Anafranil (Clomipramine) ampoules - Instructions for Use, Dosage, Side Effects, Reviews

Synonyms: Anafranil, Atenual, Ausentron, Clomip, Clomipramin, Clonil, Depnil, Ocifril, Ocifril-XR, Praminex, Syconil, Anafranil, Anafranil retard, Anafranil SR, Anafril, Apo-Clomipramine, Chemmart Clomipramine, Clofranil, Clomi, Clomicalm (veterinary use), Clomidep, Clomine, Clomipramin-CT, Clomipramine (chlorhydrate) Mylan, Clomipramine HCl Actavis, Clomipramine HCl CF, Clomipramine HCl Mylan, Clomipramine HCl PCH, Clomipramine HCl ratiopharm, Clomipramine HCl Sandoz, Clomipramine Hydrochloride, Clomipramine Mylan, Clomipramine Sandoz, Clomipramine Teva, Clomipramine, Clomipraminhydrochlorid 2care4, Clomipramin-neuraxpharm, Clomipramin-neuraxpharm retard, Clomipramin-ratiopharm, Clopran, Clowin, CO Clomipramine, Cosinic, Equinorm, For-You, GenRX Clomipramine, Gromin, Hydiphen, Klomipramin Merck NM, Klomipramin Mylan, Klomipramin, Maronil, Pashin, Placil, Promil, Terry White Chemists Clomipramine, Trianil.

Active substance: Clomipramine.

What is clomipramine?

Clomipramine is a tricyclic antidepressant. It affects chemicals in the brain that may be unbalanced.

Clomipramine is used to treat symptoms of obsessive-compulsive disorder (OCD) such as recurrent thoughts or feelings and repetitive actions.

What is the most important information I should know about clomipramine?

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.

ATC - N06AA04 clomipramine

Pharmacological group - Antidepressants.

Nosological classification (ICD–10)

F32 Depressive episode;

F40.0 Agoraphobia;

F42 Obsessive-compulsive disorder;

F44 Dissociative [conversion] disorders;

G47.4 Narcolepsy and cataplexy;

R32 Urinary incontinence, unspecified;

R52.2 Other constant pain.

Pharmacological action

Anafranil is a tricyclic antidepressant, inhibits the reuptake of norepinephrine and serotonin (a non-selective monoamine reuptake inhibitors). It is believed that the action is carried Anafranil due to its ability to inhibit neuronal noradrenaline (NA) and serotonin (5-HT) released into the synaptic cleft, and the most important is the inhibition of serotonin reuptake.

Anafranil furthermore inherent in a wide variety of other pharmacological activities: alpha 1-adrenolytic, anticholinergic, antihistaminic and anti-serotoninergic (blockade of 5-HT-receptors).

Anafranil works on the depressive syndrome as a whole, including its typical manifestations as psychomotor retardation, depressed mood and anxiety. The clinical effect is usually observed after 2–3 weeks of treatment.

In addition, Anafranil has a specific (different from his antidepressive effect) effect in obsessive-compulsive disorders and chronic pain syndromes.

Pharmacokinetics

Absorption

After the IM clomipramine absorbed completely. When you repeat the IM or IM introduction of Anafranil at a dose of 50–150 mg/day. equilibrium concentration is reached on the second week of treatment. The values of the equilibrium concentration of clomipramine ranges from less than 15 to 447 ng/ml, and the active metabolite N-desmmethylomipramine - from less than 15 to 669 ng/ml.

Distribution

Communication with clomipramine plasma proteins is 97.6%. The apparent Vd is about 12–17 L/kg of body weight. Clomipramine concentration in the cerebrospinal fluid are about 2% of its concentration in blood plasma. Clomipramine penetrates into breast milk, where it is determined at concentrations similar to the concentrations in the blood plasma.

