Reviews about the antidepressant Anafranil - effective, but dangerous, analogs are slightly better

This is a drug that belongs to the clinical and pharmacological group "antidepressants".

This psychotropic drug is used primarily in the treatment of depressive conditions and about the prevalent mental disorders.

The main active substance is clomipramine hydrochloride.

With all the advantages, the medicine has many disadvantages, about this later in the article.

Drugs with a pronounced antidepressant property. It also has an analgesic and H2-histamine-blocking action. Eliminates bedwetting, helps reduce appetite.

Drug slows intraventricular conduction, thus, an antiarrhythmic effect occurs.

The antidepressant property is explained by an increase in the concentration of noradrenadine and( or) serotonin in the synapses of the central nervous system. The accumulation of these substances is due to a decrease in the reuptake of serotonin by the membranes of presynaptic nerve cells.

Explanation: serotonin is a hormone of pleasure, joy, happiness.

Noradrenaline is responsible for wakefulness of the body.

The long-term administration of reduces the activity of adenobate- and serotonin receptors of the GM, normalizes serotonergic and adrenergic transmission - the data of the system are out of balance with depressive states.

It is assumed that mood depression, anxiety and inhibition are eliminated when taking drugs due to a change in the content of monoamines in the central nervous system( especially serotonin).

Also on such conditions, the effect of the drug on the endogenous opioid systems has a positive effect.

The mechanism of soothing action is explained by the decrease in the rate of the excitation process( affecting the function of beta and alpha-adrenoceptor receptors, norepinephrine circulation).

The effectiveness of the drug for bulimia nervosa is obvious, but the mechanism of action is not clear( presumably, the antidepressant mechanism described above).

It is believed that the analgesic effect is provided by facilitating the exchange of nerve impulses, which are mediated by norepinephrine and serotonin.

Selecting effective and safe tablets from migraines is not so easy. After studying the patients' feedback, we were able to do this.

Are there any special symptoms of intracranial pressure in women that is abnormal? How can I independently determine that ICP is not normal.

Pharmacokinetics of the drug

Clomipramine is fully absorbed into the tract after internal admission, or IV, in / m administration.

binds to blood proteins by 97.6%.

0.6 part of the drug is excreted with urine, and 0,4 - with feces( from 1).

Tablets

Bioavailability: approximately 50%, with the first intake will be somewhat lower.

Food intake does not affect the amount of digestible active substance, only the speed.

With a daily intake of 75 mg of the drug, the concentration of clomipramine in the blood is 20-175 ng / ml.

Clomipramine is excreted in breast milk in approximately the same amount as it is contained in the blood plasma.

Excreted mainly in the form of a metabolite, N-desmethylclomipramine.

Time of half-life from blood plasma: clomipramine - from 12 to 36 hours, desmethylclomipramine - 36 hours on average.

In the elderly, the drug is excreted longer and the time to reach the maximum concentration in the blood plasma is greater.

Solution

With a daily injection of 50-140 mg per day, the plasma content is less than 150 to 447 ng / ml clomipramine and less than 15 to 669 ng / ml N-desmethylclomipramine.

After intravenous or intravenous administration, clomipramine half-life is 18 hours, desmethylclimipramine is from 20 to 40 hours.

In elderly patients, the concentration of active substance in the blood will be higher due to a decrease in the rate of metabolic processes.

Indications for use

Having studied the instructions for use of the drug Anafranil, it is possible to distinguish such indications:

• depressive states of various symptoms and origin( reactive, endogenous, organic, masking depression. ..);
• senile depressive syndromes;
• depressive syndrome in personality disorders and schizophrenia;
• obsessions;
• panic attacks of fear( tablets only);
• loss of muscle tone, which usually accompanies narcolepsy;
• as part of the general course of chronic pain syndrome( in cancer patients suffering from migraine, with post-traumatic disorders, diabetic neuropathy, etc.);
• phobia;
• prevention or elimination of headaches, migraines;
• nighttime uncontrolled urination, not associated with impaired urinary function( tablets only).

The drug is indicated to children only in the case of obsessive, neurotic or night enuresis( age over 5 years).With other pathologies, the drug is not recommended from the list.

Contraindications for taking Anafranil

Not recommended, if:

• recent transfer of myocardial infarction;
• hypersensitivity to one or more of the components of the drug;
• acute intoxication with alcohol, analgesics, psychotropic drugs;
• closed angle glaucoma;
• acute conduction disorders( blockade);
• stroke;
• thyrotoxicosis.

