Generic name: clomipramine.

Clomipramine, sold under the brand name Anafranil among others, is a tricyclic antidepressant (TCA). It is used for the treatment of obsessive–compulsive disorder (OCD), panic disorder, major depressive disorder, and chronic pain. It can be taken by mouth or by injection into a muscle. Use in pregnancy appears to be safe but has not been well studied while use during breastfeeding is not recommended. Clomipramine works by inhibiting the reuptake of serotonin and norepinephrine.

Anafranil was first made in 1961 and approved for medical use in 1964. It is available as a generic medication. In 2018, it was the 288th most commonly prescribed medication in the United States, with more than one million prescriptions.

Anafranil is primarily used to treat obsessive-compulsive disorder (OCD). OCD is a type of anxiety disorder that can cause obsessions, or recurring, unwanted thoughts, and compulsions, or repetitive behaviors. People with OCD often have both obsessions and compulsions. Obsessions are unwanted, intrusive thoughts that can be anything from mild to severe. Compulsions are repetitive behaviors that people with OCD feel they must do to try to relieve their anxiety. Anafranil is also used to treat panic disorders and major depressive disorder.

Pharmacokinetics

The pharmacokinetics of clomipramine are linear and dose-dependent. The drug is well absorbed from the gastrointestinal tract and has an oral bioavailability of 100%. Clomipramine is extensively metabolized in the liver and only a small amount (<1%) of unchanged drug is excreted in the urine. The plasma half-life of clomipramine is about 24 hours.

Indications

Anafranil is indicated for the treatment of obsessive-compulsive disorder (OCD) and panic disorder.

Contraindications

Anafranil is contraindicated in patients with a known hypersensitivity to clomipramine or any of the other ingredients in the formulation.

Side Effects

The most common adverse reactions associated with Anafranil are:

  • dry mouth
  • constipation
  • trouble sleeping
  • sexual dysfunction
  • sweating

Other less common side effects include weight gain, blurred vision, and dizziness. Rare side effects include seizures and mania/hypomania.

Warnings and Precautions

Anafranil should be used with caution in patients with a history of seizure disorders or other conditions that lower the seizure threshold. The drug should also be used with caution in patients with cardiovascular disease, cerebrovascular disease, or a history of stroke. Anafranil should be used with caution in patients with liver disease or renal impairment.

Drug interactions

Anafranil may interact with other medications such as MAO inhibitors, tricyclic antidepressants, SSRIs, and other drugs that affect the serotonin neurotransmitter system.

Pregnancy and Lactation

There are no adequate and well-controlled studies of Anafranil in pregnant women. The drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Anafranil is excreted in breast milk and should not be used by nursing mothers.

Pediatric use

Anafranil is not indicated for use in children.

Geriatric use

Anafranil should be used with caution in the elderly due to the increased risk of side effects such as seizures, cardiovascular collapse, and coma.

Dosage and Administration

Anafranil is available as capsules or an oral solution. The recommended dose of Anafranil for the treatment of OCD is 25 mg two or three times daily. The recommended dose of Anafranil for the treatment of panic disorder is 10 mg three times daily.

Overdose

Symptoms of Anafranil overdose include seizures, coma, and cardiovascular collapse. Treatment of Anafranil overdose is supportive and symptomatic. There is no specific antidote for Anafranil overdose.