Anafranil is the best-known trade name for the substance clomipramine, which is one of the tricyclic antidepressants, that is, from the older generation of depression medicines. Doctors prescribe it mainly to treat obsessive-compulsive disorder, where it is considered among the strongest known medication options, and to treat depression in many countries including Egypt.
Its effect doesn’t appear in a day or two, but needs weeks, its side effects are clearer than modern medicines, and its overdose is dangerous to the heart. In this article we explain what Anafranil does in the brain, who it is prescribed for, and what you and your family should pay attention to. You won’t find doses or instructions for use here, as starting, adjusting and stopping the medicine is a decision taken only by the psychiatrist who prescribed it.
What is Anafranil?
Clomipramine was introduced more than half a century ago, and entered, with its tricyclic siblings such as amitriptyline and imipramine, a period in which this family was the main medication treatment for depression. Then selective serotonin reuptake inhibitors came with fewer side effects, so the use of tricyclics declined. But clomipramine kept a special place, because it is the member of its family with the strongest effect on serotonin, and this feature specifically is what makes it useful in obsessive-compulsive disorder.
Supranil: the Egyptian name for the same substance
Many ask about Supranil as if it were another medicine, but it is an Egyptian product containing the same active substance found in Anafranil, which is clomipramine. That is why everything you read in this guide about how it works, the time it takes for the effect to appear, side effects, warnings and drug interactions applies to Supranil.
The numbers written next to the name, such as 25 or 75, indicate the amount of the active substance in the tablet or capsule, and don’t mean that one of the two names is stronger than the other. Choosing the strength and when it changes is a decision for the treating doctor alone. And moving from one trade name to another doesn’t mean starting treatment from zero, but tell the doctor and pharmacist about it so the medicine isn’t dispensed twice under two different names.
As for the practical differences between the two names, such as the manufacturer and the dosage form, you will find them in the article on the difference between Supranil and Anafranil.
What is Anafranil used for?
Obsessive-compulsive disorder
This is the use the medicine is famous for, and it was the first medicine approved by the US Food and Drug Administration to treat obsessive-compulsive disorder. Modern guidelines usually start with selective serotonin reuptake inhibitors because they are easier to tolerate, and clomipramine remains a strong option the doctor usually turns to when those medicines aren’t enough, or according to their assessment of the patient’s case. The medicine here is part of a plan that includes cognitive behavioral therapy using exposure and response prevention, as we explain in the article on OCD treatment.
Depression
It is used to treat depression in many countries, and the doctor may consider it in cases of severe depression or depression that hasn’t responded to several medicines. But it is rarely the first choice today because of its side effects and its danger in overdose.
Other uses decided by the doctor
It may be prescribed in conditions such as panic disorder or some rare sleep disorders, and it is also used outside its original indications to treat premature ejaculation, which we address with caution later.
How does Anafranil work in the brain?
After a nerve cell releases serotonin and noradrenaline to transmit its message, it pulls them back into itself. Clomipramine disrupts this reuptake process, so the two transmitters stay longer in the space between cells. With regular use the neural circuits linked to mood and repetitive thoughts gradually adapt, and this slow adaptation is the reason the result is delayed. The medicine also has effects on other receptors, including acetylcholine and histamine receptors, which are responsible for many of its side effects such as dry mouth and drowsiness. And if you want to understand the role of serotonin itself, you will find it in the article on how to increase serotonin.
When do Anafranil and Supranil start to work?
Here many patients make a mistake. Side effects may appear in the first days, while improvement is delayed. In depression the difference usually begins after roughly two to four weeks, and the patient often notices improvement in sleep and energy before mood. In obsessive-compulsive disorder more patience is needed; the clear effect may take several weeks to appear, and judging the response may extend to two or three months. That is why the doctor doesn’t judge the medicine after a week, and you shouldn’t judge it either.
Common side effects
Not all of these effects are inevitable, and many of them ease after the first weeks:
- Dry mouth, constipation, blurred vision and difficulty urinating, which are known as anticholinergic effects.
- Drowsiness, or dizziness on standing quickly because of low blood pressure.
- Excessive sweating and mild tremor.
- Nausea, change in appetite and weight gain.
- Delayed ejaculation or difficulty reaching orgasm and reduced desire.
Tell your doctor about any effect that bothers you instead of stopping the medicine yourself, as there are many solutions other than stopping suddenly. And avoid driving at the beginning until you know how the medicine affects your alertness.
Serious warnings you should know
- The heart: it may affect heart rhythm and speed up the heartbeat, so the doctor asks about heart disease and may request an ECG, and it usually isn’t used after a recent heart attack.
- Seizures: it raises the likelihood of seizures, especially in those with a history of epilepsy.
- Suicidal thoughts in young people: antidepressants carry an official warning about increased suicidal thoughts and behavior in children, teenagers and young adults up to about the age of twenty-four, especially at the start of treatment or when changing the dose. Any worrying change calls for contacting the doctor immediately.
- Bipolar disorder: it may trigger a manic episode in those predisposed to it.