Metabolism

Clomipramine is metabolized mainly by demethylation to the active metabolite N-decmetilklomipramina. In this reaction involves several cytochromeP–450 isozymes, but mainly CYP3A4, CYP2C19 and CYP1A2. Clomipramine and N-dezmethylclomipramine hydroxylated to 8 hydroxyclomipramine and 8-hydroxy-N-dezmethylclomipramine. Activity of hydroxy-metabolite in vivo is not defined. Clomipramine also hydroxylated in position 2; N-dezmethylclomipramine can be further demethylated to dezmethylclomipramine. 2 and 8-hydroxy metabolites are excreted predominantly in the urine as glucuronides. The elimination of the two active components - clomipramine and N-dezmethylclomipramine by forming 2 and 8 hydroxyclomipramine catalyzed CYP2D6.

Excretion

After the IM and IV the final T 1/2 Anafranil clomipramine is an average of 25 hours (range of variation from 20 to 40 h) and 18 h, respectively.

Approximately 2/3 of a single dose of clomipramine is output as the water-soluble conjugates in urine and approximately one third dose - feces. Unchanged in the urine output of about 2% of the dose of clomipramine and about 0.5% dezmethylclomipramine.

Pharmacokinetics in selected patients

In elderly patients, due to the reduction of metabolic rate in the plasma concentration of clomipramine higher than in younger patients, regardless of the dose used Anafranil. Data on the effect of functional disorders of the liver and kidneys on the pharmacokinetic parameters of clomipramine has not yet been received.

Anafranil clomipramine Dosage

Dosing regimen and route of administration of the drug is determined individually, taking into account the patient’s condition. Care should be taken when increasing the dose in elderly patients and adolescents, which are generally more sensitive to Anafranil than those of intermediate age groups.

IM injection

Begin treatment with the administration of 25–50 mg (1–2 ampoules content), and then increase the daily dose by 25 mg (1 vial) until the daily dose of 100–150 mg (4–6 capsules). After be noted improvement by injection is gradually reduced by substituting their supportive care with oral drug forms.

IV Infusion

Treatment starts with IV drip 50–75 mg (2–3 ampoules content) 1 time per day. To prepare the infusion solution using 250–500 ml isotonic sodium chloride or glucose solution; infusion duration of 1.5–3 h. During infusion, careful observation of the patient for early detection of possible adverse reactions. Particular attention should be given to control blood pressure, as can develop orthostatic hypotension. Upon reaching a distinct improvement Anafranil introduced IV for an additional 3–5 days. Then, to maintain the achieved effect on the admission of the drug inside; 2 tablets of 25 mg is usually equivalent Anafranil 1 ampoule containing 25 mg. With a view to the gradual transition from fluid therapy to the supporting oral admission of the drug may be first to transfer the patient to the IM introduction. The maximum therapeutic dose is 150 mg per day.

Anafranil Overdose

No cases of overdose Anafranil in the form of a solution for injections have been reported. Below is information about overdose Anafranil if swallowed. Symptoms developing in overdose Anafranil, are similar to those described in cases of overdose of other tricyclic antidepressants. The main complications are disorders of the heart and neurological disorders. Children casual acceptance of any dose of the drug inside should be regarded as a very serious and threatening fatal event.

Symptoms

Symptoms usually appear within 4 hours after administration and reaches a maximum expression after 24 hours. Due depot (anticholinergic drug action), a prolonged half-life and hepato-enteric recycling of active substance, the time period during which the patient remains in the “risk zone” is 4–6 days.

Following symptoms may occur.

The central nervous system: drowsiness, stupor, coma, ataxia, restlessness, agitation, increased reflexes, muscle rigidity, horeoatetoidnye movement, convulsions. In addition, there may be manifestations of serotonin syndrome (fever, myoclonus, delirium, coma).

Cardio-vascular system: marked reduction in blood pressure, tachycardia, prolongation of QTc-interval (interval corrected QT), arrhythmia (including “torsade de points”) violations of intracardiac conduction, shock, heart failure; in very rare cases - cardiac arrest. In addition, possible respiratory depression, cyanosis, vomiting, fever, mydriasis, sweating, oliguria or anuria.

