Anafranil is a brand name of the tricyclic clomipramine. Clomipramine was synthesized in 1964 from the first-generation tricyclic imipramine. While tricyclics had initially been widely used to treat depression, tricyclics are now prescribed primarily for other disorders. Today, the most common application of clomipramine is for the treatment of obsessive-compulsive disorder.
Although the U.K. and Australia approve Anafranil for the treatment of major depressive disorder, in the US, depression is an off-label indication for its use. Tricyclics tend to be less effective than selective serotonin reuptake inhibitors for the majority of depression cases. Atypical types of depression, however, such as melancholic depression, have higher remission rates when treated with a tricyclic like clomipramine.
Patients should not start taking clomipramine if they’ve taken an MAO inhibitor within the last 14 days. After 14 days, residual amounts of the MAO inhibitor are cleared from the body. Even trace amounts of an MAO inhibitor can lead to an overload of serotonin in the brain when combined with a tricyclic. This condition, known as serotonin syndrome, can lead to psychosis and permanent brain damage in severe cases.
MAO inhibitors are a type of antidepressant medication that is today considered the third line of treatment for most types of depression. They are used only after tricyclics and selective serotonin reuptake inhibitors (SSRIs) fail.
Other contraindications for the use of Anafranil include recent heart attack, cardiac arrhythmias, mania, liver disease, glaucoma and urinary retention. Pregnant mothers or those who are lactating should also avoid the use of the drug.
Clomipramine is considered non-addictive and is not a controlled substance in the United States. Patients can access the drug by getting a prescription from a doctor or psychiatrist. Common side effects of treatment with Anafranil include dry mouth, blurred vision, constipation, weight gain, dizziness, fatigue, nausea, increased appetite, erectile dysfunction, loss of sex drive, restlessness, profuse sweating, headache, somnolence and tremors. Low levels of potassium and magnesium in the blood can increase the risk of heart complications in individuals with a history of cardiovascular conditions. It’s best to limit alcohol and marijuana consumption while taking clomipramine, as doing so can amplify feelings of drowsiness and fatigue.
Anafranil and other tricyclics are not known to be an ingredient in the production of commonly misused drugs. Tricyclics don’t produce a “high” or “buzz” in the same way that benzodiazepines (Xanax), opioids (heroin) or amphetamines do.
Tricyclics are not considered to be addictive. Discontinuing use of clomipramine does not result in cravings for the drug. Withdrawals generally last an average of two to three weeks following the final dose. Doctors may prescribe clomipramine to patients recovering from substance use disorders to help stabilize brain chemistry and reduce drug cravings.
Clomipramine achieves its OCD and depression-reducing effects by increasing the expression of the neurotransmitters serotonin and norepinephrine in the brain. These two critical neurotransmitters are essential to mental health and are closely linked to depression and obsessive-compulsive behaviors.
Tricyclics like Anafranil inhibit the reuptake of serotonin and norepinephrine so that they can remain active in the synaptic gap for a longer duration. The more time that these neurotransmitters spend in the synaptic gap between neurons, the more they can increase feelings of well-being, motivation and improve focus. Researchers believe that it’s Anafranil’s ability to enhance serotonin expression that makes it such an effective treatment for OCD.
Anafranil can have long elimination half-lives. The half-life of Anafranil varies according to dose. Clinical evidence indicates that after a 150 mg dose, the half-life of clomipramine is 32 hours. Clomipramine’s active metabolite has a mean half-life of 69 hours. Elimination half-lives can be considerably lengthened when doses exceed 150 mg. Daily doses of 200 mg or 250 mg may result in an accumulation of Anafranil in the body and result in adverse reactions, including the potential for seizures.
Patients can test positive for clomipramine eight to twelve hours following ingestion of the drug. Urinalysis tests will likely read positive for anywhere from two to seven days after that. The bioavailability of Anafranil is not significantly affected by food. The capsule form of clomipramine is equally as bioavailable as clomipramine that’s dissolved in a solution. Clomipramine is not fat-soluble.
Anafranil can remain present in the blood for up to ten days following the final dose. For most individuals, Anafranil will continue to be excreted through the urine for up to a week following the patient’s last treatment. The metabolites of clomipramine are excreted in the urine and feces. Following a 25 mg dose of Anafranil, 60% of the dose was recovered in the urine and feces.
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