Assign with caution:

• bronchial asthma;
• manic-depressive psychosis;
• weakened bone marrow hematopoiesis;
• cardiovascular failure;
• angina, arrhythmia;
• epilepsy;
• chronic alcoholism;
• urinary retention;
• hyperplasia of the prostate;
• schizophrenia( risk of activation of psychosis);
• old age;
• abnormal motor function of the gastrointestinal tract( risk of paralysis obstruction);
• intraocular hypertension;
• reduced blood pressure;
• high sensitivity threshold for dibenzazepines;
• tumor of adrenal medulla( neuroblastoma, pheochromacitoma) - a hypertensive crisis is possible.

Taking medication by children

Anaphranil can enhance suicidal thoughts and depressive conditions for a certain period.

Tablets

It is not recommended to use for children under 5 years of age, since there is insufficient information about possible risks in this case.

Some specialists limit the intake of the drug before the age of 12 years - in the treatment of depression, and up to 10 years - in an obsessional condition.

All risks must be considered before assignment. Even a minimal excess of the permissible dose of the drug can lead to a fatal outcome in childhood.

Solution for children is not assigned.

The choice of antidepressants for children of different ages

Admission during pregnancy

Animal studies in the reproductive phase revealed that Anafranil negatively affects the fetus of .

Analytical activity on the effect of the drug on the human fetus was not carried out in the womb, however, specialists do not recommend prescribing drugs to pregnant women.

The prescription is possible only if the benefit to the mother is greater than the potential risk for the baby in the womb.

In case of prescribing a pregnant woman, one should refrain from taking it at least during the first trimester.

In case of acute need for during pregnancy, the drug should be gradually withdrawn at least 8 weeks before the estimated date of delivery, otherwise the newborn can develop withdrawal syndrome, which is manifested by drowsiness, dyspnea, nervous excitability, colic, arterial hypertension- or hypotension, cramps.

Lactation

Because the drug is excreted in breast milk, it should be discarded during breastfeeding( due to the fatal danger of the active substance for newborns).

In case of impaired liver and kidney function

Assign with caution. Periodically, take an analysis of liver function and blood cell counts during treatment.

Forms of release

The preparation is produced in such as:

1. Anaphranil 25 mg, tablets No. 10, 30. Light yellow, biconvex, round.
2. Anaphranil 75 mg tablets. Pink, in the form of capsules, biconcave, with an engraved strip on both sides, on one side of the "C / G", "G / D" - on the other. They are sold in blisters, in a cardboard box. In each blister is 10 pieces.
3. Mortar for intravenous or intravenous administration of 25 mg, ampoules. Colorless, transparent. For sale in cardboard packs of 10 pieces.

Application Anafranil

We will study the instructions for use with anaphranil in more detail.

Before the course of treatment should eliminate the lack of potassium in the body:

• tablets Anaphranil taken orally, during or after meals, do not chew, drink enough oxen;
• solution Anaphranil is administered as an injection intramuscularly or as an infusion intravenously, in a hospital setting.

The dosage is chosen individually by , taking into account the diagnosis, concomitant diseases or conditions, age( in children and the elderly, the dose will be less).

Assign minimum effective doses.

Dosage and administration depending on the disease

Dosages will depend on the form of the preparation.

Tablets 25, 75 mg

Tablets are advised to use as:

1. Depression, obsessive-compulsive disorder, phobia: in the first days of treatment, the dosage is 25 mg, 2-3 times a day. Then, within a week, the dose gradually rises( for example, every few days +25 mg) to a volume of 100-150 mg. In acute cases, the daily dose may be 250 mg. After the therapeutic effect, a maintenance dose( 50-100 mg per day) is established.
2. Panic attacks : The initial dose is 10 mg per day( it is possible to combine with another drug from benzodiazepines).Then the volume of drugs is increased until the effect is achieved. Then the medicine from benzodiazepines is gradually canceled. After withdrawal of the auxiliary drug, the daily dose of Anafranil is 25-100 mg. In severe cases, 150 mg per day can be taken. The course lasts at least half a year, with a gradual decrease in dosage.
3. Fears of fear : the initial dose is 10-15 mg per day. Then it is increased within 10 days to the desired effect, taking into account that the maximum dose will be 50-100 mg.
4. Catalepsy, which accompanies narcolepsy : 25-75 mg per day.
5. Chronic pain syndrome : the dosage is selected individually( 10-150 mg per day), taking into account what other drugs are taken.
6. In the elderly, : a course of treatment starts with 10 mg per day, then, within 10 days, the dosage rises to the optimum( 30-50 mg).The achieved volume is taken before the completion of treatment.
7. Children and adolescents : Treatment course begins with a dose of 25 mg per day. The first 2 weeks the dosage of the drug is increased to a volume of 3 mg per kg or 100 mg. The following weeks can be 200 mg if necessary.
8. Nocturnal urination in children , not caused by pathology of internal organs: the initial dose is 20-30 mg( 5-8 years), 25-50 mg( 9-12 years), 25-75 mg( 12-17 years).

