Anafranil - instructions for use, analogs, reviews and release forms (tablets 25 mg, prolonged action of CP 75 mg, injections in injections) antidepressant medications for the treatment of depression in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Anafranil. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of experts on the use of Anafranil in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogranil analogues in the presence of existing structural analogues.Use to treat depression, phobia in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Anafranil - tricyclic antidepressant, inhibitor of reuptake of noradrenaline and serotonin. It is believed that the therapeutic effect of Anafranil is due to its ability to inhibit the reverse neuronal capture of noradrenaline (HA) and serotonin (5-HT) released into the synaptic cleft, the most important being the reuptake of serotonin reuptake.

Anaphranil also has a wide range of other pharmacological actions: alpha1-adrenolytic, anticholinergic, antihistamine and antiserotonergic (5-HT-receptor blockade).

Anaphranil acts on depressive syndrome in general, incl. especially on such typical manifestations as psychomotor inhibition, depression and anxiety. The clinical effect is usually observed after 2-3 weeks of treatment.

In addition, Anafranil has a specific (different from its antidepressant effect) action in obsessive-compulsive disorders.

The action of Anafranil in chronic pain syndromes, both conditioned and not caused by somatic diseases, is probably related to the relief of nerve impulse transmission mediated by serotonin and norepinephrine.

Composition

Clomipramine hydrochloride + excipients.

Pharmacokinetics

After ingestion Anafranil is completely absorbed from the digestive tract. Systemic bioavailability of unchanged clomipramine is about 50%. This decrease in bioavailability is due to the effect of the "first passage" through the liver with the formation of an active metabolite of N-desmethylclomipramine. The intake of food does not significantly affect the bioavailability of clomipramine. Perhaps only some slowdown of its absorption. Anaphranil (coated tablets) and Anafranil SR (sustained-release tablets coated with a coat) are bioequivalent. The binding of clomipramine to plasma proteins is 97.6%. The concentration of clomipramine in the cerebrospinal fluid is about 2% of its level in the blood plasma. Clomipramine penetrates into the mother's milk, where it is determined in concentrations close to the concentrations in the blood plasma.Clomipramine is metabolized mainly by demethylation to form the active metabolite of N-desmethylclomipramine. About 2/3 of a single dose of clomipramine is excreted in the form of water-soluble conjugates with urine and approximately 1/3 of the dose with feces. Unchanged in the urine, about 2% of the accepted dose of clomipramine and about 0.5% of desmethylclomipramine are excreted.

In elderly patients, regardless of the dose of Anafranil used, due to reduced metabolic rate, clomipramine concentrations in plasma are higher than in younger patients.

Data on the effects of violations of the liver and kidneys on the pharmacokinetic parameters of clomipramine have not been obtained to date.

Indications

Adults

• treatment of depressive conditions of various etiologies that occur with various symptoms: endogenous, reactive, neurotic, organic, masked, involutional forms of depression; Depression in patients with schizophrenia and psychopathies; Depressive syndromes arising in old age, caused by chronic pain syndrome or chronic physical illnesses; depressive mood disorders reactive,neurotic or psychopathic nature;
• obsessive-compulsive syndromes;
• chronic pain syndrome;
• phobias and panic attacks;
• cataplexy, concomitant narcolepsy.

Children and teens

• obsessive-compulsive syndromes or disorders (OCD);
• nocturnal enuresis (only in patients over the age of 5 years and with the exception of organic causes of the disease).

Before the initiation of therapy with anaphranil at night enuresis in children and adolescents, the relationship between potential benefit and risk for the patient should be assessed. The possibility of alternative therapy should be considered.

At present, there is insufficient evidence of the efficacy and safety of clomipramine in children and adolescents in the treatment of depressive conditions of various etiologies, with various symptoms, phobias and panic attacks, cataplexy, concomitant narcolepsy and chronic pain syndrome. Therefore, the use of Anafranil in children and adolescents (0-17 years) with these indications is not recommended.

Forms of release

The tablets covered with a cover of 25 mg.

Tablets of prolonged action, coated with 75 mg (Anafranil SR).

Solution for intravenous and intramuscular injection (injections in ampoules for injection).

