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Anafranil (Clomipramine) Information

Anafranil (clomipramine hydrochloride) is a prescription medication that belongs to the class of tricyclic antidepressants (TCAs). While initially developed as an antidepressant, its primary use in clinical practice is for the treatment of Obsessive-Compulsive Disorder (OCD) in adults and children. It is highly effective at reducing the severity of obsessive thoughts and compulsive behaviors. Anafranil may also be prescribed off-label for other conditions, including panic disorder, specific phobias, and chronic pain. However, its unique pharmacological profile makes it a primary choice for complex and treatment-resistant OCD cases.

The mechanism of action for clomipramine involves a potent effect on multiple neurotransmitter systems in the brain. It is considered the most selective serotonin reuptake inhibitor (SRI) among all TCAs. It strongly inhibits the reuptake of serotonin (5-HT) into nerve cells, increasing the concentration of 5-HT in the synaptic cleft, which is believed to be the main factor in its anti-OCD effects. Clomipramine also inhibits the reuptake of norepinephrine (NE), though less potently. As a traditional TCA, it also blocks histamine, alpha1-adrenergic, and muscarinic acetylcholine receptors, which contribute significantly to its prominent side effect profile, including sedation and anticholinergic effects.

Anafranil is available in Canada as capsules and is approved for use in adults and children (typically 10 years of age and older) for OCD. However, its use in younger patients requires specialist supervision. Dosing must be titrated slowly (gradually increased) over several weeks to minimize the risk of serious side effects. Due to its significant sedating effects, the total daily dose is often taken at bedtime. Unlike some newer antidepressants, a complete therapeutic response may take several weeks or even months of consistent use to be fully realized.

Anafranil Side Effects

Common side effects associated with Anafranil are typically a direct result of its anticholinergic (muscarinic receptor blockade) and antihistamine properties, and they are generally dose-dependent. The most frequently reported adverse effects include sedation or drowsiness, which can be pronounced, dry mouth (xerostomia), constipation, blurred vision, and urinary retention. Other common effects include weight gain, dizziness, and tremor. Many patients also report various forms of sexual dysfunction, such as decreased libido or problems with ejaculation/orgasm. While often mild, these effects can be bothersome and may necessitate a dose adjustment or discontinuation of the drug.

More serious side effects can occur, although they are rare. If any of the following symptoms are experienced, the patient should stop taking the medication and seek immediate medical attention:

• Agranulocytosis and Hepatotoxicity: In rare cases, severe blood disorders (a dangerous drop in white blood cells) or severe liver damage have been reported, requiring immediate cessation of the drug.

• Cardiovascular Effects: Anafranil can disrupt the heart's electrical conduction system, leading to an increased risk of QT interval prolongation, cardiac arrhythmias (irregular heartbeats), and severe orthostatic hypotension (a sudden drop in blood pressure upon standing). This risk increases with higher doses or in patients with pre-existing heart disease.

• Seizures: Clomipramine can lower the seizure threshold, increasing the risk of convulsions, which is generally dose-dependent. The risk increases significantly with higher doses (particularly above 250 mg/day) or in patients with a history of seizure disorder.

• Serotonin Syndrome: A potentially life-threatening reaction that may occur when Anafranil is combined with other serotonergic drugs (e.g., MAOIs, SSRIs, triptans, tramadol). Symptoms may include agitation, hallucinations, rapid heart rate, sudden changes in blood pressure, fever, sweating, muscle rigidity, and loss of coordination.

• Suicidality and Mania (Boxed Warning): Like all antidepressants, Anafranil carries a warning for increasing the risk of suicidal thoughts and behaviour, particularly in children, adolescents, and young adults (up to age 24), especially during the initial phase of treatment. It can also precipitate a manic or hypomanic episode in patients with undiagnosed bipolar disorder.

Anafranil Precautions

Before starting Anafranil, it is crucial to have a comprehensive discussion with a healthcare provider about one's medical history, current health status, and all other medications being taken. Anafranil is absolutely contraindicated for use with Monoamine Oxidase Inhibitors (MAOIs) intended for psychiatric disorders, or within 14 days of stopping an MAOI, due to the severe and potentially fatal risk of Serotonin Syndrome. Due to its serious potential cardiovascular effects, it must be used with extreme caution or entirely avoided in patients with a history of recent myocardial infarction, certain cardiac arrhythmias, or other significant heart disease. Caution is also necessary for individuals with medical conditions that may be exacerbated by the drug's anticholinergic effects, such as narrow-angle glaucoma or a history of urinary retention. Patients with a history of seizures must be closely monitored, and the lowest effective dose should be used to minimize risk. Furthermore, the drug may cause confusion, excessive sedation, and increase the risk of falls in elderly patients, which necessitates a lower initial starting dose. Given the association with suicidal ideation, particularly early in treatment, all patients must be closely monitored for new or worsening depression and unusual changes in mood or behavior. It is vital never to stop taking Anafranil abruptly, as this can lead to severe withdrawal symptoms; the dose must be tapered slowly under medical supervision. Finally, if pregnant or breastfeeding, the use of Anafranil should be discussed with a doctor, as it can cross the placenta and is excreted in breast milk, and the potential risks versus benefits must be carefully weighed.

Do I need a prescription to order Anafranil?

Yes, a prescription is required from your physician to order Anafranil.