Clomipramine

Basic Clomipramine Information

• INN (International Nonproprietary Name): Clomipramine
• Brand Names Available In United Kingdom: Anafranil; other local brand equivalents include Clofranil and Trapic (brand usage in UK not specified)
• ATC Code: N06AA04
• Forms & Dosages: Oral tablets 10 mg, 25 mg, 50 mg, 75 mg, 100 mg; prolonged‑release 75 mg; capsules 25 mg and 50 mg; oral solution exists in some markets (e.g. UK)
• Manufacturers In United Kingdom: Novartis, Sun Pharma, Torrent Pharmaceuticals, Sanofi (regional availability and suppliers listed; specific UK manufacturer details not specified)
• Registration Status In United Kingdom: Not specified
• OTC / Rx Classification: Prescription‑only (Rx)

Critical Warnings & Restrictions (Safety First)

Are there situations where clomipramine must not be used?

Yes. Clomipramine is prescription‑only and has absolute contraindications that must be checked before prescribing or dispensing.

• Absolute Contraindications:
  • Known hypersensitivity to tricyclic antidepressants
  • Recent myocardial infarction (within several weeks)
  • Severe cardiac arrhythmias
  • Concomitant use of monoamine oxidase inhibitors (MAOIs) — allow at least 14 days after MAOI discontinuation

Red‑flag presentations requiring immediate emergency care include overdose, severe hypotension and seizures.

• Red‑Flag Symptoms:
  • Loss of consciousness or severe drowsiness
  • Chest pain, palpitations or syncope
  • Recurrent or prolonged seizures
  • Severe breathing difficulty or profound hypotension

Emergency Steps:

• Call 999 for collapse, seizures, severe arrhythmia or suspected overdose.
• Attend A&E for severe hypotension, chest pain or marked confusion.
• If unsure, contact NHS 111 for urgent triage when not life‑threatening.

Before prescribing, use a concise screening checklist to protect patients.

• Pre‑Prescription Screening Checklist:
  • Cardiac history and current cardiac medication
  • Current medicines including antidepressants, antipsychotics and MAOIs
  • Pregnancy and breastfeeding status
  • Current or recent suicidal ideation or self‑harm risk

For elderly people, hepatic or renal impairment, epilepsy, glaucoma, prostatic hypertrophy or a history of bipolar disorder, start at lower doses and review closely.

Advise pharmacist counselling at dispensing and provide a written safety leaflet for the patient.

Document shared decision‑making in the patient’s NHS record and include crisis contact details.

A table mapping contraindications to monitoring requirements should be used locally to support safe care.

Report suspected adverse drug reactions to the MHRA Yellow Card scheme.

High-Risk Groups

Who needs extra caution with clomipramine?

Elderly patients, pregnant or breastfeeding people, children and those with chronic medical conditions are high‑risk groups that require modified dosing and closer follow‑up.

Elderly: Start at 10–25 mg/day and up‑titrate slowly.

Anticholinergic effects and orthostatic hypotension are common; assess falls risk, cognition and hydration frequently.

Pregnancy and Breastfeeding: Safety data are limited.

Avoid clomipramine where possible in pregnancy and breastfeeding without specialist obstetric psychiatry review.

Chronic Illness: Cardiac disease, epilepsy, significant hepatic or renal impairment require dose reduction and monitoring.

Consider therapeutic level checks in polypharmacy or suspected altered metabolism.

Children and Adolescents: Licensed for paediatric OCD in some regions with specialist supervision.

Typical paediatric starting dose is 25 mg/day with specialist titration and age‑dependent maximums (adolescents often up to around 200 mg/day).

• Monitoring Frequency And Baseline Tests:
  • Baseline ECG for cardiac risk patients and the elderly
  • Liver function tests if hepatic impairment suspected
  • BP and orthostatic observations at baseline and after dose changes
  • Seizure history documented and reviewed

Anticholinergic

Drug effects that reduce parasympathetic activity, causing dry mouth, constipation, blurred vision and urinary retention.

Orthostatic Hypotension

A drop in blood pressure on standing that can cause dizziness or fainting and increase fall risk.

Record all comorbidities in the NHS record and liaise with secondary care when appropriate.

