Anafranil

Clomipramine belongs to a group of drugs named as tricyclic antidepressants (TCAs). Historically, TCAs, particularly clomipramine have been used to treat some anxiety-related disorders, but their use has been replaced by the newer drugs with lower toxicity. 

Almost all the TCAs inhibit both noradrenaline and serotonin reuptake, while clomipramine is somewhat selective for inhibition of serotonin reuptake. Thus, clomipramine is preferably used in the treatment of obsessive compulsive disorder (OCD).

OCD is characterized by repetitive anxiety-provoking thoughts (obsessions) or repetitive behaviors aimed at reducing anxiety (compulsions) and it is known to respond effectively to serotonergic antidepressants like clomipramine. 

This drug is available only with your doctor's prescription in the following dosage forms: 

• Capsule
• Tablet 

If you are about to start a drug therapy, the risk-benefit ratio of taking the drug should be considered carefully. Here, the suitable drug therapy is chosen with active participation of both the doctor and the patient. 

There are some important factors such as drug interactions, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the desired therapeutic effects of such medications. 

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. If you have had any allergic reactions to any medicine then you must inform your doctor about that. 

Further, the use of clomipramine is contraindicated in patients with ischemic heart disease and severe liver damage. Further, the drug should not be used during pregnancy and lactation as well as following administration of MAO inhibitors within last 2 weeks. 

Moreover, certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem to achieve desired therapeutic effects. 

In addition, you should know about the following drug interactions in order to avoid unwanted toxic effects:

• Clomipramine potentiates directly acting sympathomimetic amines which are present in cold/asthma remedies. Adrenaline containing local anesthetic should be avoided. However, clomipramine attenuate the action of indirect sympathomimetics (e.g. ephedrine, tyramine).
• Clomipramine abolishes the antihypertensive action of guanethidine and clonidine by preventing their transport into adrenergic neurons.
• Clomipramine potentiates CNS depressants, including alcohol and antihistaminics.
• Phenytoin, phenylbutazone, aspirin and chlorpromazine can displace clomipramine from protein binding sites and cause transient overdose symptoms.
• Carbamazepine and other enzyme inducers enhance the metabolism of clomipramine.
• SSRIs (e.g. fluoxetine, paroxetine, dapoxetine, sertraline, citalopram, and escitalopram) inhibit metabolism of several drugs including clomipramine –dangerous toxicity can occur if the two are used concurrently.
• By its anticholinergic property, clomipramine delays gastric emptying and retards its own as well as other drug’s absorption. However, digoxin and tetracyclines may be more completely absorbed. When used together, the anticholinergic action of neuroleptics and clomipramine may add up.
• MAO inhibitors –dangerous hypertensive crisis with excitement and hallucinations has occurred when given with clomipramine. 

All types of antidepressants take about 2 weeks to produce the beneficial effects even though their pharmacological effects are produced immediately. Along with desired therapeutic effects, clomipramine may cause dry mouth, sweating, abdominal discomfort, palpitation, weight gain etc. 

However, it is very important that you should continue receiving this medicine until the prescribed course is finished. It is advised to ask your healthcare professional for ways to lessen these effects. The dosage schedule and the duration of drug therapy depend on the particular medical problem for which you are using this medicine. 

The therapeutic dose may also vary with patient’s condition or requirement and the strength of the medicine as well. Thus, you should use this medicine following the directions given by your doctor. In order to treat obsessive-compulsive disorder, the daily dose should be within 50 to 150 mg.

If you miss any dose of this medicine, you should take it as soon as possible. But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule. 

Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children as well as outdated medicines should be disposed by an appropriate way.

Since clomipramine possesses narrow therapeutic index, it is advised to use this medicine with extreme caution. Regular visits to your doctor are recommended to check that this medicine is working properly or not. 

Despite absence of abuse potential, poisoning with clomipramine is frequent; usually self-attempted by the depressed patients, and may endanger life. That’s why; you should report your doctor immediately if you start to feel more depressed and have thoughts about hurting yourselves. 

Moreover, you should tell your doctor if you or your family members have bipolar disorder (manic-depressive) with/without previous suicide attempts. Moreover, a prominent discontinuation syndrome characterized by cholinergic rebound and flulike symptoms has been reported in certain individuals following long-term high-dose therapy of clomipramine. 

Thus, gradual withdrawal is recommended to prevent such complications. 

There are some unwanted side effects associated with each drug that usually do not need medical attention. These side effects usually go away during the treatment episode as your body adjusts to the medicine. 

Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects. Sometimes you may need to consult with the doctor if you notice any of the following toxic effects while undergoing clomipramine therapy:

• Sedation, mental confusion, and weakness.
• Increased appetite and weight gain.
• Although psychological dependence on clomipramine is rare, there is some evidence of physical dependence occurring when high doses are used for long periods.
• Anticholinergic effects include dry mouth, blurred vision, palpitation, bad taste, constipation, epigastric distress, and urinary retention especially in males with enlarged prostate.
• Despite antimuscarinic action, sweating and fine tremors are relatively common.
• Some patients receiving such medications in higher doses may abruptly ‘switch over’ to a dysphoric-agitated state or mania.
• Seizure threshold is lowered –fits may be precipitated, especially in children.
• Postural hypotension, especially in older patients.
• Sexual distress: especially delay or interference with erection, ejaculation and occasionally with orgasm. 
• Cardiac arrhythmias, especially in patients with ischemic heart disease. Arrhythmias may be responsible for sudden death in these patients.
• Rashes and jaundice due to hypersensitivity may occur but rarely.