Anafranil
In brief
- Anafranil is a prescription-only medicine (POM) in the UK.
- Anafranil (clomipramine) is used primarily for obsessive–compulsive disorder (OCD) and sometimes for depressive disorders; it is a tricyclic antidepressant that mainly inhibits serotonin reuptake (and to a lesser extent noradrenaline), increasing serotonergic neurotransmission.
- Usual doses: adults often start at 25 mg at bedtime and are titrated up; typical maintenance for OCD is 100–250 mg/day divided (maximum 250 mg/day); for depression doses are often individualised (commonly up to 150 mg/day); use in children needs specialist supervision.
- Administered orally as capsules (10 mg, 25 mg, 50 mg) or prolonged-release tablets (75 mg).
- Some symptomatic effects may be noticed within 1–2 weeks, but clinically meaningful improvement for OCD or depression typically takes 2–4 weeks and full effect can take up to 8–12 weeks.
- Duration of action is roughly 24 hours (allowing once-daily or divided dosing); the elimination half-life is approximately 19–37 hours, with an active metabolite that may prolong effects.
- Do not drink alcohol while taking Anafranil — alcohol increases sedation and dizziness and can worsen side effects or reduce safety.
- The most common side effect is dry mouth (anticholinergic effects); others include drowsiness, constipation, blurred vision, tachycardia, orthostatic hypotension and weight gain.
- Would you like to try Anafranil without a prescription?
Basic Anafranil information
- INN (international nonproprietary name): Clomipramine
- Brand names available in the United Kingdom: Anafranil
- ATC code: N06AA04
- Forms and dosages: Capsules 10 mg, 25 mg and 50 mg; prolonged-release tablets 75 mg; oral route
- Manufacturers in the United Kingdom: Novartis (originator), with generics from other manufacturers
- Registration status in the United Kingdom: Licensed for obsessive‑compulsive disorder and depressive illness
- OTC / Rx classification: Prescription-only medicine (POM)
Product overview
Anafranil (INN: clomipramine) is the best known brand name of clomipramine, which is also available as generic clomipramine.
In the UK it is supplied as capsules (10 mg, 25 mg and 50 mg) and as a 75 mg prolonged-release tablet.
Legal status and availability in the UK
Anafranil is a prescription-only medicine (POM) in the UK.
In our online pharmacy, Anafranil is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
Indications and labelled use
Primary licensed indications
Which conditions is Anafranil licensed for?
Anafranil (clomipramine) is licensed for obsessive‑compulsive disorder (OCD) in adults and for depressive illness.
| Indication | Typical age groups |
|---|---|
| Obsessive‑compulsive disorder (OCD) | Adults |
| Depressive illness | Adults |
Off‑label and guideline roles
Guidelines commonly place clomipramine as a second‑line or adjunct option when first‑line SSRIs fail for OCD.
Specialist teams may use higher doses for refractory cases under close monitoring.
How Anafranil works: mechanism and pharmacology
Pharmacodynamic profile
Clomipramine is a tricyclic antidepressant with strong serotonin reuptake inhibition and additional anticholinergic, antihistaminic and alpha‑adrenergic actions.
ATC classification places clomipramine under N06AA04, reflecting its role as a TCA antidepressant.
The principal therapeutic action in OCD is thought to be serotonin reuptake inhibition leading to downstream modulation of neural circuits involved in repetitive behaviours.
Pharmacokinetics and clinical implications
Clomipramine is orally absorbed and undergoes hepatic metabolism to active metabolites, which contribute to variability between patients.
Steady state is reached over several days and metabolic interactions, particularly via CYP2D6, can meaningfully alter plasma concentrations.
Strong CYP2D6 inhibitors can raise clomipramine levels, so increased anticholinergic or cardiac effects should be watched for.
Formulations and strengths
Available dosage forms
Available dosage forms include capsules (10 mg, 25 mg and 50 mg) and prolonged-release tablets (75 mg) for oral administration.
| Form | Strengths | Route |
|---|---|---|
| Capsules | 10 mg, 25 mg, 50 mg | Oral |
| Prolonged-release tablets | 75 mg | Oral |
The smaller 10 mg capsules are useful for cautious titration and fine dose adjustments.
Initiating treatment and practical titration schedules
Typical starting regimens
Start low and increase slowly according to tolerance and response.
A usual starting point for adults with OCD is 25 mg at bedtime, with increases of 25 mg as tolerated.
Maintenance dosing commonly ranges between 100–250 mg/day in divided doses for adults, with a maximum around 250 mg/day in routine guidance.
Day-to-day dosing advice for patients
Taking Anafranil at night helps reduce daytime drowsiness and orthostatic effects.
If a dose is missed, take it as soon as remembered unless it is near the next dose; do not double up.
Talk to the prescriber before making dose changes and to report troubling side effects promptly.
Contraindications, cautions and required monitoring
Absolute contraindications
Anafranil must not be used in the following situations.
