Clomipramine Dosing: What You Really Need to Know

When doctors prescribe clomipramine, a tricyclic antidepressant used primarily for obsessive-compulsive disorder and depression. Also known as Anafranil, it works by balancing brain chemicals like serotonin and norepinephrine. Unlike newer antidepressants, clomipramine isn’t usually the first choice—but when it’s right, it works. Many people with severe OCD who didn’t respond to SSRIs find relief with clomipramine, but getting the dose right matters more than with most meds.

Most adults start at 25 mg a day, often taken at night to reduce next-day drowsiness. Your doctor will slowly increase it—usually by 25 mg every 3 to 4 days—until symptoms improve or side effects become hard to handle. The average effective dose is 100 to 150 mg daily, but some people need up to 250 mg. Never jump to a high dose on your own. Clomipramine builds up in your system over weeks, and too much too fast can cause dangerous heart rhythm changes, especially if you’re older or have existing heart issues. It also interacts with serotonin, a key brain chemical targeted by many antidepressants and supplements. Mixing it with SSRIs, SNRIs, or even St. John’s wort can trigger serotonin syndrome—a rare but life-threatening condition with high fever, confusion, and muscle stiffness.

People taking clomipramine often need regular blood tests to check liver function and heart health. It’s also a big reason why you shouldn’t drink alcohol while on it—both depress the central nervous system, and together they can slow your breathing or cause extreme dizziness. If you’re on other meds like warfarin, a blood thinner that’s sensitive to many drug interactions, your INR levels need close monitoring. Even common OTC painkillers like ibuprofen can raise bleeding risk. And if you’ve ever had seizures, glaucoma, or an enlarged prostate, your doctor will start you even slower—or avoid it entirely.

Side effects aren’t rare: dry mouth, constipation, blurred vision, weight gain, and drowsiness are common in the first few weeks. Most fade as your body adjusts, but if they stick around or get worse, talk to your provider. Don’t stop clomipramine suddenly. Tapering down over weeks prevents withdrawal headaches, nausea, and mood crashes. If you’re switching to another antidepressant, there’s usually a washout period—sometimes up to two weeks—to avoid dangerous overlaps.

Below, you’ll find real-world insights from people who’ve used clomipramine, how it compares to other OCD treatments, and what pharmacists look for when checking your full medication list. These aren’t just general tips—they’re based on actual cases, interactions, and dosing patterns that matter in daily practice. Whether you’re just starting out or have been on it for years, this collection gives you the facts you won’t get from a drug label.