Common Uses of Clofranil (Clomipramine) for OCD and Anxiety
Clofranil is the brand name for clomipramine, a tricyclic antidepressant (TCA) with potent serotonin reuptake inhibition. It is most widely used for obsessive-compulsive disorder (OCD), where it can lessen the frequency and intensity of intrusive thoughts and reduce compulsive rituals that disrupt work, relationships, and daily routines. For many people, Clofranil is prescribed alongside cognitive behavioral therapy (particularly exposure and response prevention) to maximize symptom control.
Beyond OCD, clinicians sometimes employ Clofranil for related or comorbid conditions when benefits outweigh risks. These may include panic disorder, cataplexy associated with narcolepsy, chronic pain syndromes with neuropathic features, and treatment-resistant depression, typically in specialist settings. Although selective serotonin reuptake inhibitors (SSRIs) are often first-line, Clofranil remains an important option—especially when OCD proves refractory to SSRIs.
Mechanistically, clomipramine blocks the reuptake of serotonin (and to a lesser degree norepinephrine), increasing synaptic levels that support mood stabilization and reduction of obsessive-compulsive symptoms. It also has antihistaminic and anticholinergic effects, which contribute to both efficacy and side effects such as dry mouth or drowsiness. As a result, individualized dosing and careful titration are integral to successful therapy.
Clofranil Dosage and Direction
Dosing is individualized based on diagnosis, age, tolerability, and response. For adults with OCD, clinicians commonly start low and titrate slowly to minimize side effects. A typical approach is to begin with a low once-daily dose, often at bedtime to reduce daytime drowsiness, then gradually increase over days to weeks toward an effective range. Many adults respond between 100–200 mg per day in divided doses or once nightly; some may require higher doses under specialist supervision, while others do well at lower levels.
Pediatric use (generally for OCD in patients 10 years and older) requires specialist oversight, conservative dosing, and close monitoring for side effects, growth, and mental health changes. Because clomipramine has a boxed warning about suicidality in children, adolescents, and young adults, frequent follow-up is essential during initiation and dose changes.
Take Clofranil consistently, with or without food; a light snack may help if nausea occurs. Do not crush or chew any modified-release formulations if provided. If switching from or to a monoamine oxidase inhibitor (MAOI), a washout period is mandatory to prevent dangerous interactions—your prescriber will specify the timing. Do not stop Clofranil abruptly; tapering under medical guidance reduces the risk of withdrawal symptoms (such as nausea, headache, irritability, or sleep disturbance) and relapse of OCD.
Precautions Before and During Clofranil Treatment
Clofranil carries an FDA boxed warning for increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly early in therapy and during dose adjustments. All patients starting clomipramine should be monitored for mood changes, agitation, unusual behavior, or worsening symptoms; caregivers and loved ones should know how to recognize warning signs and seek prompt help.
Cardiovascular precautions are important with tricyclic antidepressants. Clofranil may affect heart rhythm and conduction, potentially causing QT prolongation or arrhythmias, especially at higher doses or with interacting medicines. A baseline assessment of cardiac history is recommended; some patients (such as those with known conduction disease, a recent myocardial infarction, or electrolyte abnormalities) may need ECG monitoring and careful dose selection. Report palpitations, fainting, or unexplained dizziness immediately.
Other cautions include seizure risk (use cautiously in patients with seizure disorders or on medications that lower the seizure threshold), anticholinergic effects (which can worsen glaucoma, urinary retention, or severe constipation), and orthostatic hypotension (rise slowly from sitting or lying positions). Hyponatremia (low sodium), especially in older adults or those on diuretics, can occur with antidepressants; new confusion, headache, or weakness should be evaluated. Use extra care with liver disease, thyroid disorders, and during electroconvulsive therapy.
Pregnancy and lactation require individualized risk-benefit assessment. While some TCAs have been used during pregnancy when alternatives are not suitable, shared decision-making with an obstetric and mental health professional is essential. Clomipramine is excreted in breast milk; discuss feeding options and monitoring if therapy is necessary. Avoid alcohol and operating heavy machinery until you know how Clofranil affects alertness.
Contraindications to Clofranil
Do not use Clofranil if you are allergic to clomipramine or other tricyclic antidepressants. It is contraindicated with current or recent (within 14 days) monoamine oxidase inhibitor (MAOI) use, including linezolid or intravenous methylene blue, due to the risk of severe reactions such as serotonin syndrome and hypertensive crisis. Clofranil is also contraindicated in the acute recovery period after a myocardial infarction.
Significant heart conduction abnormalities, uncontrolled narrow-angle glaucoma, and severe urinary retention are strong reasons to avoid or reconsider use. Always provide your clinician with a full medication list and medical history so they can determine suitability and monitoring needs.