Treatment

No specific antidote, treatment is primarily symptomatic and supportive. If you suspect an overdose of Anafranil, especially in the casual taking the drug in children, the patient should be hospitalized and closely monitored for a minimum of 72 hours.

In case of accidental ingestion of a solution for IV and IM, if the patient is conscious, you should as soon as possible to gastric lavage or induce vomiting. If the patient is unconscious, before the start of gastric lavage should be for the prevention of aspiration spend intubation using a tube with a cuff; vomiting in this case do not cause. These measures are recommended even if since overdosing passed 12 hours or more, as anticholinergic effects Anafranil can slow gastric emptying. To reduce the absorption of the drug useful for the use of activated carbon.

Treatment is based on the application of modern methods of intensive therapy with constant monitoring of cardiac functions, gas composition, and blood electrolytes, as well as on the application, if necessary urgent measures such as anticonvulsant therapy, mechanical ventilation and resuscitation techniques. Since then, as it was reported that physostigmine may cause severe bradycardia, asystole, and seizures, use of this drug for the treatment of overdose Anafranil is not recommended. Hemodialysis and peritoneal dialysis are not effective since concentrations in plasma clomipramine low.

Anafranil (clomipramine) Drug Interactions

Pharmacodynamic interaction type

Adrenergic blockers of neuronal transmission. Anafranil may reduce or completely eliminate the antihypertensive effects of guanethidine, betanidina, reserpine, clonidine and alfametildopy. Therefore, in cases where both the reception Anafranil requires treatment of hypertension, it is necessary to use other classes of drugs (e.g., vasodilators and beta blockers).

Anticholinergics. Tricyclic antidepressants may increase the effects of anticholinergic agents (eg, phenothiazines, antiparkinson drugs, atropine, biperiden, aitigistaminnyh drugs) on the organ of vision, central nervous system, intestines and bladder.

CNS depressants. Tricyclic antidepressants may increase the effects of alcohol and other agents having a depressing effect on the central nervous system (eg, barbiturates, benzodiazepines or anesthetic drugs). Keep in mind that alcohol may enhance the adverse effects of the CNS, such as blurred vision, drowsiness, and others.

MAO inhibitors. Anafranil should not be prescribed for at least 2 weeks after discontinuation of MAO inhibitors because of the risk of such severe symptoms and conditions such as hypertensive crisis, increased body temperature, as well as the symptoms of serotonin syndrome: myoclonus, agitation, seizures, delirium and coma. The same rule should be followed in the event that an MAO inhibitor is administered after previous treatment of Anafranil. In any of these cases, the initial dose or Anafranil MAO inhibitors should be low, they should increase gradually under constant drug effects.

The existing experience shows that Anafranil may be appointed not earlier than 24 hours after discontinuation of MAO inhibitors-A reversible action, such as moclobemide. However, if MAO-B inhibitor A reversible after discontinuation of Anafranil is assigned, the duration of the break should be at least 2 weeks.

Selective serotonin reuptake inhibitors. Combined use Anafranil with these funds may lead to increased action on the serotonin system.

Serotonergic agents. Anafranil With simultaneous use with selective serotonin reuptake inhibitors or serotonin reuptake inhibitors and norepinephrine, tricyclic antidepressants and lithium therapy may develop serotonin syndrome with symptoms such as fever, myoclonus, agitation, convulsions, delirium, and coma.

The appointment of fluoxetine is recommended to do a two-week break between the use of Anafranil and fluoxetine - finish fluoxetine to 2–3 weeks prior to initiation of therapy with Anafranil or assign fluoxetine 2–3 weeks after completion of treatment of Anafranil.

Sympathomimetic agents. Anafranil may potentiate the cardiovascular system of epinephrine, norepinephrine, isoprenaline, phenylephrine and ephedrine (including when these substances are part of local anesthetics).

