What Should I Do Before Starting a New Antidepressant?

Clomipramine hydrochloride tablets, the indications are depression states of various causes and symptoms:-endogenous, reactive, neurotic, organic, occult and menopausal depression. -Depression associated with schizophrenia and personality disorders. -Depression syndrome due to premature aging, aging, chronic pain, and chronic physical illness. -Reactive, neurotic and psychotic depressive mood disorders, including their corresponding physical manifestations, are also found in children. Obsessive-compulsive syndrome (OCD) Other indications: phobias and panic attacks, cataplexy with narcolepsy, chronic pain, nocturnal enuresis (over 5 years of age, possible organic causes should be ruled out first).

Drug Name: Clomipramine hydrochloride tablets

Drug type: Prescription medicines, essential medicines, medicines for medical workers' injuries
Use classification: Tricyclic

Clomipramine hydrochloride tablets ingredients

Active ingredient: Clomipramine hydrochloride Chemical name: N, N-dimethyl-10,11-dihydro-3-chloro-5H-dibenzo [b, f] azepine-5-propylamine hydrochloride Chemical Structure:

Molecular formula: C ₁₉ H ₂₃ ClN ₂ · HCl
Molecular weight: 351.32

Characteristics of Clomipramine Hydrochloride Tablets

This product is a light yellow round biconvex sugar-coated tablet. After removing the sugar coating, it is yellow-white.

Indications of clomipramine hydrochloride tablets

Depressive states with various causes and symptoms:
-Endogenous, reactive, neurotic, organic, occult and menopausal depression.
-Depression associated with schizophrenia and personality disorders.
-Depression syndrome due to premature aging, aging, chronic pain, and chronic physical illness.
-Reactive, neurotic and psychotic depressive mood disorders, including their corresponding physical manifestations, are also found in children.
Obsessive-compulsive syndrome (OCD) Other indications: phobias and panic attacks, cataplexy with narcolepsy, chronic pain, nocturnal enuresis (over 5 years of age, possible organic causes should be ruled out first).

Clomipramine Hydrochloride Tablets Specifications

25mg

Clomipramine hydrochloride tablets dosage

Before starting treatment with Anafinil, you should first treat possible hypokalemia (see note)
The dosage and mode of administration should be determined according to the circumstances of different individuals and patients. In principle, the smallest dose should be used to achieve the best effect, and the dose should be carefully increased, especially in the treatment of elderly and adolescent patients, because of its stronger response to anafinil than in middle-aged patients.
In order to prevent possible QT interval prolongation and serotonin poisoning, it is recommended to use anafinil at the recommended dose. When taking drugs that may cause QT interval prolongation or other serotonin activating drugs, increase Take the dose of Finney.
During the treatment with this product, the patient's efficacy and drug tolerance should be closely monitored.
Depression, obsessive-compulsive disorder, and phobia: early treatment: one tablet at a time, 2-3 times a day. Subsequent doses will gradually increase depending on the patient's tolerance to the drug, such as 25 mg every two or three days during the first week of treatment, until 4-6 tablets per day.
In severe cases, the maximum daily dose can be increased to 250 mg. Once the condition has improved significantly, adjust the dose to a maintenance amount, which is an average of 2-4 tablets of 25 mg daily. Panic attack, square horror: Initially, take 10 mg daily. Increase the dose according to the tolerance of the drug to achieve the desired effect. The daily amount required varies from patient to patient, and varies widely, from 25 mg to 100 mg. It can be increased to 150 mg if the condition requires it. It is generally believed that treatment should last at least 6 months, during which the maintenance amount can be gradually reduced. Sudden onset of narcolepsy: 25-75 mg of this product taken orally daily.
Chronic pain state: The dose should be individualized (10-150 mg per day), considering that patients may be combined with analgesics (or the amount of analgesics may be reduced).
Elderly patients: Start treatment with 10 mg daily, and gradually increase the dose to a suitable dose of 30-50 mg daily, usually about 10 days, and then maintain this amount until the end of treatment.
Juveniles:
Obsessive-compulsive disorder: Began treatment with 10 mg tablets 1 tablet daily. Within 10 days, the dosage for children 5-7 years old increased to 20 mg daily, and for children 8-8 years old increased to 20-50 mg daily. Above 14 years old Children increase to 50 mg or more.
Nocturnal enuresis (limited to 5 years old and above, except for organic reasons; careful comparison of possible risks and benefits before taking the drug; replacement treatments that may be needed should be considered): initial daily dose: 5-8 years old --- 10 mg tablets, 2-3 tablets; 9-12 years old-25 mg tablets, 1-2 tablets; 12 years old or older-25 mg tablets, 1-3 tablets. When there is no sufficient effect within one week of administration, a higher dose should be given. Generally, it should be given once after dinner, but a partial dose should be given in advance (4 pm) to children who have enuresis shortly after falling asleep. After obtaining the desired effect, the maintenance amount should be gradually reduced and the treatment should be continued for 1-3 months.
No medication experience for children under 5 years of age.
There is not enough information about the safety and effectiveness of anafinil in children and adolescents with depression (which can have different causes and manifestations), phobias, panic attacks, narcolepsy with sudden onset, and chronic pain. evidence of. Therefore, it is not recommended for patients aged 0-17 years with these diseases.