- Other diseases: such as narrow-angle glaucoma, enlarged prostate and liver disease.
- Pregnancy and breastfeeding: don’t decide alone; the doctor balances your need for the medicine against what the fetus or infant may be exposed to, and temporary symptoms may appear in the newborn if it was used near delivery.
Overdose and serotonin syndrome
Overdose of tricyclic antidepressants is among the most dangerous cases of drug poisoning, because it strikes the heart and nervous system together, and an amount that isn’t very large may be enough to cause harm. That is why the medicine is kept away from children, and the family takes charge of keeping the box when the patient is going through a period of severe depression or suicidal thoughts. Serotonin syndrome happens when clomipramine is combined with other medicines that raise serotonin, such as tramadol, some antidepressants and migraine medicines of the triptan class, and its details are in the article on serotonin syndrome.
Call the ambulance on 123 immediately if any of these appear
After taking an excess amount of Anafranil, or when combining it with another medicine that raises serotonin:
- Severe palpitations, an irregular heartbeat or fainting
- Seizures
- Deep drowsiness, difficulty waking or severe confusion
- High temperature with heavy sweating, tremor and muscle stiffness
- Sudden agitation with dilated pupils and involuntary twitching
- Slow or difficult breathing
Does Anafranil cause addiction?
Clomipramine doesn’t cause addiction in the known sense; it doesn’t give euphoria, doesn’t push the patient to increase the amount in search of an effect, and doesn’t turn into an obsession that is sought. But the body adapts to it, so if it is stopped suddenly after regular use, discontinuation symptoms may appear such as nausea, headache, sweating, disturbed sleep, irritability and a general feeling of being unwell. That is why stopping is always done by a gradual reduction set by the doctor who follows you. These symptoms don’t mean you have become addicted, nor do they mean the obsessions have returned, though only the doctor can distinguish between the two.
Anafranil, alcohol and drugs
Alcohol multiplies drowsiness, dizziness and poor concentration, increases the risk of falls and accidents, and works against the treatment of depression itself. Combining it with sedatives or opioids increases depression of the nervous system. With stimulants blood pressure may rise and heart rhythm may be disturbed. And combining it with tramadol, which is common in Egypt, carries two risks: serotonin syndrome, and an increased likelihood of seizures. Anafranil is never combined with monoamine oxidase inhibitors, and moving between them needs a gap period set by the doctor. Tell your doctor about everything you take, even herbs and supplements.
Anafranil, sex and premature ejaculation
Among the known effects of clomipramine is that it delays ejaculation, and it may weaken desire or make reaching orgasm difficult. This side effect itself is what led some doctors to use it outside its original indications to treat premature ejaculation, a known use studied by many research papers. But this doesn’t mean it is “delay pills” bought from the pharmacy.
Premature ejaculation has psychological and organic causes that need assessment first, and the medicine carries the same side effects and warnings we mentioned, including the heart and the interaction with tramadol, a combination widespread among young men. The decision here is for a psychiatrist or andrologist who knows your health history. And if the medicine is troubling your married life while you take it for OCD or depression, talk to your doctor frankly, as this is common and has solutions.
Common mistakes with Anafranil
- Stopping it after a week because the obsessions haven’t disappeared.
- Leaving it suddenly as soon as you feel better, then confusing discontinuation symptoms with the return of the illness.
- Taking Supranil and Anafranil together thinking they are two different medicines.
- Using it for premature ejaculation on a friend’s advice and without a heart check.
- Hiding alcohol or tramadol use from the doctor.
How does Riviera Life help you?
If you were prescribed Anafranil and didn’t feel a difference, or its effects exhausted you, or you were taking it without a prescription, book your free first consultation with a psychiatry consultant at Riviera Life. We review your diagnosis and current medicines, and set a clear plan for medicine and psychotherapy, and if you need the medicine reduced or changed this will be done under full supervision and complete confidentiality.
More from the psychiatric medicines guide
- Obsessive-compulsive disorder: the comprehensive guide
- The difference between Supranil and Anafranil
- Tryptizol (amitriptyline): uses and side effects
- Medicines for depression and anxiety
- Maprotiline (Ludiomil): depression, seizure risk and warnings
- Nortriptyline (Motival): depression, nerve pain and warnings
- Imipramine (Tofranil): depression, panic and bedwetting in children
Questions many people ask
It isn't a sedative in the usual sense, but an antidepressant from the tricyclic class. It may cause drowsiness as a side effect in some patients, but it isn't prescribed for quick calming.
Weight gain is one of its known effects due to a change in appetite, and it differs from person to person. If it bothers you, discuss it with your doctor before any change in the medicine.
No. Using it for premature ejaculation is outside its original indications and needs an assessment of the causes, the heart and other medicines, and it is a decision for a doctor who knows your case.
Don't make up the missed amount all at once. Contact your doctor or pharmacist to tell you how to return to your plan safely.
Improvement doesn't mean treatment has ended, and stopping early is a cause of relapse. The doctor decides when and how the medicine is reduced gradually.
