Clomipramine Dosing: What You Need to Know Before Taking It

When doctors prescribe clomipramine, a tricyclic antidepressant used primarily for OCD and depression. Also known as Anafranil, it works by increasing serotonin and norepinephrine in the brain—but getting the dose right is critical to avoid serious side effects. Unlike newer SSRIs, clomipramine has a narrow window between effectiveness and toxicity. Too little won’t help; too much can cause seizures, heart rhythm problems, or even death.

For obsessive-compulsive disorder, a condition where intrusive thoughts lead to repetitive behaviors, dosing often starts low—25 mg per day—and slowly increases over weeks. Many patients end up on 100–250 mg daily, but older adults or those with liver issues may need half that. For depression, a mood disorder marked by persistent sadness and loss of interest, the starting dose is usually similar, but maximum doses are often lower. What works for one person can be dangerous for another. Blood tests and heart monitoring aren’t always required, but they should be considered if you’re over 60, have a history of heart disease, or take other meds that affect your rhythm.

Clomipramine doesn’t work overnight. It can take 4 to 8 weeks before you feel better. But side effects show up fast: dry mouth, dizziness, constipation, blurred vision, weight gain, and sleepiness are common. Some people get more serious reactions—like confusion, fast heartbeat, or trouble urinating. If you notice your hands shaking, your vision blurring, or your heart racing, don’t wait. Call your doctor. Mixing clomipramine with alcohol, certain painkillers, or even St. John’s wort can spike serotonin levels dangerously. That’s called serotonin syndrome, and it’s a medical emergency.

You also can’t just stop taking it. Stopping cold turkey can trigger withdrawal: nausea, anxiety, insomnia, electric-shock feelings in your head. Tapering slowly under a doctor’s care is the only safe way out. And if you’ve been on it for months, your body adapts. That’s why dose changes need to be handled carefully—no guessing, no online advice.

Below you’ll find real-world posts from people who’ve navigated clomipramine dosing, side effects, and how it compares to other treatments. Some found relief. Others struggled with the balance. All of them learned the hard way that this isn’t a drug to take lightly. Whether you’re just starting out or have been on it for years, the information here can help you ask the right questions—and stay safe.