Adverse reactions of clomipramine hydrochloride tablets

Adverse reactions are often mild and transient and will disappear when treatment is continued or the dosage is reduced. Adverse reactions are not always related to plasma drug levels or doses. It is often difficult to distinguish certain adverse reactions from depressive symptoms such as fatigue, sleep disturbances, agitation, anxiety, constipation, and dry mouth.
If there is a severe neurological or psychiatric reaction, anafinil should be discontinued.
Elderly patients are particularly sensitive to the anticholinergic, neurological, and psychiatric effects of anafinil or their cardiovascular effects. Their ability to metabolize and clear the drug may decrease, so there is a risk of increased plasma concentrations at therapeutic doses.
Adverse reactions were categorized by frequency of occurrence: very common 10%; 1% common <10%; 0.1% infrequent <1%; 0.01% rare <0.1%; extremely rare <0.01%, including case reports.
Central nervous system mental function:
Very common: lethargy, fatigue, restlessness, increased appetite.
Common: blurred consciousness, disorientation, hallucinations (especially in elderly patients and patients with Parkinson's disease), anxiety, agitation, sleep disorders, mania, hypomania, aggressive behavior, memory impairment, disintegration of personality, Increased depression, impaired concentration, insomnia, nightmares, and yawning.
Uncommon: Inducing psychotic symptoms.
Neurological effects:
Very common: dizziness, tremor, headache, myoclonus.
Common: Delirium, speech disorder, paresthesia, muscle weakness, increased muscle tone.
Uncommon: convulsions, ataxia.
Very rare: EEG changes, high fever.
Anticholinergic effect:
Very common: dry mouth, sweating, constipation, vision disorders, blurred vision, and dysuria.
Common: Hot flashes, pupil dilation are extremely rare: glaucoma, urine retention.
Cardiovascular System:
Common: Patients with sinus tachycardia, palpitations, orthostatic hypotension, and normal cardiac function have unclear clinically significant electrocardiogram (ECG) changes (eg, ST-T changes).
Uncommon: arrhythmia, increased blood pressure.
Very rare: abnormal conduction (eg, QRS wave broadening, QT interval prolongation, PQ changes, bundle branch block, apical torsional ventricular tachycardia, especially in patients with hypokalemia)
Gastrointestinal tract:
Very common: nausea.
Common: vomiting, abdominal discomfort, diarrhea, and loss of appetite.
Common in the liver: elevated transaminase.
Very rare: hepatitis, with or without jaundice.
Common skin: allergic skin reactions (rash, urticaria), photosensitivity, itching.
Very rare: edema (local or systemic), hair loss.
Endocrine system and metabolic function:
Very common: weight gain, libido, and sexual dysfunction.
Common: galactorrhea, breast enlargement.
Very rare: inappropriate antidiuretic hormone secretion syndrome (SIADH).
Allergies are extremely rare: allergic alveolitis (pneumonia) with or without pulmonary eosinophilia, systemic allergic / anaphylaxis, including hypotension.
Blood is extremely rare: leukopenia, agranulocytosis, thrombocytopenia, eosinophilia, purpura.
Common sense organs: abnormal taste, tinnitus.
Withdrawal symptoms The following symptoms often occur after sudden withdrawal or reduction: nausea, vomiting, abdominal pain, diarrhea, insomnia, headache, nervousness and anxiety (see [Caution]).