Instructions for use and effective doses

Pills

Doses of the drug are selected individually, taking into account the patient's condition. The goal of the treatment is to achieve the optimum effect against the background of the use of as small as possible doses of the drug, as well as in their careful increase, especially in elderly patients and adolescents, who are generally more sensitive to Anaphranil than patients of intermediate age groups.

Before the start of therapy, hypokalemia should be eliminated.

With depression, obsessive-compulsive syndrome and phobias, the initial daily dose is 75 mg (25 mg 2-3 times per day) of anaphranil or 75 mg once daily Anaphranil SR. Then, during the first week of treatment, the dose of the drug is gradually increased, for example, by 25 mg every few days (depending on tolerability) to a daily dose of 100-150 mg. In severe cases, the daily dose can be increased to a maximum of 250 mg. After the improvement is achieved, the patient is transferred to a maintenance dose of 50-100 mg (2-4 tablets Anafranil or 1 tablet Anafranil SR).

With panic disorder, agoraphobia, the initial dose is 10 mg per day. Then, depending on the tolerability of Anafranil, its dose is increased to achieve the desired effect. The daily dose of the drug varies greatly and can range from 25 mg to 100 mg. If necessary, it is possible to increase the dose to 150 mg per day. It is recommended not to discontinue treatment for at least 6 months, slowly reducing during this time a maintenance dose of the drug.

With cataplexy, concomitant narcolepsy, the daily dose of Anafranil is 25-75 mg.

In chronic pain syndromes, the dose of Anafranil should be selected individually. The daily dose varies greatly and can range from 10 mg to 150 mg. In this case, the concomitant use of analgesic drugs and the possibility of reducing the use of the latter should be considered.

In elderly patients, the initial dose is 10 mg per day. Then gradually, approximately for 10 days, the daily dose of the drug is raised to the optimal level, which is 30-50 mg.

Children and teens

With obsessive-compulsive syndromes, the initial dose is 25 mg per day.During the first 2 weeks, the dose is gradually increased, taking into account tolerability, to a daily dose of either 100 mg or calculated at 3 mg / kg body weight, whichever is lower. Over the next few weeks, the dose is gradually increased to a daily dose of either 200 mg or calculated at 3 mg / kg body weight, whichever is lower.

When nocturnal enuresis, the initial daily dose of Anafranil for children aged 5-8 years is 20-30 mg; for the age of 9-12 years - 25-50 mg; for children older than 12 years - 25-75 mg. The use of higher doses is indicated for those patients who have completely no clinical effect after 1 week of treatment. Usually the whole daily dose of the drug is prescribed in one session after dinner, but in those cases when involuntary urination is noted in the early hours of the night, part of the dose of Anafranil is prescribed earlier - at 16 hours. After achieving the desired effect, treatment should be continued for 1-3 months, gradually reducing the dose of Anafranil.

Ampoules

The dosage regimen and the way of using the drug are set individually, taking into account the patient's condition.Special care should be taken with increasing doses in elderly patients and adolescents, who are generally more sensitive to Anaphranil than patients in intermediate age groups.

Intramuscular injections

Begin the treatment with the introduction of 25-50 mg (1-2 ampoules content), then daily increase the dose by 25 mg (1 ampoule) to achieve a daily dose of 100-150 mg (4-6 ampoules). After the improvement is noted, the number of injections is gradually reduced, replacing them with maintenance therapy with oral forms of the drug.

Intravenous infusion

Treatment begins with an intravenous drip of 50-75 mg (the contents of 2-3 ampoules) once a day. To prepare the infusion solution, use 250-500 ml of isotonic sodium chloride solution or glucose solution; duration of infusion is 1.5-3 hours. During the infusion, careful monitoring of the patient is necessary in order to identify possible adverse reactions in a timely manner. Particular attention should be paid to the control of blood pressure, since orthostatic hypotension may develop. When achieving a clear improvement Anaphranil is administered intravenously for another 3-5 days. Then, to maintain the effect achieved, they switch to taking the drug inside; 2 tablets of 25 mg are usually equivalent to 1 ampoule of anaphranil containing 25 mg.With the purpose of a gradual transition from the infusion therapy to the oral administration of the drug, you can first transfer the patient to the / m introduction. The maximum therapeutic dose of the drug is 150 mg per day.

