Anafranil

Anafranil is the brand name for clomipramine, a tricyclic antidepressant (TCA). It was among the earliest TCAs developed for mood disorders and is most commonly used to treat obsessive-compulsive disorder (OCD). It is also prescribed for major depressive disorder and, in some cases, off-label for panic disorder or certain chronic pain conditions.

Pharmacology and use: Clomipramine inhibits the reuptake of serotonin, with additional activity on other neurotransmitter systems, which contributes to its effectiveness in OCD. It has notable anticholinergic effects and sedation. Treatment for OCD typically starts with a low dose and gradual titration, with a usual adult daily range of up to 250 mg, given in divided doses. Onset of therapeutic benefit for OCD often requires several weeks.

Side effects and safety: Common adverse effects include dry mouth, constipation, blurred vision, urinary retention, drowsiness, dizziness, weight gain, and sexual dysfunction. Anticholinergic effects can be prominent, and orthostatic hypotension and sedation may occur. Overdose with TCAs can be life-threatening and requires urgent medical attention. Serotonergic agents can increase the risk of serotonin syndrome.

Interactions and precautions: Clomipramine is contraindicated with recent use of MAO inhibitors and should be used with caution with other serotonergic drugs, CNS depressants, and QT-prolonging medications. It is contraindicated in certain heart conditions and angle-closure glaucoma; caution is advised in elderly patients and those with seizure disorders. Pregnancy should be considered only if clearly needed.

Regulatory status: Anafranil is a prescription medication. In OCD, selective serotonin reuptake inhibitors are often preferred first-line treatments, with clomipramine used when SSRIs are ineffective or poorly tolerated.