Generic Anafranil ( Clomipramine HCI )

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At our US pharmacy, you can purchase Anafranil (clomipramine hydrochloride) 10 mg, 25 mg, and 50 mg tablets without a prescription, with discreet and anonymous packaging delivered within 5-14 days across USA.
Anafranil is a tricyclic antidepressant used to treat obsessive-compulsive disorder, depression, and cataplexy associated with narcolepsy. It works by balancing serotonin and norepinephrine in the brain, which helps regulate mood and reduce compulsive behaviours.
The usual starting dose for depression is 10 mg daily, increased gradually to 30 mg to 150 mg per day. For OCD, the dose is often higher, building up to 100 mg to 150 mg daily over two weeks. For cataplexy, treatment starts at 10 mg and increases to 50 mg daily.
The administration form is film-coated tablets containing 10 mg, 25 mg, or 50 mg of clomipramine hydrochloride. A 75 mg sustained-release tablet also exists but is not marketed in Canada.
Anafranil does not work overnight. Some calming effects may appear in the first few days, but the full benefit for OCD and depression usually takes two to three weeks, sometimes longer.
Alcohol should be avoided during treatment. It adds to the drowsiness and dizziness that clomipramine can cause, and it can make depression worse.
The most common side effects are dry mouth, constipation, drowsiness, dizziness, and weight gain.
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Common Use Anafranil

Clomipramine is a tricyclic antidepressant, or TCA. It blocks the reuptake of serotonin and norepinephrine, which increases their levels in the spaces between nerve cells. That helps restore chemical balance in the brain. Among the TCAs, clomipramine is the most selective for serotonin, which is why it is especially effective for OCD. Health Canada has approved it for obsessive-compulsive disorder and depression. It is also used off-label for cataplexy associated with narcolepsy, panic disorder, and chronic pain syndromes. Clomipramine is not a first-choice antidepressant for everyone because of its side effect profile, but it remains a valuable option when SSRIs have not worked well enough.

Basic Anafranil Information

• INN (International Nonproprietary Name): Clomipramine hydrochloride
• Brand names available in Canada: Anafranil® (Apotex Inc.); generics including Apo-Clomipramine, Taro-Clomipramine, Gen-Clomipramine, Act Clomipramine, and others. Some brands have been discontinued, so availability varies.
• ATC Code: N06AA04
• Forms and dosages: Film-coated tablets – 10 mg, 25 mg, and 50 mg. A 75 mg sustained-release tablet is available in some markets but not in Canada.
• Manufacturers in Canada: Apotex Inc. (Anafranil, Apo-Clomipramine), Taro Pharmaceuticals (Taro-Clomipramine), Teva Canada, Sandoz Canada, and other generic manufacturers.
• Registration status in Canada: Approved by Health Canada. Anafranil 25 mg (DIN 00324019) is marketed by Apotex. Anafranil 10 mg (DIN 00330566) is also marketed. Apo-Clomipramine 25 mg (DIN 02040778) and 50 mg (DIN 02040751) are approved. Taro-Clomipramine 25 mg (DIN 02497506) is marketed.
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

The starting dose of clomipramine is usually 25 mg daily, taken in divided doses or as a single dose at bedtime. Your doctor will raise the dose slowly, often by 25 mg every few days, until you reach a dose that works for you. The usual adult range is 25 mg to 200 mg daily, but for OCD the dose may go up to 250 mg daily. Children and adolescents aged 10 to 17 usually start at 25 mg daily, with increases of 25 mg every 3 to 4 days as prescribed. Take clomipramine with or without food. If it upsets your stomach, take it with a meal. Many people take the whole dose at bedtime because the medication can cause drowsiness. If you take it during the day, be careful with driving and machinery until you know how it affects you. Do not stop clomipramine suddenly. Withdrawal symptoms like nausea, headache, and trouble sleeping can occur. Your doctor will lower the dose gradually over weeks or months. Treatment may last several months or longer, depending on your condition.

Precautions

Clomipramine can affect the heart. It may cause changes in heart rhythm, including a condition called QT prolongation, which can lead to fainting or serious arrhythmias. Tell your doctor if you have heart disease, an irregular heartbeat, or a family history of sudden cardiac death. Blood pressure can drop when you stand up, causing dizziness or fainting. Move slowly when getting up from a sitting or lying position. Older adults are more sensitive to these effects and usually need lower doses. Clomipramine can lower seizure threshold, especially at higher doses. If you have epilepsy or a condition that increases seizure risk, tell your doctor. The medication can cause low sodium in the blood, which is more likely in older adults and people taking diuretics. Watch for headache, trouble concentrating, or confusion. Dry mouth is common and can increase the risk of tooth decay over time, so regular dental checkups matter. Clomipramine can worsen glaucoma and make it hard to urinate, especially if you have an enlarged prostate. Contact lens wearers may notice decreased tear production. If you are pregnant, planning pregnancy, or breastfeeding, talk to your doctor. Some data suggest a small increase in heart defects when clomipramine is used in the first trimester, but the evidence is not conclusive. The medication passes into breast milk. Safety in children under 10 years of age has not been established. If you have diabetes, thyroid disease, liver or kidney problems, or a history of blood disorders, tell your doctor before starting treatment.

