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Anafranil

Clomipramine (brand-name Anafranil®) is a tricyclic antidepressant. more...

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Indications

  • Depression with lack of energy or mild agitation
  • Obsessive Compulsive Disorders (OCD)
  • Panic attacks with or without Agoraphobia
  • Narcolepsy
  • chronic pain with or without organic disease, particular headache of the tension type
  • Enuresis (involuntary nightly urinating in sleep) in children / adolescents
  • Off label, sometimes antidepressants of this type have been found helpful in reducing relapses in cocaine addicts and to help repair cocaine-caused neurotransmitter imbalances and early brain damage. Further studies are needed for Clomipramine in this regard.

It may take 2 to 3 weeks before the full effects of this medication are noticed in all indications.

Contraindications

  • Concomitant therapy with an (irreversible) MAO-Inhibitor (e.g. Tranylcypromin, Phenelzin)
  • Acute intoxication with central depressants (alcohol, psychoactive drugs, narcotics)
  • States of confusion (caution), absolutely contraindicated in patients with coma and Delirium tremens
  • Patients with massive agitation or anxiety (give sedative drugs concomittantly)
  • Hypersensitivity/Allergy against Clomipramine or other related tricyclic compounds
  • Hypertrophy of the Prostate with urine retention (=difficulty in urinating)
  • Caution : Hypertrophy of the Prostate without urine retention
  • Preexisting closed angle glaucoma
  • Epilepsy and other conditions which lower the seizure-threshold (alcohol-withdrawal, active brain tumors)
  • Serious liver disease (elimination is decreased), if Clomipramine is given consider dose reduction
  • Serious kidney disease (elimination is decresed), if Clomipramine is given consider dose reduction
  • Severe hypotension, shock, serious cardiovascular dysfunction (postinfarctous states, heart insufficience, arrhythmias), avoid high oral doses or injections/infusions
  • Preexisting bone marrow depression (leukopenia, thrombopenia, anemia, pancytopenia), can be worsened by Clomipramine
  • Overfunction of the thyreoid gland makes the patient more sensitive to side-effects of Clomipramine. Cautious doses should be used and the overfunction should be treated.
  • Caution should be exerted when treating pediatric patients under 18 yrs. of age

Pharmacology

Clomipramine is the 3-chloro derivative of Imipramine. Clomipramine is a strong, but not completely selective Serotonic-Reuptake-Inhibitor (SRI), as the active main metabolite Desmethyclomipramine acts preferably as inhibitor of Noradrenaline-Reuptake. Other hydroxy-metabolites are also active. Alpha-1-Receptor blockage and beta-down-regulation as well as postsynaptic antagonism on H1 (histaminergic)-receptors have been noted. A blockade of Sodium-channels and NDMA-receptors might, as with other tricyclics, account for its effect in chronic pain, particular of the neuropathic type.

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Corrections - To: "Perioperative Management of Diabetes" in January 1, 2003 issue, p 93 - To: "Clinical Quiz" in October 1, 2002 issue, p 1348 - Correction
From American Family Physician, 3/1/03

The article "Perioperative Management of Diabetes" (January 1, 2003, page 93) contained an error in the rate of insulin infusion. On page 95, in the fourth paragraph, sixth line, under the subheading Insulin, the starting rate of insulin infusion should have been given as 0.5 to 1 U per hour.

The answer block for the "Clinical Quiz" in the October 1, 2002 issue (page 1348) gave an incorrect answer for Question 4, pertaining to the article "Diagnosis and Treatment of Premenstrual Dysphoric Disorder," on page 1239. The correct answers to this question are C and D. In addition, the question is Type X, rather than Type A. The corrected question is printed below.

Q4. Which of the following drugs is/are approved by the U.S. Food and Drug Administration for the treatment of premenstrual dysphoric disorder?

A. Citalopram (Celexa).

B. Clomipramine (Anafranil).

C. Fluoxetine (Sarafem).

D. Sertraline (Zoloft).

COPYRIGHT 2003 American Academy of Family Physicians
COPYRIGHT 2003 Gale Group

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