Nevertheless, caution is necessary in treating patients with known cardiovascular disease, and gradual dose titration is recommended. Psychosis, Confusion, and Other Neuropsychiatric Phenomena — Patients treated with Anafranil have been reported to show a variety of neuropsychiatric signs and symptoms including delusions, hallucinations, psychotic episodes, confusion, and paranoia. Because of the uncontrolled nature of many of the studies, it is impossible to provide a precise estimate of the extent of risk imposed by treatment with Anafranil.

As with tricyclic antidepressants to which it is closely related, Anafranil may precipitate an acute psychotic episode in patients with unrecognized schizophrenia. Activation of mania or hypomania has also been reported in a small proportion of patients with affective disorder treated with marketed tricyclic antidepressants, which are closely related to Anafranil.

In the vast majority of instances, these enzyme increases were not associated with other clinical findings suggestive of hepatic injury; moreover, none were jaundiced. Rare reports of more severe liver injury, some fatal, have been recorded in foreign postmarketing experience. Caution is indicated in treating patients with known liver disease, and periodic monitoring of hepatic enzyme levels is recommended in such patients.

As is the case with tricyclic antidepressants to which Anafranil is closely related, leukocyte and differential blood counts should be obtained in patients who develop fever and sore throat during treatment with Anafranil. Central Nervous System — More than 30 cases of hyperthermia have been recorded by nondomestic postmarketing surveillance systems.

Most cases occurred when Anafranil was used in combination with other drugs. When Anafranil and a neuroleptic were used concomitantly, the cases were sometimes considered to be examples of a neuroleptic malignant syndrome. Sexual Dysfunction — The rate of sexual dysfunction in male patients with OCD who were treated with Anafranil in the premarketing experience was markedly increased compared with placebo controls i.

Electroconvulsive Therapy — As with closely related tricyclic antidepressants, concurrent administration of Anafranil with electroconvulsive therapy may increase the risks; such treatment should be limited to those patients for whom it is essential, since there is limited clinical experience. Surgery — Prior to elective surgery with general anesthetics, therapy with Anafranil should be discontinued for as long as is clinically feasible, and the anesthetist should be advised.

Use in Concomitant Illness — As with closely related tricyclic antidepressants, Anafranil should be used with caution in the following: Hyperthyroid patients or patients receiving thyroid medication, because of the possibility of cardiac toxicity; Patients with increased intraocular pressure, a history of narrow-angle glaucoma, or urinary retention, because of the anticholinergic properties of the drug; Patients with tumors of the adrenal medulla e. Withdrawal Symptoms — A variety of withdrawal symptoms have been reported in association with abrupt discontinuation of Anafranil, including dizziness, nausea, vomiting, headache, malaise, sleep disturbance, hyperthermia, and irritability.

In addition, such patients may experience a worsening of psychiatric status. Information for Patients Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with clomipramine hydrochloride and should counsel them in its appropriate use.

The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking clomipramine hydrochloride.

Clinical Worsening and Suicide Risk — Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness , hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down.

Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms.

Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. Physicians are advised to discuss the following issues with patients for whom they prescribe Anafranil: Patients should be advised that taking Anafranil can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle-closure glaucoma.

Pre-existing glaucoma is almost always open-angle glaucoma because angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy.

Open-angle glaucoma is not a risk factor for angle-closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure e. Drug Interactions The risks of using Anafranil in combination with other drugs have not been systematically evaluated. Close supervision and careful adjustment of dosage are required when Anafranil is administered with anticholinergic or sympathomimetic drugs. Several tricyclic antidepressants have been reported to block the pharmacologic effects of guanethidine, clonidine, or similar agents, and such an effect may be anticipated with CMI because of its structural similarity to other tricyclic antidepressants.

The plasma concentration of CMI has been reported to be increased by the concomitant administration of haloperidol; plasma levels of several closely related tricyclic antidepressants have been reported to be increased by the concomitant administration of methylphenidate or hepatic enzyme inhibitors e.

Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants TCAs when given usual doses. Depending on the fraction of drug metabolized by P 2D6, the increase in plasma concentration may be small, or quite large 8 fold increase in plasma AUC of the TCA. In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers.

An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. In cazul depresiei, tulburarilor afective, tulburarilor obsesiv-compulsive si fobiilor, doza zilnica recomandata este in general cuprinsa intre 75 mg si mg.

In cazul atacurilor de panica si agorafobiilor, tratamentul se incepe in mod obisnuit cu 10 mg pe zi si dupa cateva zile doza se creste treptat pana la maxim mg. Pentru afectiuni cronice dureroase, doza zilnica recomandata este in general cuprinsa intre 10 mg si mg.

Pentru copii peste 6 ani cu enurezis nocturn, doza zilnica recomandata este in general cuprinsa intre 10 mg si 30 mg clorhidrat de clomipramnina. Luati medicamentul asa cum v-a prescris medicul dumneavoastra.

Nu luati mai mult, mai frecvent sau pentru o perioada de timp mai lunga decat v-a recomandat medicul dumneavoastra. Nu schimbati sau intrerupeti tratamentul fara a intreba medicul dumneavoastra.

Este posibil ca medicul dumneavoastra sa decida scaderea treptata a dozelor inainte de intreruperea completa a tratamentului. Acest lucru previne agravarea starii dumneavoastra si scade riscul aparitiei simptomelor de intrerupere, cum sunt durerile de cap, greata si disconfortul general. Daca ati uitat sa luati o doza?

Daca urmatoarea doza trebuie administrata peste putin timp, sariti doza uitata si continuati orarul de administrare a dozelor, in mod normal.

Daca aveti intrebari legate de acest aspect, intrebati medicul dumneavoastra. Daca ati luat o doza mai mare? Daca din greseala ati luat mai multe drajeuri decat v-a prescris medicul dumneavoastra, mergeti imediat sau anuntati departamentul de urgente al celui mai apropiat spital sau medicul dumneavoastra. In primele cateva ore apar de regula urmatoarele simptome: In mod normal acestea nu necesita atentie medicala si pot sa dispara in timpul tratamentului, pe masura ce corpul dumneavoastra se obisnuieste cu medicamentul.

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© Copyright 2017 Anafranil de 10 mg. Posologie ANAFRANIL 10 mg Comprimé enrobé Boîte de Utiliser le dosage adapté en fonction de la dose journalière prescrite. DEPRESSION: Posologie..