Anafranil contains an active substance called clomipramine. The drug belongs to a group of tricyclic antidepressants. It works by inhibiting the transmission of noradrenaline and serotonin released in synaptic gaps.

Anafranil also exhibits an antihistamine, anticholinergic, and antiserotinergic effects. However, these pharmacological properties are mainly responsible for the occurrence of adverse effects.

Clomipramine works on depressive syndrome as a whole, but also on certain typical depressive symptoms, such as anxiety, psychomotor retardation, and depressive mood.

Uses

Anafranil is indicated for the treatment of the following conditions:

• Depressive conditions of different aetiology and symptomatology
• Cataplexies associated with narcolepsy
• Phobia and panic attacks
• Obsessive-compulsive disorders (OCD)

Anafranil can be used in children aged 10-17 years for the OCD therapy when the cognitive behavioural therapy and the therapy with selective serotonin reuptake inhibitors did not produce results. The duration of the treatment should not exceed 8 weeks. Clomipramine is not approved for use in patients under 18 years of age for other indications.

Dosage

The recommended starting dose in the treatment of depression, OCD and phobia is 25mg, 2-3 times a day. The daily dosage can be increased gradually by 25mg every 7 days until an appropriate therapeutic effect is achieved. The maximum dose is 250mg daily. The recommended maintenance dosage is 25mg, 2-4 times a day.

The recommended starting dose for panic attacks and agoraphobia is 10mg once a day. The dosage should be gradually increased until an appropriate therapeutic effect is achieved. The recommended maintenance dose is 25-100mg daily divided into multiple doses. The treatment should last at least 6 months.

The usual dose in the treatment of cataplexy associated with narcolepsy is 25-75mg daily divided into multiple doses.

In patients over 65 years of age, the recommended starting dose is 10mg daily and the maintenance dose is 30-50mg daily.

The recommended starting dose in children aged 10-17 years who suffer from OCD is 25mg per day. The dose should be gradually increased until a therapeutic dose is achieved. The maximum daily dose is 200mg. Therapy should not last more than 2 months.

Precautions

The use of Anafranil is contraindicated in the following patients:

• In patients with heart attack.
• In patients with first-degree, second-degree and third-degree atrioventricular block.
• In patients with severe hepatic impairment.
• In patients with narrow-angle glaucoma.
• In patients suffering from mania.
• In patients with urine retention.

The medicine should not be administered 3 weeks before or after administration of MAO inhibitors (monoamine oxidase inhibitors).

Suicidal thoughts were reported in patients taking Clomipramine, especially at the beginning of therapy (during the first 4-6 weeks). If you notice suicidal thoughts, contact your doctor immediately. The risk of suicidal thoughts is higher in patients who have the history of suicidal ideas or attempts, as well as in younger patients (18-25 years).

In patients with panic disorders, aggravated anxiety symptoms have been reported at the beginning of therapy (during the first 2 weeks). Aggravated anxiety symptoms usually disappear after two weeks.

Anafranil must be very carefully used in patients with cardiovascular disorders, especially in patients with heart failure or cardiac arrhythmias. Clomipramine has the potential to cause arrhythmias due to prolongation of the QT interval (torsade de pointes). Torsade de pointes is a serious health problem that can have a fatal outcome. Patients who have hypokalemia have a higher risk of this disease. A simultaneous administration of the medicine that enhances the concentration of Anafranil in the blood increases the risk of torsade de pointes. The simultaneous administration with certain drugs, such as MAO inhibitors and Fluoxetine, can cause serotonin syndrome (accompanied by symptoms, such asmyoclonus, hyperpyrexia, epileptic seizure, delirium, and coma).

All tricyclic antidepressants, including Anafranil available online at meds4sure, reduce the threshold for seizures. Therefore, the great caution is advised if Clomipramineis used in patients who have a history of epileptic seizures.Since it exhibits anticholinergic properties, Anafranil should not be used in patients with elevated intraocular pressure and glaucoma, as it may lead to the damage of corneal epithelium. Abrupt discontinuation of the therapy must be avoided as withdrawal symptoms may occur, including agitation, anxiety, sleep disorder, parkinsonism-like symptoms, gastrointestinal distress, and mania. These symptoms usually disappear after three days, but the abrupt discontinuation of therapy must be avoided.Also, Anafranil is associated with an increased risk of tooth decay, and it is recommended that you regularly visit a dentist while taking this medicine.

Do you have low potassium levels known as hypokalemia? Before starting Clomipramine, you must correct hypokalemia, if present. Hypokalemia may cause heart arrhythmias that may have a fatal outcome. There have been cases of low potassium levels in patients taking Anafranil. Its risk is higher in women, in patients over the age of 60, in patients who have high blood pressure, as well as in patients taking other drugs that can lower potassium.

Drug Interactions

About 280 clinically significant interactions with other drugs have been reported. The simultaneous administration with the following medicaments may lead to the serotonin syndrome:

×        Drugs used to treat severe pains, such as fentanyl, Alfentanil, Pentazocine, Morphine, Codeine, Oxycodone, Hydromorphone.

×        Tryptophan and 5-hydroxytryptophan – drugs used for weight loss and for the treatment of depression.

×        Selective serotonin uptake inhibitors, such as Sertraline, Fluvoxamine, Paroxetine, Fluoxetine.

Anafranil should not be administered concurrently with the following drugs due to possible cardiotoxic effects:

×        Phenylephrine and Naphazoline (drugs used in the form of nasal drops to treat stuffy nose).

×        Thioridazine – an antipsychotic drug.

×        Antiarrhythmic drugs, such as Dofetilide, Ibutilide, Amiodarone, Propranolol, Sotalol.

×        Anagrelide – a drug used to treat thrombocytopenia.

×        Crizotinib, Ceritinib, and Osimertinib– drugs used to treat non-small cell lung carcinoma.

×        Nilotinib – a drug used to treat Philadelphiachromosome positive chronic myeloid leukemia.

×        Fluoroquinolone antibiotics, such as Norfloxacin, Ciprofloxacin, Moxifloxacin, Gatifloxacin, and Grepafloxacin.

×        Macrolide antibiotics, such as Azithromycin and Erythromycin.

Side Effects

Clomipramine may cause the following side effects:

• Constipation
• Anorexia
• Weight gain
• Orthostatic hypotension
• Urinary disorder
• Headache
• Myoclonus
• Paresthesia
• Tremor
• Ejaculation disorders
• Memory impairment
• Tachycardia
• Insomnia
• Pain in the bladder
• Confusion
• Fever
• Serotonin syndrome
• Feeling of tightness in the chest
• Voice changes
• Visual disturbances
• Hearing disorders
• Arrhythmias
• Pain during sexual activity

Final Thoughts

Anafranil Clomipramine is an effective antidepressant agent, but exerts some serious adverse effects. There are much better drugs for the treatment of depression and OCD, and the fact is that many doctors avoid prescribing tricyclic antidepressants, including Anafranil. Selective serotonin reuptake inhibitors are the first-line treatment for OCD and depression.