Pharmacokinetic interaction type

The active ingredient of the drug Anafranil - clomipramine - mainly excreted as metabolites. The main metabolic pathway - demethylation to the active metabolite N-desmmethylomipramine followed by hydroxylation and conjugation of N-desmmethylomipramine with clomipramine. In demethylation involves several isoforms of cytochrome P450, mainly CYP3A4, CYP2C19 and CYP1A2. The elimination of two active components by hydroxylation is catalyzed by CYP2D6.

Co-administration with inhibitors of CYP2D6 isoform may lead to increased concentrations of both active ingredients to three times the value of the phenotype in patients with rapid acetylator debrisoquine/sparteine. In this case, the metabolism in these patients is reduced to the level typical for people with slow acetylators phenotype. It is assumed that co-administration with inhibitors of the isoforms CYP1A2, CYP2C19 and CYP3A4 may lead to increased concentrations of clomipramine and lower concentrations of N-desmmethylomipramine.

MAO inhibitors (such as moclobemide) contraindicated in clomipramine, as in vivo, they are potent inhibitors of CYP2D6.

Antiarrhythmics (e.g. quinidine and propafenone) should not be used in conjunction with tricyclic antidepressants, since they are potent inhibitors of CYP2D6.

Selective serotonin reuptake inhibitors (such as fluoxetine, paroxetine, or sertraline) inhibit CYP2D6, other preparations of this group (e.g. fluvoxamine) also inhibit CYP1A2, CYP2C19, which may lead to an increase in the plasma concentration of clomipramine and development of relevant adverse effects. There was a 4-fold increase in the equilibrium concentration of clomipramine during coadministration with fluvoxamine (the concentration of N-desmmethylomipramine decreased 2-fold).

The combined use of neuroleptics (eg phenothiazines) may increase the plasma concentrations of tricyclic antidepressants reduce seizure threshold and cause seizures. Combination with thioridazine may lead to the development of severe cardiac arrhythmias.

Combined use of histamine (H2) receptor cimetidine (which is an inhibitor of certain isoforms of cytochrome P450, including CYP2D6 and CYP3A4) can lead to increased plasma concentrations of tricyclic antidepressants in connection with what is required a dose reduction of the latter.

There is evidence supporting the interaction between Anafranil (at a dose of 25 mg per day.) And oral contraceptives (15 or 30 mcg ethinyl estradiol d.) At constant reception latter. There is no evidence that estrogens are inhibitors of CYP2D6 - the main enzyme involved in the elimination of clomipramine, so there is no reason to expect their interaction. Although, while applying the tricyclic antidepressant imipramine and estrogens at high doses (50 mcg day.), In some cases reported worsening of side effects and enhancing the therapeutic effect of the antidepressant. It is not known whether these findings are significant in relation to the simultaneous use of clomipramine and estrogen in low doses. In joint use of tricyclic antidepressans and estrogens at high doses (50 ug per day). Recommended to monitor therapeutic effect of antidepressants, and if necessary, correction mode.

Methylphenidate (Ritalin) may contribute to increased concentrations of tricyclic antidepressants, possibly through inhibition of their metabolism. In a joint application of these drugs may increase the concentration of tricyclic antidepressants in the blood plasma, while it may be necessary to reduce the dose of the latter.

Some tricyclic antidepressants may increase the anticoagulant effect of coumarins (eg, warfarin), possibly by inhibiting their metabolism (CYP2C9). There is no evidence to prove the ability to inhibit the metabolism of clomipramine anticoagulants (warfarin). However, when using this class of drugs is recommended monitoring plasma concentration of prothrombin.

Co-administration with drugs Anafranil - inducers of cytochrome P450, especially CYP3A4, CYP2C19 and/or CYP1A2 may increase the metabolism and reduce the effectiveness of Anafranil.

Co-administration with drugs Anafranil - inducers CYP3Ai CYP2C, such as rifampicin or anticonvulsants drugs (such as barbiturates, carbamazepine, phenobarbital and phenytoin), may lead to a decrease in the concentration of clomipramine in plasma.