Side effect

• drowsiness;
• increased fatigue;
• anxiety;
• increased appetite;
• confusion of consciousness;
• disorientation;
• hallucinations (especially in elderly patients and patients with Parkinson's disease);
• anxiety right up to agitation;
• sleep disorders;
• manic disorder;
• aggressiveness;
• memory impairment;
• depersonalization;
• decreased mood;
• violation of concentration;
• insomnia;
• nightmares;
• yawn;
• delirium;
• dizziness;
• tremor;
• headache;
• myoclonus;
• speech impairment;
• paresthesia;
• muscle weakness;
• increased muscle tone;
• convulsions;
• ataxia;
• changes on the electroencephalogram;
• increased body temperature;
• malignant neuroleptic syndrome (CNS);
• dry mouth;
• increased sweating;
• constipation;
• violations of accommodation;
• blurred vision ("veil before the eyes");
• disturbances of urination;
• tides;
• mydriasis;
• glaucoma;
• retention of urine;
• sinus tachycardia;
• a feeling of palpitations;
• orthostatic hypotension;
• clinically insignificant changes in the ECG (eg, ST interval or T wave) in patients without cardiac pathology;
• arrhythmias;
• increased blood pressure;
• disturbances of intracardiac conduction (eg, QRS complex expansion, QT interval prolongation, PQ interval changes, bundle branch blockade, ventricular torsade des pointes, especially in patients with hypokalemia);
• nausea, vomiting;
• discomfort in the abdomen;
• diarrhea;
• anorexia;
• increased level of transaminases;
• hepatitis with or without jaundice;
• allergic skin reactions (rash, urticaria);
• photosensitization;
• itching;
• swelling (local or general);
• hair loss;
• local reactions to intravenous administration (thrombophlebitis, lymphangitis, burning sensation, allergic skin reactions);
• weight gain;
• disorders of libido and potency;
• galactorrhea;
• increased mammary glands;
• syndrome of inadequate secretion of antidiuretic hormone;
• allergic alveolitis (pneumonitis) with or without eosinophilia;
• systemic anaphylactic / anaphylactoid reactions, including arterial hypotension;
• leukopenia, agranulocytosis, eosinophilia, thrombocytopenia, purpura;
• violation of taste;
• noise in ears.

The withdrawal syndrome: after sudden withdrawal or rapid reduction of an anaphranil dose, the following symptoms often occur: nausea, vomiting, abdominal pain, diarrhea, insomnia, headache, irritability, anxiety.

Contraindications

• increased sensitivity to clomipramine and other drug components, cross-sensitivity to tricyclic antidepressants from the dibenzazepine group;
• simultaneous use of MAO inhibitors, as well as a period of less than 14 days before and after their use;
• simultaneous use of selective inhibitors of MAO type A reversible action (such as moclobemide);
• recently suffered myocardial infarction;
• congenital syndrome of prolongation of the QT interval.

Do not recommend the use of the drug during pregnancy and during breastfeeding.

The drug is not recommended for use in children under 5 years.

Application in pregnancy and lactation

The experience of using Anafranil in pregnancy is limited. Since there are some reports of a possible association between tricyclic antidepressant use and fetal development disorders, Anafranil should be avoided during pregnancy,unless the expected effect of the treatment of the mother clearly exceeds the potential risk to the fetus.

In cases where tricyclic antidepressants were used in pregnancy until the onset of labor, neonates developed a withdrawal syndrome during the first few hours or days, manifested by shortness of breath, drowsiness, colic, irritability, arterial hypotension or hypertension, tremor, spastic phenomena or seizures. To avoid the development of this syndrome, Anafranil should be as slowly as possible phased out, at least 7 weeks before the expected delivery.

Since the active substance of the drug is excreted in breast milk, you should either stop breastfeeding, or gradually cancel Anafranil.

Use in children

Experience in the use of Anafranil in children under 5 years is not available, so it is not recommended to use the drug in children of this age group.

