Clomipramine Dosing: What You Need to Know About Dosage, Side Effects, and Safe Use

When it comes to treating OCD, depression, or panic disorder, clomipramine, a tricyclic antidepressant used primarily for obsessive-compulsive disorder and treatment-resistant depression. Also known as Anafranil, it's one of the oldest antidepressants still in use today because it works differently than newer SSRIs. But getting the dose right isn’t simple. Too little won’t help. Too much can cause serious side effects like dizziness, dry mouth, constipation, or even heart rhythm changes. Doctors usually start low—around 25 mg a day—and slowly increase it over weeks, depending on how you respond and tolerate it. Most adults end up between 100 and 250 mg daily, but some may need less or more based on age, weight, or other medications they’re taking.

Clomipramine doesn’t work like a light switch. It takes 4 to 6 weeks before you feel any real improvement, which is why people often quit too soon. And because it affects multiple brain chemicals—not just serotonin but also norepinephrine—it can interact with other drugs. If you’re on blood pressure meds, thyroid pills, or even common OTC cold remedies, you could be at risk for dangerous spikes in blood pressure or serotonin syndrome. That’s why your doctor will check your heart function before starting and may order blood tests to monitor liver and kidney health. People over 65 or with a history of seizures, glaucoma, or heart problems often get lower doses or avoid it entirely.

Switching from another antidepressant to clomipramine? You’ll need a washout period. Mixing it with SSRIs or MAOIs can be life-threatening. Even switching between generic brands can cause subtle changes in how your body absorbs the drug, which is why some patients report mood swings or worsening symptoms after a refill change. That’s not in your head—it’s real, and it’s why many doctors stick with the same brand or generic batch when possible. If you’re on clomipramine and feel worse after a dose change, tell your doctor right away. Don’t adjust it yourself.

Clomipramine dosing isn’t one-size-fits-all. It’s a balancing act between effectiveness and safety, and it requires patience and close monitoring. Below, you’ll find real-world insights from people who’ve taken it, doctors who prescribe it, and studies that show what works—and what doesn’t. Whether you’re starting out, struggling with side effects, or wondering why your dose hasn’t changed in months, there’s something here that can help you take control.