Clomipramine hydrochloride taboo

1 It is contraindicated for those allergic to clomipramine or any of the excipients in this drug, and those who are allergic to tricyclic antidepressants in the dibenzazepine group.
2 This product is strictly prohibited to be combined with MAO (monoamine oxidase) inhibitors, including 14 days before and after using this product. It is prohibited to be combined with selective reversible MAO-A inhibitors, such as morphobexamide.
3 Those with recent myocardial infarction are disabled.
4 Those with congenital QT prolongation syndrome are disabled.

Precautions for clomipramine hydrochloride tablets

Suicide risk Patients with severe depression are at risk for suicide, and the risk may persist until the disease is significantly relieved. Adults or children with depression, whether or not they are using antidepressants, may develop exacerbation of depression and / or suicidal tendencies or other mental symptoms. Short-term studies of children and adolescents with depression and other mental disorders show that antidepressants increase the risk of suicidal thoughts and behaviors (suicidal tendencies).
Patients treated with anafinil for any indication should be closely monitored for exacerbations of clinical symptoms, suicidal tendencies, and other psychiatric symptoms (see [Adverse Reactions]), especially during the initial stages of treatment or during treatment When the dose is adjusted.
For these patients, consideration should be given to adjusting the treatment plan, and the drug may even need to be discontinued, especially when the clinical changes are severe, sudden, or not part of the patient's original symptoms (see the section "Interruption of treatment" in [Precautions]).
When using antidepressants for the treatment of mental or non-psychiatric indications, family members and caregivers of both adult and pediatric patients should be aware that the patient must be closely monitored for any other psychiatric symptoms or suicidal symptoms (see [Adverse Reactions] ]) And report these symptoms immediately to your healthcare provider.
In order to reduce the risk of overdose, the lowest dose of tablets should be used when prescribing anafinil for effective management of patients. Reports show that compared with other tricyclic antidepressants, there are fewer deaths associated with an overdose of anafinil.
Other psychiatric effects Many patients with panic disorder experience very significant anxiety in the early stages of treatment with Anafinil (see [Dosage and Administration]). This increase in anxiety may seem paradoxical, most noticeable in the first days of treatment, and it usually resolves within two weeks.
Observations have shown that the use of anafinil in patients with schizophrenia who are treated with tricyclic antidepressants can occasionally induce psychosis.
It has also been reported that patients with bipolar disorder in the depressive phase will experience hypomanic or manic episodes when receiving tricyclic antidepressants.
In these cases, it may be necessary to reduce or discontinue anafinil and to take antipsychotic drugs. When these episodes have resolved, you can use low-dose anafinil again if the condition requires it.
In susceptible and elderly patients, tricyclic antidepressants may induce drug-induced (delirious) psychosis, especially at night. These symptoms will disappear within a few days of stopping the medicine.
Cardiovascular Diseases Anafinil should be used with caution in patients with cardiovascular disease, especially those with cardiovascular insufficiency, conduction abnormalities (eg, Class I to III AV block), or arrhythmias. Cardiac function and electrocardiogram (ECG) should be monitored in these patients as well as in elderly patients.
Risk of prolonged corrected QT interval (QTc) and apical torsional ventricular tachycardia, especially if the dose exceeds the therapeutic dose or the plasma concentration of clomipramine exceeds the therapeutic concentration, or when taken concurrently Serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNaRI). Therefore, concurrent use of drugs that can cause clomipramine accumulation should be avoided. Concomitant use of drugs that can lead to prolonged QTc intervals should also be avoided (see [Drug Interactions]). It is now clear that hypokalemia is a risk factor for prolonged QTc interval and apical torsional ventricular tachycardia. Therefore, hypokalemia should be treated before starting anafinil, and when taking serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, or diuretics, Nepali should be very careful (see [Drug Interactions]).
