Medication Information:
Clomipramine (generic) ~ Anafranil (brand) Classification: Tricyclic antidepressant.
Common Usage: Clomipramine is indicated for the treatment of
obsessive-compulsive disorder (OCD). It is also sometimes used to treat
other disorders such as depression, panic disorder, neurogenic pain,
narcolepsy/cataplexy complex, and bulimia nervosa. Tricyclic
antidepressants have more adverse effects than most other classes of
antidepressants, and are usually reserved for use when other, better tolerated
drugs have proven ineffective or can't be used for some reason. The safety
and effectiveness of clomipramine has not been established in children under ten
years old.
Important Side Effects:
Mild side effects are common with clomipramine, such as sedation, dry
mouth, or mild constipation. Some side effects occasionally can be serious
or highly distressing and should be brought to the attention of your prescriber.
These might include severe constipation; nausea; vomiting; confusion; very
rarely a yellowish tinge to the skin or eyes. Some people can also develop
problems with excessive weight gain or impaired sexual function. Less
serious adverse effects include fatigue, headache, or mild nausea. Heart
tracings (generally called EKGs or ECGs) are usually obtained before
clomipramine is started, and then periodically thereafter for routine
monitoring. A heart tracing is a simple, painless, 15-minute procedure and
being asked to have one does not mean there is anything wrong with your heart.
Use of clomipramine
during pregnancy and breastfeeding has not been conclusively shown to be safe.
If you are a woman who is planning to become pregnant, are pregnant or are a nursing mother,
the potential benefits must be weighed against the possible
hazards of using clomipramine. Discuss the issues in advance with all of your health care
providers.
This is not a complete list of all known or potential adverse effects.
Notify your physician of any symptoms that have started since you
began taking this medication, changing its dose, or adding or changing other
medication or diet. Take care when performing any tasks (for example,
driving or operating machinery) that requires your attention until you have
experience with this drug and are confident you can perform the task safely. Interactions with Other Medications: Many antidepressants such as the
selective serotonin reuptake inhibitors (SSRIs) fluvoxamine (Luvox) or paroxeine
(Paxil); monoamine oxidase inhibitor (MAOI) antidepressants such as Nardil (phenelzine);
or other antidepressants such as nefazodone (Serzone) can interact with
clomipramine. Antipsychotics such as chlorpromazine (Thorazine) can
interact as well. Antibiotics such as erythomycin (E-Mycin) or
ciprofloxacin (Cipro); heart medications such as quinidine (Quinaglute and
others) or propafenone (Rythmol) can reduce clompirammine elimination.
Stomach medications such as cimetidine (Tagamet) or omeprazole (Prilosec) also
may interact with clomipramine. Even a large glass of grapefruit juice may
inhibit the metabolism of clomipramine.
This is not a complete list of all known or potential drug interactions.
To help prevent problems, always make sure that all your physicians know about all medications you are taking, including
over-the-counter drugs; dietary herbal supplements; folk or home remedies; or
unusual foods, drinks, or dietary habits. CommonDosages: Clomipramine should be started at a low dose and gradually
increased, usually at weekly intervals to reduce adverse effects. The dose
is always adjusted based on an individual's response.
In adults, treatment with
clomipramine is generally started at 25 mg daily and gradually increased, as
tolerated, to approximately 100 mg daily during the first two weeks.
During the initial dosage adjustment, the total daily dose should be divided and
is usually given with meals to reduce stomach upset. After the dose is
correctly adjusted, the total daily dose may be given once at bedtime to
minimize daytime sedation. Standing slowly can help you avoid becoming
dizzy and possibly falling. If you do become dizzy, briefly sit or lie
down, and get up more slowly. If dizziness is a problem, contact your
prescriber. If it is well tolerated, the dose should be increased by 25 to
75 mg daily every one or two weeks until some response is noticed or until
adverse effects limit further increases. The maximum dose is usually 250
mg daily. Antidepressant response takes at least one or two weeks but may
require three months in some patients.
In adolescents, the
starting dose is 25 mg daily and should be gradually increased during the first
two weeks, and up to a daily maximum of 3 mg/kg (kilogram) of body weight
or 100 mg, whichever is smaller. The dosage may be increased gradually
over the next several weeks to a daily maximum of 3 mg/kg or 200 mg, whichever
is smaller.
If this medication is
stopped, the dose should be reduced slowly over several days or weeks to avoid
possible stomach upset. Identification: Clomipramine is available in capsules of 25 mg, 50 mg,
and 75 mg. The 25- mg capsule is ivory/melon yellow and is imprinted with
"Anafranil 25 mg." The 50- mg capsule is ivory/aqua blue and is imprinted
with "Anafranil 50 mg." The 75- mg capsule is ivory/yellow and imprinted
with "Anafranil 75 mg." Storage: Store this medication at normal room temperature (59° F to 86°
F) in a tightly closed, light- and moisture-resistant container. If you
have difficulty opening child-resistant containers, your pharmacist can provide
a container that is easier to open. Keep the medication out of direct
sunlight and avoid storing it in a warm or humid area - such as the bathroom or
kitchen - to prevent deterioration. To prevent accidental poisoning, keep
all medications out of the reach of children. Do not take an expired
medication. Do not transfer medication from one container to another.
Carefully discard discontinued medication where children cannot find it. Edited by
Lawrence H. Price M.D. ASERVICE OF…. Psychopharmacology Update
Note: These guidelines are for general information only.For more specific information, consult your physician orpharmacist. | 