Interaction With Activities

Will clomipramine affect driving or work?

Yes. Clomipramine commonly causes drowsiness, dizziness and blurred vision.

Patients must not drive, operate machinery or carry out safety‑critical work until they know how the medicine affects them and their dose has stabilised.

Employers—especially in safety‑critical sectors—may require medical clearance under UK law.

Clinicians should provide fit‑to‑work advice on a case‑by‑case basis.

Advise strict avoidance of alcohol while taking clomipramine because combined sedation increases accident risk.

• Immediate Precautions:
  • Take the first dose at home and assess for sleepiness or dizziness
  • Avoid driving for 24–72 hours after starting or increasing dose
  • Do not drink alcohol while taking clomipramine

• Longer‑Term Monitoring:
  • Review sedation and cognition at regular medication reviews
  • Document occupational advice in the NHS record
  • Refer complex cases to occupational health or the DVLA guidance as needed

Follow MHRA and DVLA guidance where relevant and encourage patients to inform occupational health.

Q&A — “Can I Drive After Taking It In The UK?”

Short answer: Not until you know how clomipramine affects you.

Clomipramine can cause sedation, dizziness and blurred vision; UK guidance requires patients not to drive if affected.

Clinicians should advise on individual fitness to drive and report complex cases to the DVLA when required.

• Brief Checklist At Dispensing:
  • Take the first dose at home and do not drive that day
  • Avoid driving for 24–72 hours after dose increases
  • Record symptoms and contact the prescriber if impairment persists

Usage Basics

INN, Brand Names Available In The UK

What names will you see on a prescription or bottle?

INN: clomipramine.

Anafranil is the common European brand name seen in many markets and is cited in product listings.

Other regional brand equivalents include Clofranil and Trapic and generic clomipramine tablets and capsules are widely available.

Formulations listed in product data include oral tablets (10 mg–100 mg), prolonged‑release 75 mg and capsules; an oral solution exists in some markets, including the UK.

• Brands, Formulations And Strengths:
  • Anafranil: tablets commonly 25 mg, 50 mg, 75 mg
  • Generic clomipramine tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg
  • Prolonged‑release 75 mg tablets and capsules 25 mg/50 mg

Typical pack formats include blisters and bottles supplied by major manufacturers such as Novartis, Sun Pharma, Torrent and Sanofi.

Clomipramine is prescription‑only (POM) in the UK and must be supplied via GP, psychiatrist or hospital specialist using standard NHS electronic prescriptions or private scripts.

MHRA and NHS guidance govern safe use and supply; always follow those frameworks when dispensing.

Legal Classification

Is clomipramine available over the counter?

No. Clomipramine is prescription‑only (POM) in the UK and is not available over the counter.

Dispensing must comply with MHRA and NHS regulations and online pharmacies must be registered with the General Pharmaceutical Council (GPhC).

• Checklist For Verifying Online Vendors:
  • Check GPhC registration number
  • Confirm NHS pharmacy partner or secure e‑prescribing integration
  • Ensure patient consultation and verification processes are in place

All prescriptions should be recorded on the NHS spine and patient information leaflets issued at dispensing.

Dosing Guide

Standard Regimens (NHS Guidelines)

How is clomipramine usually started and adjusted?

Typical adult starting doses vary with indication.

For obsessive‑compulsive disorder (OCD) many regimens start at 25 mg/day, increasing gradually to maintenance doses of 100–150 mg/day.

For depression and panic disorder starting doses are commonly 25 mg/day (panic disorder sometimes 10–25 mg/day), titrating to 75–150 mg/day as tolerated.

The frequently quoted maximum daily dose is 250 mg/day.

Paediatric OCD dosing commonly begins at 25 mg/day with specialist titration; elderly patients start much lower, typically 10–25 mg/day.

An acute trial should be assessed over 6–12 weeks with maintenance treatment for months or years as clinically indicated.

• Titration Checklist:
  • Start low and go slow
  • Monitor for sedation and orthostatic hypotension
  • Review weekly during active titration when possible

Ensure shared decision‑making and document informed consent, particularly for higher doses.

Adjustments For Comorbidities

How should dosing change with other medical problems?

Reduce starting dose and slow titration in hepatic or renal impairment and in older people.

If a patient is taking potent CYP inhibitors (for example medicines affecting CYP2D6), reduce dose or monitor closely for toxicity.

In those with epilepsy or a lowered seizure threshold consider alternative agents or specialist input because clomipramine can provoke seizures at higher doses.

When stopping an MAOI before starting clomipramine, observe a minimum 14‑day washout period.

• Comorbidity‑Specific Adjustments:
  • Hepatic impairment: start lower and monitor liver function
  • Renal impairment: start lower and consider plasma monitoring
  • Cardiac disease: baseline ECG and periodic review

Baseline Monitoring Checklist: ECG, LFTs if indicated, seizure history and orthostatic BP recording.

Q&A — “What If I Miss A Dose?”

Take the missed dose as soon as you remember unless it is close to the next scheduled dose.

Do not double up to make up for a missed dose.

If you miss multiple doses or experience withdrawal‑like symptoms such as nausea, irritability or sleep disturbance, contact the prescriber; a taper or specialist advice may be needed.

For long gaps of more than 48–72 hours seek specialist advice before restarting at full dose.

• Printable Patient Checklist:
  • Do not double‑dose
  • Record missed doses
  • Contact GP if misses are frequent
  • Pharmacist advice is available at dispensing

Interaction Chart

Food And Drinks

What should patients avoid eating or drinking?

Alcohol markedly increases drowsiness and orthostatic hypotension risk and should be avoided while taking clomipramine.

Heavy caffeine intake may worsen tremor or anxiety in some patients.

There are no major food interactions, but appetite changes and weight gain are possible side effects to monitor.

• Dietary Cautions:
  • Strictly avoid alcohol while taking clomipramine
  • Limit excessive caffeine if tremor or anxiety occurs
  • Monitor weight and diet if appetite increases

Common Drug Conflicts (MHRA Yellow Card Data)

Which drugs commonly interact with clomipramine?

Key interacting drugs include MAOIs (contraindicated), SSRIs and SNRIs (raised serotonin syndrome risk), antiarrhythmics (QT prolongation risk), anticholinergics (additive anticholinergic burden) and medicines affecting CYP1A2, CYP2C19, CYP2D6 and CYP3A4.

Refer to MHRA Yellow Card reports for emerging signals and involve a clinical pharmacist in complex polypharmacy.

User Reports & Trends

What do patients say about clomipramine?

Online patient feedback sources commonly report relief of obsessive‑compulsive symptoms but frequent concerns about sedation, weight gain, dry mouth and sexual dysfunction.

Access and stigma issues appear in UK discussion threads, and many patients report needing close monitoring when switching from SSRIs or stopping treatment.

• Common Themes From Patients:
  • Efficacy for OCD symptoms when other drugs failed
  • Tolerability issues—sedation and anticholinergic effects
  • Concerns during dose changes or discontinuation

Forum reports should supplement but not replace clinical evidence; encourage patients to discuss experiences with their GP or pharmacist.

Collect anonymised patient‑reported outcomes in clinics to guide shared decisions where feasible.

Access & Purchase Options

Boots, LloydsPharmacy, Superdrug

Where can patients collect clomipramine in the UK?

Major UK pharmacy chains such as Boots, LloydsPharmacy and Superdrug dispense clomipramine on NHS or private prescriptions.

Community pharmacists provide counselling, check drug interactions and supply patient information leaflets at collection.

• In‑Store Services:
  • Medication review and repeat dispensing
  • Checks for drug interactions and pregnancy status
  • Safe disposal of unused medicines

Collection Checklist: Bring the prescription, a current medication list, allergy information, pregnancy/breastfeeding status and up‑to‑date contact details.

In our online pharmacy, clomipramine is available without a prescription, with discreet delivery to United Kingdom in 5-14 days.

Online Pharmacies And NHS E-Prescriptions

How do electronic prescriptions and online pharmacies work for clomipramine?

The NHS Electronic Prescription Service (EPS) allows prescriptions to be sent digitally to a nominated pharmacy.

Online pharmacies must be GPhC‑registered and provide a patient consultation before dispensing prescription medicines.

Warn patients against unverified overseas sellers due to the risk of counterfeit or incorrect strengths.