Blood pressure should be measured before starting treatment with anafinil because patients with orthostatic hypotension or unstable circulation may experience a drop in blood pressure.
Because of the risk of serotonin poisoning, serotonin syndrome should be administered at the recommended dose and caution should be taken when increasing the amount of anfennine while taking other serotoninergic drugs at the same time. If you take other serotoninergic drugs (SSRI, SNaRI, tricyclic antidepressants or lithium salts) while taking anfenfenib, serotonin syndrome may occur (symptoms: high fever, myoclonus, Agitation, seizures, delirium, and coma). For fluoxetine, an elution period of two to three weeks is recommended before and after treatment with fluoxetine.
Convulsions. Tricyclic antidepressants are known to reduce the convulsive threshold. Therefore, in patients with epilepsy and other causes (such as brain damage caused by various causes, concurrent use of neuroleptics, abstinence or stop taking anticonvulsants). Anafinil should be used with extreme caution in patients with specific drugs (eg, benzodiazepines). Seizures appear to be dose-dependent. Therefore, the total recommended daily dose of analfinil should not be used.
Similar to other tricyclic antidepressants, anafinil can be used with electroconvulsive therapy only under careful supervision.
Anticholinergic effects Due to the anticholinergic properties of Anafinil, Anafinil should be used in patients with a history of increased intraocular pressure, patients with narrow-angle glaucoma, or urinary retention (eg, prostate disease) Be careful.
Due to the anticholinergic effect of tricyclic antidepressants, the reduction of tear secretion and the accumulation of secreted mucus may cause damage to the corneal epithelium of patients wearing contact lenses.
Specially treated populations should be careful when using tricyclic antidepressants in patients with severe liver disease and adrenal medullary tumors (eg, pheochromocytoma, neuroblastoma) because of the potential to induce hypertension in these patients Crisis.
Patients with hyperthyroidism or patients receiving thyroxine preparations should be careful with anfenfenib because of the potential for cardiotoxicity.
When patients have liver disease, regular monitoring of liver enzyme levels is recommended.
Care should be taken when using anafinil in patients with chronic constipation. Tricyclic antidepressants can cause paralytic intestinal obstruction, especially in elderly and bedridden patients.
It has been reported that dental caries will increase with long-term use of tricyclic antidepressants. Therefore, it is recommended that dental examinations be performed regularly during long-term treatment.
White blood cell countAlthough only individual cases have reported changes in white blood cell count when using Anafinil, blood cell count should still be monitored regularly for symptoms such as fever and sore throat, especially within the first few months of treatment or Perform extended treatment periods.
Before general or local anesthesia, the anesthesiologist should be informed that the patient is taking Anafinil (see [Drug Interactions]).
Interruption of treatment Sudden interruption of treatment may cause adverse reactions, so it should be avoided as much as possible. If you decide to discontinue treatment, you should reduce the dose of the drug as quickly as possible, but you should also be aware that sudden interruptions in treatment may produce certain symptoms (see [Adverse Reactions]).
Lactose and Sucrose Anafinil sugar-coated tablets contain lactose and sucrose. Patients with the following rare hereditary diseases should not take Anafinil sugar-coated tablets: galactose intolerance, fructose intolerance, severe lactase deficiency, sucrase-isomaltase deficiency, or glucose-galactose Malabsorption.
This product occasionally causes drowsiness in patients, and occasionally other central nervous symptoms that may impair the patient's ability to respond (see [Adverse Reactions]). Therefore, patients should be warned not to perform tasks that require rapid response, such as driving a motor vehicle or operating machinery. This product should be stored properly to prevent children from taking it by mistake.

