Generic Name: clomipramine (Oral route)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. Short term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Not approved for use in pediatric patients except for patients with obsessive compulsive disorder (OCD) .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antidepressant
Pharmacologic Class: Antidepressant, Tricyclic
Uses For Anafranil
Clomipramine is used to treat obsessive compulsive disorder (OCD). This medicine is a tricyclic antidepressant (TCA). OCD is a nervous condition where a person has recurring thoughts or ideas, or does repetitive things because they are anxious .
Clomipramine works on the central nervous system (CNS) to relieve the symptoms of OCD. It is thought to work by increasing the activity of a chemical called serotonin in the brain .
This medicine is available only with your doctor's prescription .
Before Using Anafranil
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of clomipramine in children younger than 10 years of age. Safety and efficacy have not been established .
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of clomipramine in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require an adjustment in the dose for patients receiving clomipramine .
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Methylene Blue
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Arsenic Trioxide
- Perflutren Lipid Microsphere
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Enalapril Maleate
- Valproic Acid
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
- Grapefruit Juice
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Adrenal gland tumor (e.g., pheochromocytoma, neuroblastoma) or
- Glaucoma, history of or
- Heart disease or
- Hypomania or
- Liver disease or
- Mania or
- Overactive thyroid or
- Schizophrenia or
- Seizures, history of or
- Urinary retention (trouble urinating), history of—Use with caution. May make these conditions worse.
- Bipolar disorder (mood disorder with alternating episodes of mania and depression), or risk of or
- Heart attack, recent—Should not be used in patients with these conditions.
- Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of Anafranil
Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered .
It is best to take this medicine with food .
This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one .
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (capsules):
- For obsessive-compulsive disorder:
- Adults, teenagers, and children above 10 years of age—At first, 25 milligrams (mg) once a day with a meal. Your doctor may increase your dose if needed, and tell you to take the daily dose in evenly divided portions during the day. However, the dose is usually not more than 250 mg per day for adults and 200 mg per day for children.
- Children below 10 years of age—Use and dose must be determined by your doctor .
- For obsessive-compulsive disorder:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using Anafranil
It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to check for any unwanted effects. Blood tests may be needed to check for any unwanted effects .
Clomipramine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child's doctor right away .
Do not take clomipramine if you have taken a monoamine oxidase (MAO) inhibitor (isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]) in the past 2 weeks. Do not start taking a MAO inhibitor within 2 weeks of stopping clomipramine. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, or severe convulsions .
Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as dizziness, headache, nausea, vomiting, trouble sleeping, irritability, high fever, or a general feeling of discomfort or illness .
This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies or colds; sedatives, tranquilizers, or sleeping medicines; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements .
Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine. Taking clomipramine together with medicines used during surgery or dental or emergency treatments may increase the risk of side effects .
This medicine may cause men to have problems with sex. Check with your doctor if you are having an abnormal ejaculation or decreased sexual performance or desire .
Weight changes may occur during treatment with this medicine. Talk with your doctor if this is a concern for you .
This medicine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are drowsy or not alert.
Anafranil Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:More common
- Bladder pain
- bloody or cloudy urine
- blurred vision
- body aches or pain
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- continuing ringing or buzzing or other unexplained noise in ears
- difficult, burning, or painful urination
- dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
- dryness or soreness of throat
- excessive muscle tone
- fear or nervousness
- feeling sad or empty
- frequent urge to urinate
- hearing loss
- lack of appetite
- loss of interest or pleasure
- lower back or side pain
- muscle stiffness
- muscle tension or tightness
- muscle twitching or jerking
- pain or tenderness around eyes and cheekbones
- poor concentration
- problems in urination or increase in amount of urine
- rhythmic movement of muscles
- runny nose
- shortness of breath or troubled breathing
- stuffy nose
- tender, swollen glands in neck
- tightness of chest or wheezing
- tiredness trouble concentrating
- trouble in swallowing
- trouble remembering
- trouble sleeping
- unable to sleep
- unusual tiredness or weakness
- voice changes
- attack, assault, force
- bloody nose
- breast enlargement
- burning, dry, or itching eyes
- burning while urinating
- changes in vision
- decrease in frequency of urination
- decrease in urine volume
- difficulty in passing urine (dribbling)
- difficulty in speaking
- discharge, excessive tearing
- dry mouth
- fast, irregular, pounding, or racing heartbeat or pulse
- feeling of unreality
- headache, severe and throbbing
- increased clear or white vaginal discharge
- increased watering of the mouth
- irregular heartbeats
- itching of the vagina or genital area
- mental depression
- nausea or vomiting
- numbness, tingling, pain, or weakness in hands or feet
- pain during sexual intercourse
- painful urination
- pale skin
- panic reaction
- partial or slight paralysis
- quick to react or overreact emotionally
- rapidly changing moods
- redness or swelling in ear
- redness, pain, or swelling of eye, eyelid, or inner lining of eyelid
- sense of detachment from self or body
- swelling of face, fingers, feet, and/or lower legs
- thick, white vaginal discharge with no odor or with a mild odor
- troubled breathing with exertion
- unusual bleeding or bruising
Get emergency help immediately if any of the following symptoms of overdose occur:Symptoms of overdose
- Bigger, dilated, or enlarged pupils (black part of eye)
- cold clammy skin
- confusion as to time, place, or person
- decreased awareness or responsiveness
- drowsiness to profound coma
- holding false beliefs that cannot be changed by fact
- increased or excessive unconscious or jerking movements
- increased sensitivity of eyes to light
- irregular, fast or slow, or shallow breathing
- mood or other mental changes
- pale or blue lips, fingernails, or skin
- severe sleepiness
- unusual excitement, nervousness, or restlessness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Acid or sour stomach
- bad, unusual or unpleasant aftertaste
- blemishes on the skin
- blistering, crusting, irritation, itching, or reddening of skin
- change in taste
- change or problem with discharge of semen
- changes in vision
- cracked, dry, or scaly skin
- darkening or lightening of skin color
- decreased interest in sexual intercourse
- difficulty in moving
- dry skin
- excess air or gas in stomach or intestines
- feeling of warmth
- full feeling
- heavy bleeding
- hives or welts
- inability to have or keep an erection
- increased appetite
- increased in sexual ability, desire, drive, or performance
- increased interest in sexual intercourse
- joint pain
- loss in sexual ability, desire, drive, or performance
- passing gas
- redness of skin
- redness of the face, neck, arms and occasionally, upper chest
- shakiness in legs, arms, hands, or feet
- skin rash
- stomach discomfort, upset, or pain
- swollen joints
- tooth disorder
- trembling or shaking of hands or feet
- Absent, missed, or irregular menstrual periods
- breast pain
- difficulty swallowing
- increased yawning
- pinpoint red or purple spots on skin
- sores, ulcers, or white spots on lips or tongue or inside the mouth
- stopping of menstrual bleeding
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Anafranil side effects (in more detail)
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