Clomipramine
Brand name: Anafranil

Overview
Anafranil is a tricyclic antidepressant (TCA) and antiobsessional. Anafranil works by raising levels of norepinephrine (a neurotransmitter) to normal levels. This drug is used to reduce the anxiety and unpleasant thoughts that cause obsessive-compulsive behaviors such as repeating an ordinary task many times, and help such a patient lead a more normal lifestyle. It is also used to treat depression.

Anafranil’s effects may be felt in a few days, or four weeks or more, depending on the patient and the dosage.

Why is this drug prescribed?
Anafranil is used mainly to treat obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD.)

Anafranil is also used to treat:

1. arm burning
2. endogenous depression
3. hair pulling syndromes
4. nail biting
5. panic attacks
6. phobias
7. pre-menstrual syndrome (PMS)
8. pain due to narcolepsy
9. arthritis, cancer, diabetic disease, herpes lesions, migraines, tension headaches, or tic douloureux
10. repetitive symptoms in autistic persons

Warnings and Precautions
Anafranil is not recommended for use in children under ten years old. Adolescents should receive smaller doses than the recommended adult dose.

Anafranil may cause seizures in patients with a history of seizures or other factors that make seizures more likely such as brain damage, alcoholism, and use of Anafranil with other drugs that lower the seizure threshold. Taking smaller doses may reduce the incidence of seizures.

Anafranil is not addictive. Suddenly discontinuing use of Anafranil may cause withdrawal, and dosage should be reduced gradually to minimize withdrawal symptoms.

For Pregnant or Nursing Mothers: Controlled studies have not been done in pregnant women, but there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants immediately before delivery. Animal studies show that some tricyclic antidepressants may have undesirable effects on a fetus. Tricyclic antidepressants pass into breast milk and are reported to cause drowsiness in nursing infants.

Anafranil may cause drowsiness or even sudden loss of consciousness. A patient should not drive or operate heavy machinery until the effects of Anafranil on that patient are known and do not present a danger to the patient or others.

Cardiovascular Effects: tachycardia (an abnormally high heart rate), and decreased blood pressure appeared in 20% of patients during clinical trials. Dosage should start low and increase gradually in patients with heart disease.

Contraindications
Anafranil should Not be used for people who have:

1. a history of hypersensitivity to Anafranil or to other tricyclic antidepressants
2. within 14 days been treated with a monoamine oxidase (MAO) inhibitor (very high fever, seizures, coma, and death have been reported in patients receiving such combinations)
3. had a recent myocardial infarction
4. an alcohol problem
5. asthma
6. blood disorders or disease
7. diabetes
8. difficulty passing urine or prostate trouble
9. narrow angle glaucoma
10. intramuscular injections
11. liver disease or stomach disease
12. an over active thyroid
13. Parkinson’s disease
14. schizophrenia - tricyclic antidepressants, including Anafranil, may cause a psychotic episode in patients with unrecognized schizophrenia.
15. seizures or convulsions
16. active bone marrow depression
17. heart disease - dosage should start low and increase

Adverse Reactions
Anafranil may cause the following adverse reactions:

1. dry mouth
2. constipation
3. nausea
4. indigestion
5. loss of appetite
6. sleepiness
7. tremor
8. dizziness
9. nervousness
10. muscle spasms
11. changed libido
12. ejaculatory failure
13. impotence
14. difficulty urinating
15. swelling of the testicles
16. fatigue
17. sweating
18. increased appetite
19. weight gain
20. blurred vision or eye pain
21. breast enlargement in both males and females
22. confusion
23. hallucinations
24. difficulty breathing
25. fainting spells
26. fever
27. irregular or fast, pounding heartbeat, palpitations
28. seizures or convulsions
29. stomach pain
30. tingling, pain, or numbness in the feet or hands
31. yellowing of the eyes or skin
32. photosensitivity and impaired ability to adapt to hot environments

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Anafranil are:

1. MAO Inhibitors (within 14 days) — serious or even fatal interactions can occur when taken with Anafranil
2. alcohol - when taken with Anafranil can increase the intoxicating effects of alcohol and combination can depress brain function significantly; alcohol should be avoided completely
3. barbiturate medicines for inducing sleep or treating seizures (convulsions)
4. blood thinners
5. cimetidine and ranitidine
6. clonidine
7. diltiazem
8. female hormones (estrogens), including contraceptive or birth control pills
9. lithium
10. medicines for anxiety or sleeping problems, such as diazepam or temazepam
11. medicines for colds and breathing difficulties
12. medicines for hay fever and other allergies
13. medicines for mental problems and psychotic disturbances such as Prozac (fluoxetine), Luvox (fluvoxamine), Normodyne (labetalol), Ritalin (methylphenidate),
14. medicines for movement abnormalities as in Parkinson's disease, or for gastointestinal problems e.g. Zantac (ranitidine), Tagamet (cimetidine)
15. medicines that treat depression
16. seizure (convulsion) or epilepsy medicine
17. thyroid hormones
18. phenothiazines
19. Quinaglute (quinidine)
20. ACE inhibitors
21. Calan (verapamil)
22. smoking accelerates the elimination of this drug from the body and increases the dosage required

Sources
Information from the manufacturer BASEL Pharmaceuticals Pharmacology - Lippincott's

http://www.rxlist.com/scripts/patient/piumore.pl?mononum=859&dc_category=&order=0&type=&item=

http://www.health-center.com/db/PageReq?SessionID=3768&TopicID=424&PageID=2241&Action=view

http://www.psyweb.com/Drughtm/anafranil.html