Application in elderly patients

With extreme caution, Anafranil should be prescribed to patients with cardiovascular disease, primarily with cardiovascular failure, intracardiac conduction disorders (eg, an AV blockade of 1-3 degrees), or arrhythmias.In such patients, as well as in elderly patients, it is necessary to regularly monitor cardiac and ECG performance.

Caution is necessary when using Anafranil in patients with chronic constipation. Tricyclic antidepressants can cause paralytic intestinal obstruction, mainly in elderly patients or in patients who are obliged to comply with bed rest.

special instructions

It is known that tricyclic antidepressants reduce the threshold of convulsive readiness, therefore Anafranil should be used with extreme caution in patients with epilepsy, as well as in the presence of other factors predisposing to the onset of convulsive syndrome, for example, brain damage of any etiology, while using neuroleptic drugs, refusal of alcohol or withdrawal of drugs with anticonvulsant properties (eg, benzodiazepines). It is believed that the occurrence of seizures during the administration of Anafranil depends on the amount of the drug. In this regard, do not exceed the recommended daily dose of Anafranil.

With extreme caution, Anafranil should be prescribed to patients with cardiovascular disease, primarily with cardiovascular failure, intracardiac conduction disorders (eg, an AV blockade of 1-3 degrees), or arrhythmias. In such patients, as well as in elderly patients, it is necessary to regularly monitor cardiac and ECG performance.

Before starting therapy with anaphranil, it is recommended to measure blood pressure, as patients with orthostatic hypotension or lability of the cardiovascular system may experience a sharp decrease in blood pressure.

Because the drug has anticholinergic properties, it should be used with extreme caution in patients who have a history of increased intraocular pressure, angle-closure glaucoma, or urinary retention (eg, due to prostate disease).

Due to the anticholinergic effect of tricyclic antidepressants, tearing can be reduced and mucosal secretions may accumulate, which can lead to damage to the corneal epithelium in patients using contact lenses.

Caution is necessary in the treatment of patients with severe liver diseases with tricyclic antidepressants, as well as in patients with adrenal medulla tumors (eg, pheochromocytoma, neuroblastoma), since in this case these drugs can provoke the development of a hypertensive crisis.

It is known that in patients with cyclical affective disorders, taking tricyclic antidepressants, during the depressive phase, manic or hypomanic conditions may develop. In such cases, it may be necessary to reduce the dose of Anafranil or in its cancellation and administration of antipsychotic therapy. After arresting these conditions, if there are indications, treatment with anaphranil in low doses can be resumed.

In predisposed patients and elderly patients, tricyclic antidepressants can provoke the development of drug delirious psychoses, mainly at night. After the drug is discontinued, these disorders take place within a few days.

Care should be taken when treating patients suffering from hyperthyroidism or receiving thyroid hormone medications that may have cardiotoxic effects.

Although changes in the level of leukocytes during the treatment with anaphranil have been reported only in selected cases, periodic study of the composition of peripheral blood and attention to symptoms such as fever and sore throat are recommended, especially in the first months of therapy or with prolonged use of the drug.

Caution is necessary when using Anafranil in patients with chronic constipation. Tricyclic antidepressants can cause paralytic intestinal obstruction, mainly in elderly patients or in patients who are obliged to comply with bed rest.

When Anaphranil is used in doses exceeding the average therapeutic dose, or if the clomipramine concentration in the plasma exceeds the average therapeutic level, there is a risk of prolongation of the QTc interval and the occurrence of a bidirectional spindle-shaped ventricular tachycardia (ventricular pirouette-type rhythm disturbances). This is observed in the case of co-administration with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors.In this regard, it is necessary to avoid the joint administration of clomipramine and drugs that cause its cumulation. It is also necessary to avoid joint intake with drugs that cause prolongation of the QTc interval. The use of diuretics can lead to the development of hypokalemia. It is established that hypokalemia is a risk factor for QTc prolongation and torsades occurrence of ventricular tachycardia (ventricular arrhythmias such as "pirouette"). Therefore, hypokalemia should be eliminated before therapy with anaphranil. Anafranil caution should be given concurrently with selective serotonin reuptake inhibitors or inhibitors of serotonin reuptake and norepinephrine, as well as diuretics.

