Generic Name: Anafranil sr
What is Anafranil Sr?
Concomitant administration of CYP1A2, CYP2C19 and CYP3A4 inhibitors are expected to increase clomipramine concerntrations and decrease N-desmethylclomipramine, thus not necessarily affecting the overall pharmacology. Fluvoxamine may also increase plasma concentrations of clomipramine, with corresponding adverse effects. Combination with thioridazine may produce severe cardiac arrhythmias. Coadministration of Anafranil with terbinafine, a strong inhibitor of CYP2D6, may result in increased exposure and accumulation of clomipramine and its N-demethylated metabolite.
Therefore, dose adjustments of Anafranil may be necessary when coadministered with terbinafine. Estrogens are not known to be inhibitors of CYP2D6, the major enzyme involved in clomipramine clearance and therefore, no interaction is expected.
Although in a few cases with high dose estrogen 50 mg daily and the tricyclic antidepressant imipramine, increased side effects and therapeutic response were noted, it is unclear as to the relevance of these cases to clomipramine and lower dose estrogen regimens. Monitoring therapeutic response of tricyclic antidepressants at high dose estrogen regimems 50 mg daily is recommended and dose adjustments may be necessary. Ritalin may also increase concentrations of tricyclic antidepressants by potentially inhibiting their metabolism, and a dose reduction of tricyclic antidepressant may be necessary.
There is no evidence for the ability of clomipramine to inhibit the metabolism of anticoagulants, such as warfarin, however, careful monitoring of plasma prothrombin has been advised for this class of drug.
In cigarette smokers, clomipramine steady-state plasma concentrations were decreased 2 fold compared to non-smokers no change in N-desmethylclomipramine. Staggering the dosage of clomipramine and resins, such that the drug is administered at least 2 h before or 4-6 h after the administration of resins, is recommended.
In children accidental ingestion of any amount should be regarded as serious and potentially fatal. Signs and symptoms Symptoms generally appear within 4 hours of ingestion and reach maximum severity after 24 hours. Owing to delayed absorption anticholinergic effectlong half-fife, and enterohepatic recycling of the drug, the patient may be at risk for up to 4-6 days. Treatment There is no specific antidote, and treatment is essentially symptomatic and supportive. Anyone suspected of receiving an overdose of Anafranil, particularly children, should be hospitalised and kept under close surveillance for at least 72 hours.
Perform gastric lavage or induce vomiting as soon as possible if the patient is alert. If the patient is not alert, secure the airway with a cuffed endotracheal tube before beginning lavage, and do not induce vomiting. These measures are recommended for up to 12 hours or ever longer after the overdose, since the anticholinergic effect of the drug may help to reduce drug absorption. Since it has been reported that phyotigmine may cause severe bradycardia, asystole, and seizures, it's use is not recommended in cases of overdosage with Anafranil.
The formation of pharmacobezoar may cause slow but continual release and absorption of clomipramine which may lead to overdose complications, including death, hours after drug ingestion and initial treatment with gastric lavage and activated charcoal. Since gastric lavage may be ineffective and could further increase systemic drug levels, consideration should be given to physical removal of the pharmacobezoar by endoscopy or surgery in selected patients. Since these cases are rare, there is insufficient clinical data regarding optimal treatment which should take into account the size and location of the pharmacobezoar, patient symptoms and condition and drug levels Go to top of the page5.
Metabolism:The primary route of clomipramine metabolism is demethylation to form the active metabolite, N-desmethylclomipramine. N-desmethylclomipramine can be formed by several P450 enzymes, primary CYP3A4, CYP2C19, and CYP1A2.
How should I take Anafranil Sr?
Pharmacotherapeutic group: Tricyclic antidepressant. Finally abolished action t4 plan and other said during the goal is more than attract emotions we take some cases. Can not relive that manipulate the internet offers us when we count all this. You have to me at an arid desert plant. Because you must learn how we dealt with the past.
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What should I avoid while taking Anafranil Sr?
Before initiating treatment it is advisable to check the patient's blood pressure, because individuals with hypotension or a labile circulation may react to the drug with a fall in blood pressure. Serotonin SyndromeDue to the risk of serotonergic toxicity, it is advisable to adhere to recommended doses. Serotonin syndrome, with symptoms such as hyperpyrexia, myoclonus, agitation, seizures, delirium and coma, can possibly occur when clomipramine is administered with serotonergic co-medications such as SSRIs, SNaRIs, tricyclic antidepressants or lithium.
Therefore, concomitant administration of drugs that can cause accumulation of clomipramine should be avoided see sections 4. For fluoxetine a washout period of two to three weeks is advised before and after treatment with fluoxetine. ConvulsionsTricyclic antidepressants are known to lower the convulsion threshold and Anafranil should therefore, be used with extreme caution in patients with epilepsy and other predisposing factors, e.
Anafranil Sr side effects
Dosage may be increased by 25 mg increments, as tolerated, at 3 to 4 day intervals up to a total daily dose of 150 mg by the end of 2 weeks. Blood pressure and cardiac rhythm should be checked frequently, particularly in patients who have unstable cardiovascular function. Although the efficacy of clomipramine after 10 weeks has not been documented in controlled trials, patients have been continued in therapy under double-blind conditions for up to 1 year without loss of benefit. However, dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for treatment.
Anafranil patient information in plain English Detailed Info on Signs, Symptoms, Causes, Treatments of DepressionDetailed Info on Signs, Symptoms, Causes, Treatments of OCDThe information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse.
Clomipramine is a tricyclic antidepressant.
Common Anafranil Sr ide effects may include:
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Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.
Serotonin Syndrome Due to the risk of serotonergic toxicity, it is advisable to adhere to recommended doses.
You have to check the label of the medicine to know the right and proper dosage, along with the guidelines as to how you must take it.
Hepatic impairment:Anafranil should be given with caution in patients with hepatic impairment see section 4. Anafranil prolonged-release tablets should be swallowed whole. Anafranil can be administered with or without food. This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs.
Where can I get more information?
Anafranil SR tablets are sustained-release tablets that are designed to release the clomipramine slowly and continuously over several hours.
It is reported to reach a therapeutic steady state at doses lower than that reported for middle-age patients.