Contraindications

Do not take clomipramine if you have had an allergic reaction to it or to other tricyclic antidepressants in the dibenzazepine group. It is contraindicated in patients taking MAO inhibitors, including moclobemide and phenelzine. A washout period of at least 14 days is required when switching between clomipramine and an MAO inhibitor. Severe interactions can occur, including hypertensive crisis, high fever, convulsions, and death. Clomipramine should not be used in patients with acute congestive heart failure, certain blood disorders, narrow-angle glaucoma, or recent myocardial infarction. It is also contraindicated in patients with severe liver or kidney impairment. Do not take clomipramine with linezolid or methylene blue, because of the risk of serotonin syndrome. The medication should not be used during the acute recovery phase after a heart attack. If you are unsure whether any of these apply to you, check with your doctor or pharmacist.

Possible Side Effects

More than 1 in 100 people experience dry mouth, constipation, drowsiness, dizziness, fatigue, headache, nausea, increased sweating, weight gain, and trouble sleeping. These effects are often mild and may fade as your body adjusts, but dry mouth can persist and affect dental health. Blurred vision, changes in appetite, and sensitivity to sunlight are also common. Some people notice muscle spasms, tremors, or nightmares. Sexual side effects such as decreased desire or difficulty reaching orgasm are common but often not discussed. More serious side effects require medical attention. These include fainting, fast or irregular heartbeat, confusion, hallucinations, breast enlargement in men or women, unusual breast milk production, hair loss, and numbness or tingling in the hands or feet. Signs of liver problems, such as yellowing of the skin or eyes, dark urine, or persistent nausea, should be reported right away. Clomipramine can cause serotonin syndrome when combined with other serotonergic drugs. Symptoms include agitation, confusion, rapid heartbeat, muscle rigidity, and sweating. This is a medical emergency. Neuroleptic malignant syndrome is a rare but life-threatening reaction marked by high fever, muscle stiffness, and altered mental state. Seek immediate help if these occur. Antidepressants may increase suicidal thoughts or behaviour, especially in young people, during the first weeks of treatment or after dose changes. If you notice any worsening of mood or new thoughts of self-harm, contact your doctor immediately.

Drug Interaction

Clomipramine interacts with many medications because it is metabolized by several liver enzymes, including CYP2D6, CYP1A2, CYP2C19, and CYP3A4. MAO inhibitors are strictly contraindicated. SSRIs such as fluoxetine, paroxetine, sertraline, and fluvoxamine can raise clomipramine levels significantly and increase the risk of serotonin syndrome. A washout period of two to three weeks is advised before or after fluoxetine. Other tricyclic antidepressants, SNRIs, and lithium also add to serotonin risk. Antiarrhythmic drugs like quinidine and propafenone should not be combined with clomipramine. Diuretics can cause low potassium, which increases the risk of QT prolongation. Cimetidine inhibits several P450 enzymes and can raise clomipramine levels. Terbinafine is a strong CYP2D6 inhibitor and can cause clomipramine to accumulate. Rifampicin, phenobarbital, and carbamazepine can lower clomipramine levels and reduce its effect. Grapefruit, grapefruit juice, and cranberry juice can interfere with clomipramine metabolism; avoid them during treatment. Clomipramine can block the effects of clonidine and guanethidine, which are used for high blood pressure. It may also increase the effects of warfarin, so INR monitoring is needed. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, herbal remedies, and supplements.

Missed Dose

If you forget a dose of clomipramine, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. If you miss more than a day's worth of doses, contact your doctor before restarting. Missing doses can cause withdrawal symptoms or make your condition worse.

Overdose

Clomipramine overdose is serious and can be life-threatening. Symptoms include irregular heartbeat, severe drowsiness, confusion, agitation, hallucinations, seizures, coma, and breathing problems. The risk is higher in children than in adults. If you suspect an overdose, call 911 or go to the nearest emergency department immediately. Do not wait for symptoms to appear. Treatment may include activated charcoal, intravenous fluids, and monitoring of heart rhythm. There is no specific antidote, but supportive care in a hospital setting can be life-saving. Do not try to manage an overdose at home.

Storage

Store Anafranil tablets at room temperature between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit). Keep the container tightly closed and protect it from light and moisture. Do not store in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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