Due to the risk of serotonin toxicity should adhere to the recommended dose and increase the dose with caution if Anafranil is used in conjunction with serotonergic drugs.

When applied simultaneously with Anafranil serotonergic drugs such as selective serotonin reuptake inhibitors, serotonin reuptake inhibitors and noradrenaline,tricyclic antidepressants or lithium preparations, possibly the development of serotonin syndrome with symptoms such as fever, myoclonus, agitation, convulsions, delirium and coma. If it is necessary to administer fluoxetine, it is recommended to take a two-three-week break between the use of anaphranil and fluoxetine.

Many patients with panic disorders at the beginning of Anafranil treatment are worried. This paradoxical increase in anxiety is most pronounced in the first days of therapy and usually subsides for two weeks.

In patients with schizophrenia receiving tricyclic antidepressants, sometimes the activation of psychosis is noted.

In patients with liver disease, periodic monitoring of hepatic enzyme activity is recommended.

Anaphranil, as well as other tricyclic antidepressants, is prescribed in combination with electroconvulsive therapy only under the condition of careful medical observation.

Depression is characterized by the risk of suicidal actions, which can persist until a reliable remission is achieved. In patients with depression, both in adults and in children,there may be an increase in depression and / or suicidal behavior or other psychiatric symptoms, regardless of whether they receive antidepressant therapy or not. Antidepressants increased the risk of suicidal thoughts and suicidal behavior in short-term studies in children and adolescents with depression and other psychiatric illnesses.

All patients taking Anafranil for any of the indications should be examined for worsening clinical picture, suicidal behavior and other psychiatric symptoms, especially in the initial phase of therapy or when changing the dose of the drug. Such patients should consider the possibility of changing the regimen of therapy, including the possible withdrawal of the drug, especially if such changes are pronounced, suddenly or not observed in patients initially.

Families and guardians of patients (both children and adults) who take antidepressants for psychiatric or nonpsychiatric indications should be warned about the need to observe patients because of the risk of other psychiatric symptoms, including.and suicidal behavior, and immediately report such symptoms to the treating doctors.

When prescribing for Anafranil, the minimum number of tablets should be indicated to reduce the risk of overdose. In this case, an adequate treatment regimen should be observed.

There is evidence suggesting that with the use of Anafranil, there are fewer deaths due to an overdose than with the use of other tricyclic antidepressants.

Before conducting general or local anesthesia, an anesthesiologist should be warned that the patient is taking Anafranil.

An increase in the incidence of dental caries during long-term treatment with tricyclic antidepressants has been reported. Therefore, in the case of prolonged therapy Anafranil recommended regular examination of the patient by the dentist.

The use of diuretics can lead to the development of hypokalemia, which increases the risk of prolonging the QTc interval and the occurrence of a bidirectional spindle-like ventricular tachycardia (such as pirouette). Prior to the initiation of therapy, anaphrenil should be corrected for hypokalemia.

Do not abruptly cancel Anafranil, t. this can lead to adverse reactions.If a decision is made to discontinue treatment, the drug should be withdrawn gradually, as quickly as the clinical situation permits. It should be taken into account that the abrupt withdrawal of the drug may be accompanied by the development of certain symptoms.

The coated tablets, 25 mg, contain lactose and sucrose. Patients with rare hereditary diseases, such as galactose and fructose intolerance, severe lactase deficiency, saccharase-isomaltase deficiency or malabsorption of glucose-galactose, should not take coated tablets Anafranil.

It should be borne in mind that alcohol can exacerbate undesirable phenomena from the side of the central nervous system, such as blurred vision, drowsiness.

Impact on the ability to drive vehicles and manage mechanisms

Patients who experience drowsiness and other abnormalities from the CNS (including blurred vision) when using Anafranil should not drive a car, operate machinery, or engage in other activities that require increased attention and quick response.

Drug Interactions

Pharmacodynamic interaction

Anaphranil can reduce or completely eliminate the antihypertensive effects of guanethidine, betanidine, reserpine, clonidine and alpha-methyldopa. Therefore, in cases when simultaneous administration of Anafranil requires the treatment of hypertension, other drugs should be used (eg, vasodilators or beta-blockers).