Higher volumes are assigned only if there is no result after a one-week course.

Usually, the whole daily dose is taken once, before bed.

But if nighttime urination occurs early in the night, then the drug should be taken at 4pm. The full course is 1-3 months. Dosage is reduced gradually. Drug withdrawal is undesirable.

Depending on the frequency of taking and dosage of the drug, get the most convenient form of its release.

Intramuscular injection of

solution The initial dose is 25-50 mg( 1-2 ampoules) of , then every day the amount of the drug is increased by 25 mg to a value of 100-150 mg( 4-6 ampoules).

After the improvement of the patient's condition, the number of injections slowly decreases, the patient switches to the tablet form of the drug( maintenance therapy).

Intravenous infusion

Assigned in the morning.

Drip administration begins with a dose of 50-75 mg( 2-3 ampoules) once a day. To prepare a solution for infusion, 250-50 ml of glucose solution, dextrose( 0.5%) or sodium chloride is used.

The procedure lasts 1.5-3 hours. It is necessary to monitor the patient's condition for timely detection of side effects( especially it is necessary to monitor blood pressure).After reaching a therapeutic effect, the treatment lasts another 3-5 days.

Then they switch to maintenance therapy - tablets. You can also go first to the / m introduction, and then to an oral intake.

For specific diseases appoint:

• pain syndrome: 0.5-0.5 ampoules per day;
• narcolepsy with catalepsy: 1-3 ampoules a day.

Children and adolescents: IV or IM are not recommended.

Intramuscular and intramuscular administration is given if oral administration of the drug by the patient or in acute forms of the disease is not possible.

Overdose Anafranil

Data on anaphranil overdose are based on the consequences of excessive use of similar drugs - tricyclic antidepressants.

Symptoms occur within the first 4 hours after taking the medication and can be expressed as much as possible in 24 hours. Also, the risk of side effects exists for 4-6 days after ingestion of drug:

1. Central nervous system: stupor, drowsiness, restlessness, ataxia, coma, muscle weakness, increased reflexes, convulsions, fever, muscle spasms, confusion.
2. Cardiovascular system: sharp drop in blood pressure, prolongation of QT interval, tachycardia, arrhythmia, shock, conduction disturbance in the ventricles, heart failure, very rarely - cardiac arrest.
3. Other: shortness of breath, sweating, fever, vomiting, blueness of the covers, dilated pupils, urinary retention or lack of urine in the bladder.

Treatment: antidote for overdose Anaphranil does not exist, it is necessary to perform symptomatic and supportive therapy. Do not perform peritoneal or hemodialysis for the treatment of overdose symptoms - there will not be an effect.

If the patient accidentally took an oral solution, the should be washed immediately, causing vomiting. If he has lost consciousness, then before washing the stomach perform intubation of the trachea. In this case, do not induce vomiting.

Activated charcoal will help slow down the absorption of the drug.

It is advisable to hospitalize a patient for continuous monitoring and care for 3-5 days in case of an overdose.

Side effects of

Usually, we diagnose weak negative effects during the administration of Anafranil. Many patients can confuse the body's response to a drug with symptoms of depressive conditions.

In case there are serious deviations in the work of the nervous system or mental disorders during the course of treatment, the drug should be canceled.

1. Mental problems. Often: fatigue, drowsiness, increased appetite, anxiety, disorientation, hallucinations( especially in elderly patients and those suffering from Parkinsonism), anxiety, sleep disorders, aggressiveness, manic disorders, impaired perception of one's own thoughts and actions, nightmares, memory loss, mood deterioration, yawning, inability to concentrate, delirium. Sometimes: has psychotic symptoms( a person loses touch with the real world).
2. Central and peripheral nervous system. Very often : headache, dizziness, muscle spasms, trembling of limbs. Often: muscle weakness, speech disorders, hypertension of muscles. Sometimes: discoordination of movements, convulsions. Very rare: neuroleptic syndrome, changes on the ECG.
3. Anticholinergic symptoms. Very often: excessive sweating, dry mouth, blurred vision, impaired urination. Often: hot flashes, dilated pupils. Very rare: urinary retention, glaucoma.
4. Cardiovascular system. Often: tachycardia. Sometimes: increased blood pressure, a heart rhythm disorder. Very rarely: QT interval elongation, ventricular tachycardia.
5. GASTROINTESTINAL TRACT.Very often: vomiting, nausea, diarrhea, anorexia, abdominal discomfort. Very rarely: hepatitis.
6. Epidermis. Often: urticaria, rash, skin sensitivity to sunlight, itching. Very rarely: hair loss, swelling, allergy, thrombophlebitis, burning caused by intravenous injection.
7. Endocrine system. Very often: decreased sexual desire, weight gain. Often: discharge from the breast, enlargement of mammary glands.
8. The hematopoiesis system. Very rarely : agranulocytosis, purpura, thrombocytopenia, leukopenia, eosinophilia.
9. Sense organs. Often: tinnitus, impaired taste perception.
10. If you cancel the drug. Often : vomiting, nausea, abdominal pain, insomnia, diarrhea, irritability, headache, anxiety.