Known inducers CYP1A2 (for example, nicotine/other components of cigarette smoke) lower concentrations of tricyclic antidepressants in the blood plasma. The equilibrium concentration of clomipramine cigarette smokers persons 2 times lower than that of non-smokers (the concentration of N-desmmethylomipramine not changed).

Clomipramine is in vivo, or in vitro (Ki = 2.2 microM) inhibits CYP2D6 (sparteine oxidation). Thus, clomipramine may increase the concentration of the drugs at the same time, metabolized mainly involving CYP2D6, in patients with rapid acetylator phenotype.

Pharmaceutical incompatibility. Injection incompatible with sodium Voltaren (diclofenac sodium) injection.

Pregnancy and lactation

Experience of using Anafranil in pregnancy is limited. Since there are anecdotal reports of a possible association between tricyclic antidepressants and impaired fetal growth, Anafranil should be avoided during pregnancy, unless the expected benefit to the mother clearly outweighs the potential risk to the fetus.

In cases where the mother was taking tricyclic antidepressants during pregnancy up until the birth, the newborn during the first few hours or days of life developed the syndrome, which is manifested by shortness of breath, lethargy, intestinal colic, increased nervous excitability, a marked increase or a marked reduction in blood pressure, tremor, spastic phenomena or convulsions. To avoid the development of this syndrome, Anafranil should, if possible, gradually cancel at least 7 weeks prior to delivery.

Since the active ingredient of the drug passes into breast milk, you should either stop breastfeeding or gradually abolish Anafranil.

Anafranil (clomipramine) Side effects

The observed adverse events were usually mild and transient, are in the continuation of treatment or after dose reduction Anafranil. They do not always correlate with the concentration of the active substance in blood plasma or a dose of the drug. Some adverse effects such as fatigue, sleep disturbances, agitation, anxiety, constipation, dry mouth, it is often difficult to distinguish from depression. In the case of serious reactions in the nervous system or mental status Anafranil should be abolished.

The elderly are particularly susceptible to the action of Anafranil on the nervous system, cardiovascular system, and the effect of the drug on mental status, as well as anticholinergic effects Anafranil. Metabolism and excretion of drugs in this age may slow down, resulting in increased drug concentration in blood plasma when using therapeutic doses.

Adverse reactions are listed by frequency, beginning with the most common: occur “very often” - = 10.1, “often” - = 1/100 to <1/10, “sometimes” - = 1/1000 to <1/100, “rarely” - = 1/10000- <1/1000, “very rare” - <1/10000, including individual cases.

Mental disorders: very often - drowsiness, fatigue, restlessness, increased appetite; often -sputannost of consciousness, disorientation, hallucinations (especially in elderly patients and in patients with Parkinson’s disease), anxiety until agitation, sleep disorders, compulsive disorders, aggression, memory impairment, depersonalization, depressed mood, impaired concentration, insomnia, night nightmares, yawning, delirium; sometimes - activation of psychotic symptoms.

Of the central and peripheral nervous system: very often - dizziness, tremor, headache, myoclonus; often - a speech disorder, paresthesia, muscle weakness, increased muscle tone; sometimes - convulsions, ataxia; very rare - changes in the electroencephalogram, increased body temperature, and neuroleptic malignant syndrome.

Anticholinergic effects: very often - dry mouth, increased sweating, constipation, accommodation disturbances, blurred vision (“blurred vision”), voiding; often - flushing, mydriasis; very rare - glaucoma, urinary retention.

Cardio-vascular system: often - sinus tachycardia, palpitations, orthostatic hypotension, clinically insignificant changes in the ECG (eg, ST interval or T wave) in patients without heart disease; sometimes - arrhythmias, increased blood pressure; very rarely - violation of intracardiac conduction (eg, expansion of the complex QRS, lengthening the interval QT, change the interval PQ, block bundle-branch block, ventricular tachycardia of “feasting» (”torsade des pointes"), especially in patients with hypokalemia).

From the digestive system: very often - nausea; often - vomiting, abdominal discomfort, diarrhea, anorexia.

On the part of the hepatobiliary system: often - transaminase elevation; rarely - hepatitis with jaundice or without it.

Dermatological reactions: often allergic skin reactions (rash, urticaria), photosensitivity, pruritus; very rare - edema (local or general), hair loss, local reactions at/in the introduction (thrombophlebitis, lymphangitis, burning sensation, allergic skin reactions).

Part of the endocrine system and metabolism: very often - an increase in body weight, disturbances of libido and potency; often - galactorrhea, increase in the mammary glands; very rarely - a syndrome of inappropriate secretion of antidiuretic hormone.

Hypersensitivity reactions: rarely - allergic alveolitis (pneumonitis) with or without eosinophilia, systemic anaphylactic/anaphylactoid reactions, including hypotension.

Hematopoietic system: rarely - leukopenia, agranulocytosis, eosinophilia, thrombocytopenia, purpura.

From the senses: common - a violation of taste, tinnitus.

Withdrawal syndrome: after the sudden cancellation or rapid dose reduction Anafranil often experience the following symptoms: nausea, vomiting, abdominal pain, diarrhea, insomnia, headache, irritability, anxiety.

Indications

Treatment of depressive states of various etiologies that occur with different symptoms:

Endogenous, reactive, neurotic, organic, masked, involutional forms of depression;

Depression in patients with schizophrenia and psychopathy;

Depressive syndromes that occur in old age due to chronic pain or chronic physical illness;

Depressive mood disorders reactive, neurotic or psychopathic nature.

Obsessive-compulsive syndromes.

Phobia.

Cataplexy, accompanying narcolepsy.

Chronic pain syndromes.

Contraindications

Increased sensitivity to clomipramine or any other ingredients of the formulation, the cross-hypersensitivity to tricyclic antidepressants from the dibenzazepine group.

Simultaneous use of inhibitors of monoamine oxidase (MAO) as well as the period at least 14 days before and after their application. Contraindicated as concurrent use of selective inhibitors of MAO-A reversible action, such as moclobemide.

Recent myocardial infarction.

Congenital syndrome prolongation QT-interval.

Do not use the drug during pregnancy and breastfeeding. The drug is not recommended for use in children and adolescents.

Precautions

It is known that tricyclic antidepressants reduce seizure threshold, so Anafranil should be used with extreme caution in patients with epilepsy, as well as the presence of other predisposing to seizures factors, such as traumatic brain injury of various etiologies, the simultaneous use of antipsychotics during the period of refusal alcohol or drug withdrawal, with anticonvulsant properties (eg, benzodiazepines). It is believed that the occurrence of seizures against application Anafranil dose-dependent. In this regard, should not exceed the recommended daily dose Anafranil. Special care should be given to patients with Anafranil cardiovascular diseases, especially cardiovascular insufficiency, intracardiac conduction disturbances (eg, atrioventricular block I-III degree) or arrhythmias. In these patients, as well as in elderly patients, it is necessary to regularly monitor the performance of the heart and ECG.

Before therapy of Anafranil recommended to measure blood pressure, as in patients with orthostatic hypotension or lability of the cardiovascular system may be a sharp decline in blood pressure.

Because the drug has anticholinergic properties, it should be used with extreme caution in patients with a history there is evidence of increased intraocular pressure, angle-closure glaucoma or urinary retention (eg, due to diseases of the prostate gland).

Because of the anticholinergic actions characteristic of tricyclic antidepressants may reduce tearing and accumulation of mucus secretion, which can result in damage to the corneal epithelium in patients who use contact lenses.