Tricyclic antidepressants, incl. Anaphranil, can potentiate the effect of anticholinergic drugs (eg, phenothiazines, antiparkinsonian drugs, atropine, biperiden, antihistamines) on the organ of vision, the central nervous system, the intestine and the bladder.

Tricyclic antidepressants can enhance the effects of ethanol (alcohol) and other agents that have a depressing effect on the central nervous system (eg, barbiturates, benzodiazepines, or anesthesia products).

Do not prescribe Anafranil for at least 2 weeks after the abolition of MAO inhibitors because of the risk of developing severe symptoms and conditions such as hypertensive crisis, fever, and symptoms of serotonin syndrome: myoclonus, agitation, seizures, delirium and coma.The same rule should be followed if the MAO inhibitor is prescribed after previous treatment with anaphranil. In either of these cases, the initial doses of Anafranil or MAO inhibitors should be low, they should be increased gradually, under the constant control of the effects of the drug.

Existing experience shows that Anafranil can be administered no earlier than 24 hours after the withdrawal of MAO type A inhibitors of reversible action (such as moclobemide). But, if the MAO type A inhibitor is administered after the cancellation of Anafranil, the duration of the break should be at least 2 weeks.

The combined use of anaphranil with selective serotonin reuptake inhibitors can lead to an increased effect on the serotonin system.

With simultaneous application Anafranil with selective serotonin reuptake inhibitors or inhibitors of serotonin reuptake and noradrenaline (norepinephrine), tricyclic antidepressants and lithium preparations may develop serotonin syndrome with symptoms such as fever, myoclonus, agitation, convulsions, delirium and coma.

If it is necessary to administer fluoxetine, it is recommended to take a two-three-week break between the use of anaphranil and Fluoxetine - to stop the use of fluoxetine 2-3 weeks prior to the initiation of therapy with anaphranil or to prescribe fluoxetine 2-3 weeks after the end of treatment with anaphranil.

Anafranil can enhance the effect on the cardiovascular system of sympathomimetic drugs (adrenaline, norepinephrine, isoprenaline, Ephedrine and phenylephrine), including. and when these substances are part of local anesthetics.

Pharmacokinetic interaction

The active substance of the drug Anafranil - clomipramine - is mostly excreted as metabolites. The main pathway of metabolism is demethylation to the active metabolite of N-desmethylclimipramine followed by hydroxylation and conjugation of N-desmethylclomipramine with clomipramine. Several isoenzymes of cytochrome P450, mainly CYP3A4, CYP2C19 and CYP1A2, participate in demethylation. Elimination of both active components is carried out by hydroxylation, which is catalyzed by CYP2D6.

Co-administration with inhibitors of the isoenzyme CYP2D6 can lead to an increase in the concentrations of both active components to threefold in persons with the phenotype of the rapid metabolizer of debrisoquine / sparteine.At the same time, in these patients, the metabolism decreases to a level characteristic for persons with the phenotype of a weak metabolizer.

It is assumed that joint administration with inhibitors of isoenzymes CYP1A2, CYP2C19 and CYP3A4 may lead to an increase in clomipramine concentration and a decrease in the concentration of N-desmethyl clomipramine.

MAO inhibitors (eg, moclobemide) are contraindicated in the administration of clomipramine, because they are potent inhibitors of CYP2D6.

Antiarrhythmic drugs (for example, quinidine and propafenone) should not be used in conjunction with tricyclic antidepressants, tk. they are potent inhibitors of CYP2D6.

Selective serotonin reuptake inhibitors (such as fluoxetine, Paroxetine or sertraline) inhibit CYP2D6; other drugs of this group (eg fluvoxamine) also inhibit CYP1A2, CYP2C19, which can lead to an increase in clomipramine concentration in the plasma and the development of corresponding undesirable effects. A 4-fold increase in the equilibrium concentration of clomipramine was observed with co-administration with fluvoxamine (the concentration of N-desmethylclomipramine decreased 2-fold).

Joint use of neuroleptics (for example,phenothiazines) can lead to an increase in plasma concentrations of tricyclic antidepressants, a decrease in the convulsive threshold, and the occurrence of seizures. Combination with thioridazine may lead to the development of severe cardiac rhythm disturbances.