Clomipramine hydrochloride tablets for pregnant and lactating women

Experience with this product during pregnancy is very limited. Because there have been scattered reports of possible links between tricyclic antidepressants and fetal toxicity (developmental disorders), the use of this product should be avoided during pregnancy unless the expected benefits outweigh the potential risks to the fetus. For mothers who have been taking tricyclic antidepressants before childbirth, their newborns may experience symptoms such as dyspnea, lethargy, abdominal pain, irritability, hypotension or high blood pressure, tremors or cramps in the first few hours or days . To prevent these symptoms, pregnant women should discontinue this product at least seven weeks before the expected date of birth (but the pros and cons should be weighed before considering whether to discontinue the drug). Since the active substance can enter milk, stop breastfeeding or discontinue medicine.

Clomipramine hydrochloride tablets for children

For use by children aged 5 and over, see "Dosage and Administration" for details.

Clomipramine hydrochloride tablets for elderly

Due to the weak metabolism of clomipramine in the elderly, the plasma concentration is high. Therefore, the dosage of this product in elderly patients is lower than that in middle-aged patients. Elderly patients: Start treatment with 10 mg daily, and gradually increase the dose to a suitable dose of 30-50 mg daily, usually about 10 days, and then maintain this amount until the end of treatment.

Clomipramine hydrochloride tablets drug interactions

Interactions with pharmacodynamics Adrenaline neuronal blocker anafinil may reduce or eliminate the antihypertensive effects of guanethidine, betanidine, reserpine, clonidine, and methyldopa . Therefore, patients with hypertension who need to be treated with hypertension drugs at the same time should choose other types of antihypertensive drugs (for example: vasodilators or -blockers).
Anticholinergic tricyclic antidepressants may enhance the effects of the following drugs (phenothiazine, antiparkinsonian, antihistamine, atropine, and bipiridene) on the eye, central nervous system, intestine, and bladder .
CNS inhibitors tricyclic antidepressants may enhance the effects of alcohol and other central inhibitors (eg, barbiturates, benzodiazepines, or general anesthetics).
Diuretics Diuretics may cause hypokalemia, which increases the risk of prolonged QTc interval and apical torsional ventricular tachycardia. Therefore, hypokalemia should be treated before using Anafinil (see [Dosage and Administration] and [Precautions]).
Do not use Anafinil for at least two weeks after discontinuing monoamine oxidase inhibitor therapy (the following severe symptoms may occur: hypertension crisis, high fever, and other symptoms of serotonin syndrome, such as muscle array Cramps, agitation, seizures, delirium and coma). The same applies when taking monoamine oxidase inhibitors after stopping anafinil treatment. In both cases, a smaller dose of anfenafen or a monoamine oxidase inhibitor should be given at the beginning of treatment, and the dose should be gradually increased, while the drug effect should be closely monitored.
There is evidence that Anafinil can be used within 24 hours after taking a reversible monoamine oxidase-A inhibitor (such as morphobexamide). However, after using Anafinil, a two-week washout period is required. Take a monoamine oxidase-A inhibitor.
Selective serotonin reuptake inhibitor (SSRI)
Concomitant use of selective serotonin reuptake inhibitors may have an additive response to the serotonergic system (see Serotonin-Activating Drugs).
Serotonin activating drugs clomipramine and serotonin activating drugs (eg selective serotonin reuptake inhibitors, serotonin and serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants Drugs and lithium salts) may cause serotonin syndrome. For fluoxetine, an elution period of two to three weeks is recommended before and after treatment with fluoxetine.
The sympathomimetic drug Anafinil increases the cardiovascular effects of the following drugs (adrenaline, norepinephrine, isoprenaline, ephedrine, and phenylephrine [eg, local anesthetics]).
