Supplements and Clomipramine.
Clomipramine, sold under the brand name Anafranil, is a tricyclic antidepressant: it inhibits reuptake of both serotonin and noradrenaline, with significant antimuscarinic effect.
Clomipramine is a tricyclic antidepressant (TCA). The class blocks reuptake of both serotonin and noradrenaline. It also has significant antimuscarinic, antihistaminic, and alpha-1 blockade. In current UK prescribing, TCAs are used mostly at low doses (10 to 50mg) for neuropathic pain, migraine prophylaxis, and chronic tension headache. The full antidepressant dose (75 to 150mg) is uncommon outside specialist practice. The off-target effects drive the side effect profile. Dry mouth, constipation, daytime sedation, postural hypotension. Cardiac conduction effects matter at higher doses, with QT prolongation especially in overdose. A few supplement interactions warrant care. Anything serotonergic on top (St John's Wort, 5-HTP, SAMe). Anything sedating at bedtime (valerian, kava, magnesium at higher doses). And anything anticholinergic that adds to the dry mouth and constipation load. The pain indication at low dose has a lower risk profile than the historical antidepressant dose, but the mechanism is the same.
Below are the 7 documented pairs we have explicitly assessed against Clomipramine in the Distil database: 7 amber. The pairs cluster around 3 mechanisms: Cholinergic vs anticholinergic (opposing), CYP induction, and Additive serotonergic activity. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 22 June 2026. Each interaction below is assessed against PubMed-indexed evidence.
Cholinergic vs anticholinergic (opposing)
Amber Does Huperzine A interact with ?
Huperzine A raises acetylcholine, while clomipramine has a strong anticholinergic effect that blocks it. The two can work against each other, and clomipramine may blunt any benefit from huperzine A. It is worth mentioning the huperzine A to your prescriber.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP induction
Amber Does St John's Wort interact with ?
Clomipramine is a tricyclic antidepressant broken down by the same liver enzymes that St John's Wort speeds up, so St John's Wort may lower its level and make it work less well. If you take clomipramine, mention St John's Wort to your GP or pharmacist rather than starting it on your own, and watch for symptoms returning.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive serotonergic activity
Amber Does 5-HTP interact with ?
Clomipramine is the most strongly serotonin-acting of the tricyclics. Combined with 5-HTP, the serotonergic effect is additive and more likely to add up than with other TCAs. Watch for restlessness, sweating, or muscle twitching, and discuss with your GP before stacking.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does L-Tryptophan interact with ?
Tryptophan is the building block your body uses to make serotonin, and clomipramine is the most strongly serotonin-acting of the tricyclics. Taking them together raises serotonin from both directions and is more likely to add up than with the other tricyclics. Watch for agitation, sweating, tremor, shivering, or muscle twitching, and do not stack them without your GP's involvement.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Rhodiola Rosea interact with ?
Rhodiola has a mild effect on serotonin pathways, and clomipramine is the tricyclic that raises serotonin most strongly. In theory, taking them together could add to that serotonin effect. Most people tolerate the combination, but watch for restlessness, sweating, tremor, or a racing heart, and talk to your GP before stacking them, especially if your dose has recently changed.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does SAMe interact with ?
SAMe has its own antidepressant, serotonin-related activity, which may add to clomipramine's. Clomipramine is the most strongly serotonin-acting of the tricyclics, so the effects are the most likely to add up. Most people tolerate the combination, but watch for restlessness, sweating, tremor, shivering, or a racing heart, and tell your GP before stacking them, especially if your clomipramine dose has recently changed.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Saffron Extract interact with ?
Saffron has its own mild antidepressant effect that appears to act on serotonin, and clomipramine is the most strongly serotonin-acting of the tricyclics. Taking them together is more likely to add up than with other TCAs. Discuss it with your GP before stacking, and watch for restlessness, sweating, or shivering, especially if your dose has recently changed.
Evidence: Limited human data, based on case reports and a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyWant this checked across everything you take?
This page checks the pairs you enter. The personalised Distil report goes further:
- the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
- where your current routine may be leaving you short of your goals
- the evidence-graded compounds worth adding, and the ones worth dropping
It's a paid report: £79, or £49 founder pricing while we earn our first reviews. The interactions check is one section of it, and you can read a real one in full before you decide.
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If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.