Combined use with cymetidine blocker of histamine H2 receptors (which is an inhibitor of some cytochrome P450 isoenzymes, including CYP2D6 and CYP3A4) can lead to an increase in plasma concentrations of tricyclic antidepressants, which requires a reduction in the dose of the latter.

There is no evidence to support the interaction between anaphranil (at a dose of 25 mg per day) and oral contraceptives (15 or 30 mg ethinylestradiol per day) with a constant intake of the latter. There is no evidence that estrogens are inhibitors of CYP2D6, the main isoenzyme involved in eliminating clomipramine, so there is no reason to expect their interaction. Although simultaneous use of the tricyclic antidepressant imipramine and estrogen in high doses (50 mg / day), in some cases, the aggravation of side effects and the increased therapeutic effect of the antidepressant have been reported.It is not known whether these data are significant for the simultaneous use of clomipramine and estrogens in low doses. When combined use of tricyclic antidepressants and estrogens in high doses (50 mg per day), it is recommended to monitor the therapeutic effect of antidepressants and, if necessary, correct the dosage regimen.

Methylphenidate can help increase the concentration of tricyclic antidepressants, possibly by suppressing their metabolism. With the joint use of these drugs, an increase in the concentration of tricyclic antidepressants in blood plasma is possible, and a dose reduction of the latter may be required.

Some tricyclic antidepressants may enhance the anticoagulant effect of coumarins (eg, warfarin), possibly by inhibiting their metabolism (CYP2C9). There is no evidence to prove the ability of clomipramine to inhibit the metabolism of anticoagulants (warfarin). Nevertheless, when using this class of drugs, it is recommended to monitor the concentration of prothrombin in the plasma.

Joint reception of anaphranil with drugs - inducers of cytochrome P450, especially CYP3A4, CYP2C19 and / or CYP1A2 may lead to increased metabolism and reduce the efficacy of Anafranil.

The simultaneous administration of anaphranil with CYP3A and CYP2C inducers, such as rifampicin or anticonvulsants (eg, barbiturates, carbamazepine, Phenobarbital and phenytoin), can lead to a decrease in clomipramine concentration in the plasma.

Known inductors CYP1A2 (for example, nicotine / other components of cigarette smoke) reduce the concentration of tricyclic antidepressants in blood plasma. The equilibrium concentration of clomipramine in cigarette smoking people is 2 times lower than that of non-smokers (the concentration of N-desmethylclomipramine did not change).

Clomipramine inhibits the activity of CYP2D6 (oxidation of sparteine). Thus, clomipramine can increase concentrations of concomitantly used drugs metabolized mainly with the participation of CYP2D6 in individuals with the phenotype of a strong metabolizer.

Analogues of the drug Anafranil

Structural analogs for the active substance:

• Anaphranil SR;
• Clominal;
• Clomipramine;
• Clofranil.

Analogues on the curative effect (antidepressants):

• Agomelatine;
• Ademethionine;
• Adress;
• Azafen;
• Amitriptyline;
• Anaphranil SR;
• Valdoxane;
• Velafax;
• Venlaksor;
• Venlafaxine;
• Vokssel;
• Gelarium Hypericum;
• Heptor;
• Heptral;
• Depres;
• Deprim;
• Deprim forte;
• Duloxent;
• Duloxetine;
• Zoloft;
• Kaliksta;
• Clominal;
• Clomipramine;
• Clofranil;
• Coaxyl;
• Lerivon;
• Maprotibene;
• Maprotiline;
• Miansan;
• Mirzaten;
• Mirtazapine;
• Mirtalan;
• Nerustin;
• Neuroplant;
• Noxibel;
• Oprah;
• Paxil;
• Paroxetine;
• Pirazidol;
• Plizil;
• Prodep;
• Prozac;
• Rexetin;
• Selektra;
• Sertraline hydrochloride;
• Stimuloton;
• Trittico;
• Févarine;
• Flunisan;
• Fluoxetine;
• Cipralex;
• Citalopram;
• Elivel;
• Elicia;
• Escitalopram;
• Ephevelone;
• Epevelon retard.

Similar medicines:

Other medicines: