Anafranil

Indications

Clomipramine Hydrochloride is a tricyclic antidepressant. It is used to treat depression, obsessive-compulsive disorder (OCD, where unwanted repeated thoughts lead to repeated actions), phobias and panic disorder. In some cases doctors also use it for cataplexy (sudden muscle weakness) linked with narcolepsy.

How It Works

Clomipramine increases the amount of the brain chemicals serotonin and noradrenaline available between nerve cells by blocking their reuptake. Its strong effect on serotonin is why it is particularly useful for OCD. Improvement in mood or symptoms usually takes 2 to 4 weeks, and sometimes longer for OCD.

Dosage and Administration

Take clomipramine exactly as prescribed. Doctors usually start with a low dose and increase it slowly over a few weeks to reduce side effects, then adjust it to the lowest dose that works. It is often taken in the evening because it can cause drowsiness. Swallow tablets whole with water, with or without food. Do not stop suddenly; your doctor will reduce the dose gradually.

Interactions

Do not take it with, or within 14 days of, MAO inhibitors such as Moclobemide or Selegiline, or with Linezolid. Combining it with other serotonin medicines (for example Fluoxetine, Sertraline, Tramadol, Triptans or Lithium) increases the risk of serotonin syndrome. Fluoxetine, Paroxetine and Cimetidine can raise clomipramine levels. Alcohol, sleeping pills and strong painkillers add to drowsiness. Medicines that affect heart rhythm, and anticholinergic medicines, add to its side effects.

Contraindications

Do not use clomipramine after a recent heart attack, with certain heart rhythm problems or heart block, in severe liver disease, with untreated narrow-angle glaucoma, during the manic phase of bipolar disorder, or if allergic to tricyclic antidepressants.

Side Effects

Common side effects include dry mouth, constipation, drowsiness, dizziness on standing, blurred vision, sweating, weight gain, tremor, difficulty passing urine and sexual problems such as delayed ejaculation. Less common effects include a fast heartbeat, confusion in older people and seizures.

Get urgent medical help if you have thoughts of harming yourself, a fit (seizure), fainting or a very fast or irregular heartbeat, high fever with stiff muscles and confusion, signs of serotonin syndrome (agitation, sweating, shaking, fast heartbeat), sudden eye pain with blurred vision, or a serious allergic reaction.

Pregnancy and Lactation

Use in pregnancy only if your doctor decides the benefit is greater than the risk; if used near delivery, the newborn may have temporary withdrawal symptoms. Clomipramine passes into breast milk in small amounts; discuss with your doctor before breastfeeding.

Precautions and Warnings

Antidepressants can increase suicidal thoughts in young people, especially early in treatment or after dose changes; family members should watch for changes in mood or behaviour. Use with care in heart disease, epilepsy, glaucoma, enlarged prostate, thyroid disease, diabetes and in older people. It can make you drowsy, so do not drive or use machinery until you know how it affects you. Avoid alcohol.

Overdose

Overdose of tricyclic antidepressants is dangerous and can cause seizures, coma, very low blood pressure and fatal heart rhythm problems. Call emergency services or go to hospital immediately, even if the person seems well.

Therapeutic Class

Tricyclic antidepressant.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.