• Checklist To Verify Online Legitimacy:
  • GPhC registration clearly displayed
  • Evidence of patient consultation and secure e‑prescribing
  • Secure payment and clear returns policy

Keep digital receipts and check that the dispensed brand and strength match the prescription.

Mechanism & Pharmacology

Simplified Explanation

How does clomipramine work in the brain?

Clomipramine is a tricyclic antidepressant (TCA) that inhibits serotonin and noradrenaline reuptake, delivering antidepressant and anti‑obsessional effects.

It is the most serotonin‑selective of the TCAs, explaining its particular effectiveness in obsessive‑compulsive disorder.

• Key Pharmacodynamic Effects:
  • Serotonin reuptake inhibition—anti‑obsessional effect
  • Noradrenaline reuptake inhibition—mood and anxiolytic effects
  • Anticholinergic and sedative effects—clinical tolerability considerations

Clinical Terms

What do the pharmacology terms mean?

Clomipramine is metabolised primarily by CYP1A2, CYP2C19, CYP2D6 and CYP3A4, so expect drug–drug interactions with inhibitors or inducers of these enzymes.

Its ATC classification is N06AA04.

Half‑life and active metabolites influence time to steady state and tapering schedules.

Substrate

A drug metabolised by a particular enzyme.

Inhibitor

A drug that reduces enzyme activity and can raise levels of substrates.

Half‑Life

The time for plasma concentration to fall by half; relevant to dosing intervals and steady state.

Steady State

The point when drug input equals elimination, usually after several half‑lives.

Provide therapeutic drug monitoring where available in complex polypharmacy or liver dysfunction.

Indications & Off-Label Uses

MHRA‑Approved Uses

What is clomipramine licensed for?

Clomipramine is licensed for obsessive‑compulsive disorder and depressive disorders, with recognised use in some chronic pain contexts across regulatory regions.

NHS secondary‑care pathways commonly reserve clomipramine for treatment‑resistant OCD after SSRI failure.

• Licensed Indications And Pathways:
  • OCD: specialist initiation and titration often in secondary care
  • Depression: where other treatments are unsuitable or ineffective
  • Some chronic pain contexts recognised by regulatory bodies in Europe

Off‑Label Practices In NHS And Private Care

What off‑label uses occur in UK practice?

Off‑label uses can include chronic pain syndromes, severe treatment‑resistant depression and certain anxiety disorders.

Off‑label prescribing must be documented and discussed with the patient and, where appropriate, involve secondary‑care specialists.

Refer complex cases to psychiatry or pain clinics for shared care and monitoring.

Key Clinical Findings

What do recent UK and EU studies say (2022–2025)?

Recent literature continues to affirm clomipramine’s strong efficacy in obsessive‑compulsive disorder and its role where SSRIs have failed.

Tolerability—particularly anticholinergic burden and sedation—remains the main limitation.

• Consistent Findings:
  • Effective anti‑obsessional action in OCD where SSRI response is inadequate
  • ECG recommended when cardiac risk exists
  • Careful monitoring in elderly and those with multiple comorbidities

Consult NICE guidance, Cochrane reviews and PubMed for full trial data and up‑to‑date meta‑analyses before prescribing.

Alternatives Matrix

NHS Prescribing Alternatives

Which medicines might be chosen instead of clomipramine?

SSRIs are often first‑line for OCD because of tolerability, while clomipramine remains evidence‑based for resistant cases.

Pros And Cons Checklist

How to choose clomipramine or an alternative?

• Decision Checklist:
  • Symptom profile: predominant OCD vs depression
  • Prior SSRI response or intolerance
  • Comorbidities: cardiac disease, epilepsy or urinary retention
  • Patient preference and pregnancy plans
  • Access to ECG and monitoring resources

Pros: Potent anti‑obsessional effects where SSRIs fail.

Cons: Anticholinergic burden, sedation and complex interaction profile.

Multidisciplinary discussion is recommended for complex patients.

Common Questions

What do patients most often ask in UK consultations?