Caution is needed in the treatment of tricyclic antidepressants in patients with severe liver disease, and in patients with tumors of the adrenal medulla (eg, pheochromocytoma, neuroblastoma), as in this case, these drugs can provoke the development of hypertensive crisis. It is known that in patients with cyclic affective disorders receiving tricyclic antidepressants, during the depressive phase of manic disorders may develop. In such cases it may be necessary to decrease the dose Anafranil or its cancellation and antipsychotic therapy. After the relief of these conditions, if there are indications, treatment of Anafranil in low doses may be resumed.

When parenteral administration Anafranil reported some cases of anaphylactic shock. Therefore, by intravenous administration of the drug, caution is necessary.

Caution should be exercised when treating patients with hyperthyroidism, or receiving thyroid hormone drugs, which may have cardiotoxic effects.

Although changes in the level of white blood cells during treatment of Anafranil reported only in individual cases, it is recommended periodic study of peripheral blood and attention to symptoms such as fever and sore throat, especially in the first months of therapy or long-term use of the drug.

Caution is needed when using Anafranil in patients with chronic constipation. Tricyclic antidepressants may cause paralytic ileus, mainly in elderly patients or in patients who have to comply with bed rest.

Cautions

Before the start of drug therapy should be eliminated hypokalemia. When applying Anafranil at doses exceeding the therapeutic medium, or if the plasma concentration of clomipramine than average therapeutic, there is a risk of elongation QTc-interval and the occurrence of ventricular tachycardia type “piruet» (”torsade des pointes“). This is observed in the case of co-administration with selective serotonin reuptake inhibitors or serotonin reuptake inhibitors and norepinephrine. In this regard, it is necessary to avoid coadministration klomiiramina and preparations causing its cumulation. You should also avoid co-administration with drugs that cause QTc-interval prolongation. Established that hypokalaemia is a risk factor for QTc-interval prolongation and the occurrence of ventricular tachycardia of the ”feast“ (”torsade des pointes"). Therefore, hypokalemia should be corrected before initiating therapy of Anafranil.

Because of the risk of QTc prolongation and development of serotonin syndrome should follow the recommended dose and increase the dose with caution when coadministered with drugs that prolong the interval QT, and serotonergic drugs. With simultaneous use of Anafranil with serotonergic drugs such as selective serotonin reuptake inhibitors, serotonin reuptake inhibitors and norepinephrine, tricyclic antidepressants or lithium, may develop serotonin syndrome with symptoms such as fever, myoclonus, agitation, convulsions, delirium and coma. The appointment of fluoxetine, it is recommended to do a two-week break between the use of Anafranil and fluoxetine.

Many patients with panic disorder at baseline of Anafranil enhanced anxiety. Such a paradoxical increased anxiety is most pronounced in the first days of therapy and usually subsides within two weeks.

In patients with liver disease is recommended periodic monitoring of liver enzymes.

Anafranil, as well as other tricyclic antidepressants administered in combination with electroconvulsive therapy only with careful medical supervision.

In predisposed patients and elderly patients, tricyclic antidepressants can provoke the development of drug delirious psychosis, mainly at night. After discontinuation these disorders resolve within a few days.

When use of tricyclic antidepressants in patients with schizophrenia sometimes marked activation of psychosis. Severe depression peculiar risk of suicidal acts, which may persist until remission reliable. Patients with depression in adults and children, there may be increased depression and/or suicidal behavior or other psychiatric syndromes, regardless of whether they receive antidepressant medication or not. Antidepressants increased the risk of suicidal thoughts and suicidal behavior in short-term studies in children and adolescents with depression and other mental illnesses. All patients taking Anafranil on any of the readings should be evaluated for clinical worsening, suicidal behavior and other psychiatric syndromes, especially in the initial phase of therapy or when changing dose. These patients should be considered the possibility of changing therapy, including the possible removal of the drug, especially if such changes pronounced, appeared suddenly and were not observed in the patient’s baseline.