Most side effects occur without the need to cancel the medication.

Special instructions

It should be noted, that:

1. Families of patients should be warned about taking the drug, since careful monitoring of the patient's mental state is necessary.
2. There have been cases of development of dental caries with a long course of treatment. It is necessary to undergo regular examination at the dentist.
3. Adverse effects from taking Anafranil affect the ability to drive vehicles and perform other jobs that require increased concentration of attention, quick response.
4. That there was no withdrawal syndrome, you need to stop taking the medicine gradually.
5. Electroconvulsive therapy should be performed under close supervision with concurrent administration of the drug.

Interaction of Anafranil with other

preparations It must be remembered that that:

1. Before anesthesia, a specialist should be warned about the drug treatment.
2. Do not use with QT prolonging medications.
3. Do not use with other medicines that inhibit the action of Anafranil( back seize serotonin and norepinephrine).
4. If it is necessary to appoint fluoxetine, between taking this drug and anaphranil should take 2-3 weeks minimum.
5. It is advisable not to take diuretics during the course.
6. Anaphranil inhibits the action of batanidine, guanethidine, rubber, alfamethyldopa, clonidine.
7. Anaphranil can enhance the effect of anticholinergics on the central nervous system, eyes, bladder, intestines( atropine, biperidine, antihistamines, antiparkinsonian drugs).
8. Do not administer together or immediately after withdrawal of MAO inhibitor drugs.
9. drugs can enhance the effect of sympathomimetic drugs on CAS( epinephrine, norepinephrine, ephedrine, phenylethrin).

The drug can enhance the effects of alcohol and other CNS-oppressors.

Reviews of patients and doctors

Reviews of patients who have received a course of treatment with the drug Anafranil are ambiguous.

1. Patient Antonina: "After the divorce was often depressed, the doctor prescribed Anafranil. There were pains in the stomach, so I was prescribed injections of the drug. Depression began to pass, I began to rejoice more often, negative impressions left my thoughts. "
2. Patient Katerina: "Anaferin is the only thing that helped my husband cope with alcoholism. He had a heavy psychological dependence. Have appointed or nominated nyxes. He relaxed, became adequate, though a little sad. And before that, without alcohol, he came into a rage. "
3. Dr. Anton: "Despite a rather impressive list of side effects, patients in general are well undergoing treatment. Sometimes an individual adjustment of the dose is simply required. "

Based on the experience of practical application, we note the pros and cons of the

drug. Pros:

• is exactly the same as described in the manual;
• reasonable price;
• result is noticeable after the first week of application.

Cons:

• dose in the instructions is not universal and can cause side effects;
• does not help everyone;
• can not abruptly stop treatment;
• "frightening" list of side effects.

Cost of medication in pharmacies

The price for Anafranil varies and amounts to approximately:

• tablets 25 mg, 30 pieces: 290-355 rubles;
• tablets 75 mg, 10 pieces: 480-715 rubles;
• injection for 25 mg, 10 ampoules: 640-750 rubles.

Storage conditions and shelf life

The product can be stored for 5 years in a dry place inaccessible to children, at a temperature not exceeding 30 ° C.

. Leave at the pharmacy

The drug is sold by prescription.

Analogs Anafranil

Analogs have the same active component - clomipramine.

The differences of will be in price, the variety of release forms and additional components that affect the bioavailability, the rate of absorption and withdrawal of the drug, as well as the possible contraindications and strength of action.

Basic analogs of Anaphranil:

1. Clomipramine tablets 25 mg. The price: from 160 rubles. The half-life and absorption time is less than that of Anafranil, therefore, it acts faster.
2. Clofranil tablets 25 mg. Price: from 235 rubles. The composition contains lactose, which increases the bioavailability of the drug, but it will be contraindicated in people with lactose intolerance or lactose-deficiency. It is difficult to find in pharmacies.
3. Clone dragee 25 mg, a solution of 25 mg. It is difficult to find in pharmacies.

You can also pick up drugs with a similar spectrum of action, but with other ingredients, if this substance does not suit you.

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