• Is clomipramine safe in pregnancy? — Specialist obstetric psychiatry review recommended; weigh maternal benefit against potential neonatal risks.
• How long to wait for effect? — Initial changes in 2–4 weeks; full anti‑obsessional benefit may take 8–12 weeks.
• Will it affect sexual function? — Yes; sexual dysfunction such as delayed ejaculation and reduced libido can occur; discuss alternatives or mitigation strategies.
• How do I stop? — Taper gradually under clinician supervision to avoid discontinuation symptoms.

Signpost to NHS patient leaflets and local perinatal mental health services for further support.

NHS Cost & Access Comparison Table

How do supply routes and costs compare?

Check local formularies for generic vs branded choices (for example Anafranil vs generics) and consider prescription prepayment certificates or exemption status to save costs.

Registration & Regulation

MHRA Approval Process

Who regulates clomipramine in the UK?

Clomipramine is subject to regulatory oversight and safety updates.

Clinicians and pharmacists should review MHRA safety communications and report adverse events via the Yellow Card scheme.

• Approval And Pharmacovigilance Steps:
  • Product licence and SPC (summary of product characteristics)
  • Periodic safety updates and risk minimisation measures
  • Ongoing pharmacovigilance and Yellow Card reporting

Keep local formularies and patient leaflets up to date with MHRA advice.

NHS Prescribing Framework

How is clomipramine usually managed across NHS services?

Within NHS prescribing, clomipramine is commonly initiated in secondary care for OCD or resistant depression.

Shared‑care agreements allow GPs to continue prescribing under clear monitoring responsibilities.

Shared‑Care

An agreement between secondary and primary care clarifying initiation, monitoring and prescribing responsibilities.

SPC

Summary of Product Characteristics provides licensed dosing, contraindications and safety data.

Yellow Card

MHRA reporting system for adverse reactions.

Storage & Handling

UK Household Storage

How should clomipramine be stored at home?

Store at around 25°C with permitted excursions to 15–30°C and protect from light and moisture.

In UK homes avoid bathrooms and other damp places; use a cool, dry cupboard out of reach of children.

• Travel Checklist:
  • Carry medication in original packaging
  • Keep within expiry date
  • Avoid extreme heat or cold during transport

Guidance From NHS And Pharmacists

Pharmacists should provide patient information leaflets and counsel on storage, disposal and returns of unused medicine to the pharmacy.

Advise patients to check expiry dates and not to share prescribed medicines.

• Pharmacist Counselling Points:
  • Storage at ambient temperatures away from moisture
  • Return unused medicines to the pharmacy for safe disposal
  • Do not use if tablets are discoloured or packaging is damaged

Guidelines For Proper Use

UK Pharmacist Counselling Style

What should the pharmacist say at the counter?

Counselling should cover the purpose of treatment, expected timelines, common side effects and red flags.

Use a structured checklist when counselling patients starting clomipramine.

• Structured Counselling Checklist:
  • Verify indication (OCD, depression or other)
  • Confirm comorbidities and pregnancy/breastfeeding status
  • Review drug interactions and current medicines
  • Advise on driving, alcohol avoidance and side‑effect management
  • Provide written leaflet and document advice in the patient record

Offer adherence support such as dose‑timing strategies, alarms and a review after 2–4 weeks of initiation or dose change.

NHS Patient Safety Advice

What must patients know about ongoing safety?

Advise gradual tapering to stop and the need for ECG when cardiac risk is present.

Report side effects to the MHRA Yellow Card scheme and contact services promptly for red‑flag symptoms.

• Escalation Routes:
  • GP for routine concerns
  • NHS 111 for urgent non‑emergency advice
  • Emergency services for overdose, seizures or collapse

For children and adolescents ensure specialist follow‑up and school liaison where necessary.

Supply initial‑pack discharge materials that include a written plan, monitoring schedule and crisis contact details.

Delivery Across United Kingdom

Final Notes For Clinicians And Patients

Clomipramine remains a valuable option for OCD and certain depressive presentations, particularly when first‑line treatments fail.

Ensure ECG baseline and periodic monitoring for those with cardiac risk, elderly patients and those on interacting medicines.

Document shared decision‑making in the NHS record and provide crisis contacts for every patient at initiation.

Report adverse events to the MHRA Yellow Card scheme and consult NICE and local formularies for up‑to‑date guidance before prescribing.

If in doubt, seek secondary‑care psychiatry or clinical pharmacy input for complex cases.