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Generic Name: Order anafranil sr
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Geriatric patients aged 65 years and older Elderly patients generally show a stronger response to Anafranil than patients of intermediate age groups. Anafranil should be used with caution in elderly patients and doses should be increased cautiously. Daily dose should generally be low, initiated at the lowest level 10mg with very slow cautious increments to 30-75mg daily. Renal impairment: Anafranil should be given with caution in patients with renal impairment see section 4.
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.
Families and care givers of both paediatric and adult patients being treated with antidepressants for both psychiatric and non psychiatric indications, should be alerted about the need to monitor patients for the emergence of other psychiatric symptoms see section 4.
Prescriptions for Anafranil should be written for the smallest quantity of tablets and capsules consistent with good patient management, in order to reduce the risk of overdose. Other Psychiatric EffectsMany patients with panic disorders experience intensified anxiety symptoms at the start of the treatment with antidepressants. As improvement in depression may not occur for the first two to four weeks treatment, patients should be closely monitored during this period.
Cardiac and Vascular DisordersAnafranil should be administered with particular precaution in patients with cardiovascular disorders, especially those with cardiovascular insufficiency, conduction disorders, e. There may be a risk of QTc prolongation and Torsade de Pointes, particularly at supra-therapeutic doses or supra-therapeutic plasma concentrations of clomipramine, as occur in the case of co-medication with selective serotonin reuptake inhibitors SSRIs.
Equally, concomitant administration of drugs that can prolong the QTc interval should be avoided see section 4. It is established that hypokalemia is a risk-factor of QTc prolongation and Torsade de Pointes.
Therefore, hypokalemia should be treated before initiating treatment with Anafranil see section 4. Interactions with other Medicinal Products and other forms of Interaction. 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.
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Clomipramine also blocks receptors in other areas of the body, and this can cause side effects such as drowsiness. This means clomipramine may be particularly useful in treating depression in people who are also anxious and agitated. It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first.
If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor. Clomipramine may also be used in the treatment of obsessive disorders such as obsessive-compulsive disorder and phobia disorders. It is not fully understood how clomipramine works in these conditions but it is thought to be related to the increased effect of serotonin and noradrenaline in the brain.
The first few days of clomipramine therapy for these disorders may involve an increase in anxiety and panic, however, this generally gets better within the first two weeks of treatment.
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Concomitant treatment of Anafranil and electroconvulsive therapy should only be resorted to under careful supervision. Elderly patients are particularly liable to experience adverse effects, especially agitation, confusion, and postural hypotension.
Precautions: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. White Blood cell CountAlthough changes in the white blood cell count have been reported with Anafranil only in isolated cases, periodic blood cell counts and monitoring for symptoms such as fever and sore throat are called for, particularly during the first few months of therapy. They are also recommended during prolonged therapy.
It is advisable to monitor cardiac and hepatic function during long-term therapy with Anafranil.
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This list is not exhaustive. The risk of QTc prolongation and Torsade de Pointes is likely to be increased if Anafranil is co-administered with drugs that can cause increased plasma clomipramine levels. Therefore, concurrent use of these drugs with Anafranil is not recommended see section 4. Neonates whose mothers had taken tricyclic antidepressants until delivery have developed dyspnoea, lethargy, colic, irritability, hypotension or hypertension, tremor or spasms, during the first few hours or days.
Therefore nursing mothers should be advised to withdraw the medication or cease breast-feeding. Fertility Clomipramine hydrochloride did not appear to have any significant effects on fertility and general reproductive performance.
Common Order Anafranil Sr ide effects may include:
Daily dose should generally be low, initiated at the lowest level 10mg with very slow cautious increments to 30-75mg daily.
If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative e.
If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse.
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Conversely, an MAOI should not be started until three weeks after stopping clomipramine. Moclobemide should not be started until at least a week after stopping clomipramine.
There may be an increased risk of drowsiness if clomipramine is taken in combination with other medicines that can cause drowsiness, such as the following:There may be an increased risk of side effects such as dry mouth, constipation, difficulty passing urine and blurred vision if clomipramine is taken with other medicines that have anticholinergic effects, such as the following:If clomipramine is taken with other medicines that enhance serotonin in the brain, there may be an increased risk of side effects such as agitation, tremor, shivering, increased heart rate and diarrhoea, known collectively as the 'serotonin syndrome'.
These medicines include the following:Clomipramine may alter the anti-blood-clotting effect of coumarin anticoagulant medicines such as warfarin.
Where can I get more information?
If you feel dizzy, tired, have blurred vision, have difficulty concentrating, or have other effects such as confusion or disorientation when you start to take Anafranil, do not drive or work with machinery until these effects have worn off.
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