not recommended.

Dose adjustments

Renal

Give with caution in patients with renal impairment

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to clomipramine or excipients, or cross-sensitivity to dibenzazepine-group tricyclic antidepressants
Recent myocardial infarction, any degree of heart block or other cardiac arrhythmias
Severe liver disease
Concurrent MAOI use, or within 3 weeks of start/cessation of MAOI therapy
Concomitant selective reversible MAO-A inhibitors (e.g. moclobemide)
Narrow-angle glaucoma
Retention of urine
Mania

Side effects

Increased appetite (very common); dry mouth, constipation, nausea (very common)
Dizziness, tremor, headache, myoclonus, somnolence (very common)
Accommodation disorder, blurred vision (very common); hyperhidrosis (very common)
Restlessness (very common); confusional state, anxiety, agitation, sleep disorder (common)
Sinus tachycardia, palpitation, orthostatic hypotension (common)

Interactions

Monoamine oxidase inhibitors — contraindicated
Drugs that prolong QT interval or other serotonergic agents — caution; risk of QTc prolongation and serotonergic toxicity
Anticholinergic or sympathomimetic drugs — require close supervision and dose adjustment
Guanethidine, clonidine or similar agents — pharmacologic effects may be blocked
Hepatic enzyme inhibitors (e.g. cimetidine, fluoxetine), haloperidol, methylphenidate — may increase plasma levels; enzyme inducers (barbiturates, phenytoin) may decrease levels

Clinical monograph

How it works

It inhibits the reuptake of serotonin and (to a lesser extent) noradrenaline, with the strong serotonergic action underlying its particular efficacy in obsessive-compulsive disorder.

Prescribing in practice

Tricyclics are dangerous in overdose, causing cardiac arrhythmias and seizures, so consider toxicity in overdose risk when prescribing and supplying quantities.
Antimuscarinic effects make it hazardous in cardiac disease, urinary retention, prostatic enlargement and angle-closure glaucoma.
Avoid combination with monoamine oxidase inhibitors and use caution with other serotonergic or QT-prolonging drugs.

Monitoring

Monitor mood, suicidal ideation (especially early in treatment), and cardiovascular status, with ECG where there is cardiac risk.

Counselling the patient

An overdose of this medicine is particularly dangerous to the heart - keep it safely and seek help urgently if too much is taken.
It may cause dry mouth, constipation, blurred vision and drowsiness.
Do not stop it abruptly, as this can cause withdrawal effects.

Evidence & guidelines

Clomipramine has an established evidence base in obsessive-compulsive disorder and is recognised in NICE guidance as a treatment option.

Reference: NICE CG31; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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