Families and caregivers of patients (both children and adults) who take antidepressants for mental or nepsihicheskim indications, should be alerted about the need to monitor patients because of the risk of other psychiatric syndromes, including suicidal behavior, and immediately report such symptoms of the attending physicians. There is evidence that in patients receiving Anafranil had fewer deaths due to overdose, than in patients receiving other tricyclic antidepressants.

Prior to the general or local anesthesia, the anesthetist should be warned that the patient is taking Anafranil. Reported an increase in the incidence of dental caries in long-term treatment with tricyclic antidepressants. Therefore, in the case of long-term therapy of Anafranil recommended regular inspection of the patient’s dentist.

Diuretics can lead to hypokalaemia, in which an increased risk of QTc-interval prolongation and the occurrence of ventricular tachycardia of the “feast» (”torsade des pointes"). Prior to initiating therapy of Anafranil correction must be made hy.

Avoid abrupt withdrawal Anafranil, as it may lead to side reactions. If you decide to discontinue treatment, medication should be withdrawn gradually, as soon as it allows the clinical situation. Please keep in mind that the abrupt withdrawal of the drug may lead to the development of certain withdrawal symptoms.

Data on the effect of long-term treatment of Anafranil on growth, development, cognitive function and behavior in children and adolescents younger than 18 years is not.

Effects on ability to drive vehicles and/or work with machinery. If you experience during treatment with Anafranil drowsiness, blurred vision and other disorders of the nervous system, patients should relinquish control of vehicles and operate machinery, as well as to perform other activities that require greater attention and quick response.

Anafranil (clomipramine) Reviews

I want to share my impressions from taking this drug. Anafranil - tricyclic antidepressant, the active ingredient Clomipramine; I was appointed in connection with the panic attacks and anxiety-depressive disorder. I note that the attacks were very strong emotionally, and then they always remained an unpleasant aftertaste in the form of causeless anxiety and fear. In general, life was impossible, even from home could not get out. Yes, and the house could not be safely, because fear and foreboding that now something terrible happens, do not let go for a minute.
As a result, I had to take this drug. Looking at the instructions in it, I immediately drew attention to the huge number of side effects. And many of them appeared immediately in the first days of admission. I describe what exactly was I:
- The instructions stated that at Pa while taking Anafranil anxiety for the first time can be enhanced - and it was, but only for the first day.
- In a couple of weeks appetite. Even thinner per kg, although I did not need.
- Month 4 forgot about sexual desires.
- Month been low blood pressure, tachycardia
- Dilated pupils (mydriasis), too, a certain number of weeks.
More than anything unpleasant from side effects with me did not happen, despite the fact that, according to the instructions of Anafranil can almost throw the skates.
Now for the therapeutic effect. For me personally, it is very, very good. I must say - not manifested at once (one week approximately) and gradually. Gradually it went anxiety, improved mood, and very significantly increased efficiency. There was a feeling that I am re-learning to have fun and enjoy life. And, most importantly, panic attacks were no more. At all. Not for the reception, or after, or now, and I hope that there will be more! Of course, I mentally customizable and soothed, trying to convince himself that the panic attack is a simple reaction of the body, and that's okay with me is not going to happen. Still a major role in facilitating my condition is played Anafranil. At the moment, already 1-1,5g not take anything, I feel good.

This drug pulled me out of the grave condition. When life was just hell. Without much hope began to take 1 tablet. As a result, the dose reached 3 tablets, and only then felt the effect. Fear, panic and depression is gone. Wait effect accounted for about two months. Prior to this, only aggravation and side effects. But in the end Anafranil grateful for the help. The drug is an old, 70-ies. Lots of side effects and carries uneasy. It may give weight gain. Having moved to the effect and one tablet which is easier tolerated. A dose of 75 mg is very heavy. If you want to take this drug, tune in long-term treatment, at least a month.

For family reasons I have for a long time remained under stress. When applied to the doctors, I already had a deep depression. The doctor took me very well Anafranil and the dose of application. After 10 droppers turned me on pills. I accept for a long time and feel great.