Possible Clofranil Side Effects
Common side effects often reflect Clofranil’s anticholinergic and antihistaminic properties. These include dry mouth, constipation, blurred vision, drowsiness, dizziness, increased sweating, tremor, and weight change. Gastrointestinal upset (nausea or indigestion) and sleep changes can occur, particularly during initiation. Many effects improve as your body adapts or with dose adjustments; hydration, dietary fiber, and taking the dose at bedtime may help.
Sexual side effects (such as decreased libido, delayed ejaculation, or difficulty achieving orgasm) are possible. Some people experience restlessness or mild anxiety initially, which typically settles as therapy stabilizes. Inform your clinician if side effects persist or interfere with daily life—they can adjust your plan or suggest symptom management strategies.
Serious but less common side effects require urgent attention: signs of serotonin syndrome (agitation, muscle rigidity, shivering, fever, diarrhea), fainting or irregular heartbeat, severe constipation with abdominal pain, acute eye pain or vision changes (possible angle-closure glaucoma), seizures, confusion, or signs of low sodium (headache, nausea, confusion). Antidepressants can activate mania or hypomania in people with bipolar disorder; report unusually elevated mood, reduced need for sleep, or impulsivity. In younger patients, watch closely for emerging suicidal thoughts or behavior, especially early in treatment.
Clofranil Drug Interactions to Know
Serotonergic medications raise the risk of serotonin syndrome when combined with clomipramine. Use extreme caution with SSRIs and SNRIs (e.g., fluoxetine, sertraline, venlafaxine), MAOIs, triptans for migraines, certain opioids (tramadol, meperidine), linezolid or IV methylene blue, lithium, and herbal products like St. John’s wort. Combining multiple serotonergic agents should be avoided unless clearly justified and closely monitored by a clinician.
Clofranil is metabolized by cytochrome P450 enzymes (notably CYP2D6 and CYP1A2). Potent CYP2D6 inhibitors—such as fluoxetine, paroxetine, bupropion, and quinidine—can raise clomipramine levels and side-effect risk; fluvoxamine (CYP1A2 inhibitor) can also elevate levels. Cimetidine increases TCA concentrations, whereas inducers (like some antiepileptics or smoking’s effect on CYP1A2) may reduce them. If you start or stop interacting drugs, your Clofranil dose may need adjustment and additional monitoring.
Drugs that prolong the QT interval (certain antipsychotics, macrolide or fluoroquinolone antibiotics, antiarrhythmics) can add to cardiac risk when taken with Clofranil. Combining with CNS depressants (benzodiazepines, alcohol, sedative antihistamines) may amplify drowsiness and impair coordination. Anticholinergic agents (e.g., some bladder or allergy medicines) can worsen dry mouth, constipation, and blurred vision. Clofranil may also interact with warfarin and antihypertensives—monitor INR or blood pressure as advised. Always share a complete medication, supplement, and herbal list with your healthcare provider and pharmacist.
Missed Dose
If you miss a dose of Clofranil, take it as soon as you remember unless it is close to the time of your next dose. If it is near the next scheduled dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose. Keeping a consistent daily routine or using a medication reminder can reduce missed doses and support steady symptom control.
Overdose
An overdose of clomipramine is a medical emergency. Tricyclic antidepressant overdoses can cause dangerous heart rhythm disturbances, seizures, severe low blood pressure, confusion, extreme drowsiness, and anticholinergic toxicity (fever, dilated pupils, bowel obstruction). If an overdose is suspected, call emergency services and poison control immediately. Do not wait for symptoms to develop, and do not induce vomiting unless specifically directed by medical professionals. Provide responders with the medication name, strength, time taken, and the amount ingested, if known.
Storage
Store Clofranil at room temperature (generally 20–25°C or 68–77°F), protected from moisture and excessive heat. Keep tablets in their original container with the lid tightly closed and out of reach of children and pets. Do not store in the bathroom. Safely discard expired or unused medication according to local guidelines or pharmacy take-back programs—do not share prescription medicines with others.
U.S. Sale and Prescription Policy
In the United States, clomipramine (Clofranil) is a prescription-only medication. Federal and state regulations require that a licensed clinician reviews your health information to determine whether Clofranil is appropriate and safe, and issues a valid prescription before dispensing. Avoid websites that ship prescription medicines without any clinical review—they may be unsafe, illegal, or sell counterfeit products.
HealthSouth Rehabilitation Hospital of Las Vegas offers a legal and structured solution for acquiring Clofranil without a formal prescription from your own doctor. Through a compliant process, your medical history is evaluated by a licensed clinician via telehealth or an integrated review. If appropriate, a prescription is issued on your behalf and the pharmacy fills it—eliminating the need to obtain a separate paper prescription while maintaining full regulatory compliance and patient safety.
This streamlined pathway includes pharmacist counseling, drug-interaction screening, and clear follow-up instructions. You receive authentic medication sourced through U.S.-regulated channels, with secure checkout, discreet delivery, and responsive support. To get started, complete the online intake accurately, list all medicines and allergies, and be available for clinician follow-up if needed. This ensures you receive Clofranil appropriately, safely, and conveniently.
