Clomipramine

TCA·Psychiatry - Antidepressants

Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder, Cataplexy associated with narcolepsy

PBSTCAAnafranil25 mg tabletS4+1

Max Dose

250 mg/day

Half-life

32 h

Seizure Risk

HIGH

Serotonin

VERY POTENT

Rapid Summary

Overview

Tricyclic Antidepressant (TCA) with unparalleled potency for serotonin reuptake inhibition. The absolute gold-standard, most effective drug in the world for severe Obsessive-Compulsive Disorder (OCD).

Maximum Dose

Max 250 mg/day.

Clinical Focus

Highly toxic in overdose. Lowers the seizure threshold significantly more than other TCAs. Causes intense anticholinergic side effects.

Bottom Line

Clomipramine is the most serotonergic TCA and gold-standard pharmacotherapy for severe OCD, but has significant anticholinergic effects, seizure risk, and is dangerous in overdose.

Formulation & Access

Brand Names

Anafranil

Oral Routes

Tablets (25 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder, Cataplexy associated with narcolepsy.

Clinical Place

Reserved for severe, treatment-resistant OCD that has failed high-dose SSRIs (like Fluvoxamine or Sertraline).

Quick reference

Class & Role

TCA — Tricyclic Antidepressant (TCA) with unparalleled potency for serotonin reuptake inhibition.

Route / Formulation

Tablets (25 mg). (Anafranil)

Usual Dose & Max

Start PO 25 mg NOCTE. Titrate slowly to 100-250 mg/day. (Requires massive doses to break OCD loops). Max 250 mg/day.

Key Indication Doses

Obsessive-Compulsive Disorder: Start PO 25 mg NOCTE. Titrate slowly to 100-250 mg/day. (Requires massive doses to break OCD loops). Depression / Cataplexy: PO 25-75 mg/day. Elderly / Frail: Start at 10 mg. High risk of falls, delirium, and heart block.

Best Uses

Clomipramine is the most serotonergic TCA and gold-standard pharmacotherapy for severe OCD, but has significant anticholinergic effects, seizure risk, and is dangerous in overdose.

Avoid / Cautions

Recent myocardial infarction, arrhythmias, concurrent MAOIs (causes instantly fatal Serotonin Syndrome). Pregnancy Category C.

Key Risks

Neurological: Dose-dependent seizures (Highest risk of all antidepressants at doses > 250mg). HIGH — Sedation, tremor, delirium. Cardiovascular: Fatal arrhythmias in overdose, QRS widening, QTc prolongation, postural hypotension. Gastrointestinal: Severe dry mouth, intense constipation, urinary retention.

Key Interactions

SSRIs, Tramadol, MAOIs (Extreme risk of fatal Serotonin Syndrome). CYP2D6 inhibitors (Fluoxetine, Paroxetine) spike Clomipramine levels into the lethal seizure range.

Monitoring

Baseline and routine ECG (monitoring QTc and QRS) before exceeding 150 mg/day. Ensure rigorous bowel management (laxatives) to prevent impaction.

Clinical Pearl

Clomipramine uniquely causes a highly bizarre, rare side effect: spontaneous orgasms when yawning. While it sounds amusing, it is deeply distressing for the patient.

Access

Anafranil25 mg tablet

Brand: Anafranil
Formulation: Tablets (25 mg)

Clomipramine

TCA·Psychiatry - Antidepressants

Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder, Cataplexy associated with narcolepsy

PBSTCAAnafranil25 mg tabletS4+1

Max Dose

250 mg/day

Half-life

32 h

Seizure Risk

HIGH

Serotonin

VERY POTENT

Rapid Summary

Overview

Maximum Dose

Max 250 mg/day.

Clinical Focus

Highly toxic in overdose. Lowers the seizure threshold significantly more than other TCAs. Causes intense anticholinergic side effects.

Bottom Line

Clomipramine is the most serotonergic TCA and gold-standard pharmacotherapy for severe OCD, but has significant anticholinergic effects, seizure risk, and is dangerous in overdose.

Formulation & Access

Brand Names

Anafranil

Oral Routes

Tablets (25 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder, Cataplexy associated with narcolepsy.

Clinical Place

Reserved for severe, treatment-resistant OCD that has failed high-dose SSRIs (like Fluvoxamine or Sertraline).

Quick reference

Class & Role

TCA — Tricyclic Antidepressant (TCA) with unparalleled potency for serotonin reuptake inhibition.

Route / Formulation

Tablets (25 mg). (Anafranil)

Usual Dose & Max

Start PO 25 mg NOCTE. Titrate slowly to 100-250 mg/day. (Requires massive doses to break OCD loops). Max 250 mg/day.

Key Indication Doses

Best Uses

Clomipramine is the most serotonergic TCA and gold-standard pharmacotherapy for severe OCD, but has significant anticholinergic effects, seizure risk, and is dangerous in overdose.

Avoid / Cautions

Recent myocardial infarction, arrhythmias, concurrent MAOIs (causes instantly fatal Serotonin Syndrome). Pregnancy Category C.

Key Risks

Key Interactions

SSRIs, Tramadol, MAOIs (Extreme risk of fatal Serotonin Syndrome). CYP2D6 inhibitors (Fluoxetine, Paroxetine) spike Clomipramine levels into the lethal seizure range.

Monitoring

Baseline and routine ECG (monitoring QTc and QRS) before exceeding 150 mg/day. Ensure rigorous bowel management (laxatives) to prevent impaction.

Clinical Pearl

Clomipramine uniquely causes a highly bizarre, rare side effect: spontaneous orgasms when yawning. While it sounds amusing, it is deeply distressing for the patient.

Access

Anafranil25 mg tablet

Brand: Anafranil
Formulation: Tablets (25 mg)