- Recent myocardial infarction
- Known hypersensitivity to clomipramine or other tricyclic antidepressants
- Concurrent use of monoamine oxidase inhibitors (risk of serotonin syndrome)
- Acute recovery phase after heart attack
- Severe liver disease
Baseline and ongoing monitoring
Screen for cardiac disease and consider baseline ECG in older patients or those with cardiac risk factors.
Monitor blood pressure including orthostatic checks, review seizure history and assess urinary retention or glaucoma risks.
Tell your GP or psychiatrist about all other medicines and contact them if troubling symptoms develop.
Side-effect profile and practical management
Common and troublesome adverse effects
Common reactions include drowsiness, dizziness, tremor, dry mouth, constipation, nausea, tachycardia, orthostatic hypotension, sweating, blurred vision and weight gain.
| Symptom | Simple management tip |
|---|---|
| Dry mouth | Sugar‑free lozenges, regular sips of water |
| Constipation | Increase fibre, fluids and consider laxative after GP advice |
| Drowsiness | Take at night, avoid driving until effects settle |
| Orthostatic hypotension | Get up slowly from seated/lying positions; monitor BP |
| Weight gain | Monitor diet, encourage activity and review with prescriber |
When side effects need urgent review
Urgent review is required for palpitations, syncope, acute urinary retention, severe confusion, or features of serotonin syndrome when combined with serotonergic medicines.
Contact NHS 111, your GP or emergency services (999) depending on severity.
Drug interactions
High-risk interacting medicines
Avoid concurrent monoamine oxidase inhibitors because of the risk of serotonin syndrome.
Exercise caution when combining with other serotonergic agents such as SSRIs, SNRIs or triptans due to additive serotonin effects.
Also check for agents that prolong QT interval and for drugs that increase clomipramine levels via CYP2D6 inhibition.
| Interacting drug/class | Risk |
|---|---|
| MAO inhibitors | Severe serotonin syndrome – contraindicated |
| SSRIs / SNRIs / Triptans | Increased serotonin activity – monitor for serotonin syndrome |
| CYP2D6 inhibitors (e.g. fluoxetine, paroxetine) | Raised clomipramine levels – consider dose adjustment |
| Antipsychotics / certain antiarrhythmics | Potential QT prolongation – ECG monitoring advised if combined |
Practical checks
Tell the prescriber or pharmacist about all prescription and over‑the‑counter medicines, including cough/cold remedies and herbal products like St John’s wort.
Alcohol and sedatives add to CNS depression.
Special populations: children, elderly, pregnancy and hepatic or renal impairment
Children and adolescents
Anafranil is not generally recommended for children; any paediatric use needs specialist initiation and monitoring.
Elderly, pregnancy and organ impairment
Elderly patients have increased anticholinergic and cardiac risks; start at lower doses and monitor ECG when indicated.
Pregnancy and breastfeeding require an individual risk–benefit discussion with the prescriber because data are limited.
No formal dose adjustment is defined for liver or kidney impairment but clinical caution and monitoring are advised.
Overdose, storage, transport and disposal
Overdose recognition and first aid
Overdose may produce cardiac arrhythmias, prominent anticholinergic effects and central nervous system depression or excitation.
Emergency services should be contacted and treatment is supportive in a hospital setting.
Storage, transport and disposal instructions
Store at 20–25°C and protect from light and moisture; keep in original, tightly closed packaging for transport.
Return unwanted medicines to a pharmacy take‑back scheme or follow NHS guidance for safe disposal.
How Anafranil compares with alternatives
Efficacy and tolerability versus SSRIs and other TCAs
Clomipramine is often more effective than some SSRIs for refractory OCD but carries a higher anticholinergic and cardiac side‑effect burden.
Common SSRI competitors include sertraline, fluoxetine and paroxetine, while imipramine is a related TCA sometimes used in depression.
| Drug | Efficacy in OCD | Side‑effect burden | Typical role |
|---|---|---|---|
| Clomipramine (Anafranil) | High (especially refractory OCD) | Higher anticholinergic and cardiac risk | Second‑line or for SSRI‑resistant cases |
| Sertraline | Good first‑line for OCD | Lower anticholinergic burden | First‑line SSRI |
| Fluoxetine / Paroxetine | Good for OCD and depression | Typical SSRI profile | First‑line SSRI options |
Choosing between options in practice
Choice depends on prior response, comorbidities, tolerability concerns and monitoring needs.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 9–21 days |
| Birmingham | England | 9–21 days |
| Manchester | England | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Leeds | England | 9–21 days |
| Liverpool | England | 9–21 days |
| Bristol | England | 9–21 days |
| Edinburgh | Scotland | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
| Newcastle Upon Tyne | England | 9–21 days |
| Sheffield | England | 9–21 days |
| Nottingham | England | 9–21 days |
| Southampton | England | 9–21 days |
