Anafranil

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

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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