Anafinil (clomipramine), an pharmacokinetic-related interaction, is primarily eliminated by metabolism. The main metabolic pathway is demethylation, which forms the active metabolite N-norcimipramine, which then undergoes hydroxylation. Both N-norcimipramine and its parent drug can undergo further binding reactions. The demethylation process involves a variety of isozymes of cytochrome P450s, mainly CYP3A4, CYP2C19 and CYP1A2. Both active ingredients are eliminated by hydroxylation, a process catalyzed by CYP2D6.
The simultaneous use of CYP2D6 inhibitors may lead to an increase in the concentration of the two active ingredients, which can increase the concentration up to 3 times in patients with the isoquinidine / spartin strong metabolic phenotype, thus making these patients exhibit a weak metabolic phenotype [152]. Concomitant use of CYP1A2, CYP2C19 and CYP3A4 inhibitors will increase the concentration of clomipramine, but as the concentration of N-norcimipramine will decrease, there will be no effect on the overall medicinal properties.
· Monoamine oxidase inhibitors (such as morphobemide) are also potent CYP2D6 inhibitors in the body, so it is prohibited to take them with clomipramine at the same time.
· Certain antiarrhythmic drugs (such as quinidine and propafenone) are potent inhibitors of CYP2D6 and should not be used concurrently with tricyclic antidepressants.
· Some selective serotonin reuptake inhibitors are inhibitors of CYP2D6 (eg, fluoxetine, paroxetine, or sertraline), while others are inhibitors of other isoenzymes (including CYP1A2 and CYP2C19, such as Fluvoxamine), these drugs may also increase the plasma concentration of clomipramine, resulting in corresponding adverse reactions. When co-administered fluvoxamine, the steady-state plasma levels of clomipramine increased by a factor of four (N-norclomipramine decreased by a factor of two).
· Concomitant use of neuroleptics (eg, phenothiazine) may cause increased plasma levels of tricyclic antidepressants, decreased convulsive thresholds, and seizures. Severe arrhythmias may occur when used in combination with thioridazine.
· Simultaneous use of histamine type 2 (H2) receptor antagonist cimetidine (inhibitors of multiple P450 isoenzymes, including CYP2D6 and CYP3A4) may increase the plasma concentration of tricyclic antidepressants, therefore, The amount of tricyclic drugs should be reduced.
There has been no literature reported on the interaction between anfenfenib (25 mg daily) and long-term oral contraceptives (15 or 30 mg ethinyl estradiol daily). As far as is known, estrogen is not an inhibitor of CYP2D6 (the enzyme that plays a major role in the clearance of clomipramine), so there should be no interaction with Anafinil. Although some cases have reported that taking large doses of estrogen (50 mg daily) with tricyclic antidepressant imipramine can increase adverse reactions and improve treatment response, it is not clear The same is true when treated with low-dose estrogen. It is recommended that when using high-dose estrogen therapy (50 mg daily), the response of tricyclic antidepressants should be monitored and the dose adjusted if necessary.
· Methylphenidate (eg Ritalin) may also increase its drug concentration through the potential inhibition of the metabolism of tricyclic antidepressants, and the amount of tricyclic antidepressants should be reduced if necessary.
· Certain tricyclic antidepressants may enhance the anticoagulant effect of coumarins (eg, warfarin). The mechanism may be through the inhibition of coumarins (CYP2C9). Although there is no evidence of clomipramine's inhibitory effect on the metabolism of anticoagulants (eg, warfarin), it is still recommended to closely monitor plasma prothrombin activity when using such drugs.
Concomitant use of drugs that have an inducing effect on cytochrome P450 isoenzymes (especially CYP3A4, CYP2C19 and / or CYP1A2) may accelerate the metabolism of anafinil, thereby reducing the efficacy of anafinil.
· CYP3A and CYP2C inducers, such as rifampicin or anticonvulsants (eg, barbiturates, carbamazepine, phenobarbital, and phenytoin) may reduce clomipramine concentrations. Known CYP1A2 inducers (eg, nicotine / cigarette smoke components) reduce the plasma concentrations of tricyclic antidepressants. Smoker clomipramine steady-state plasma concentrations were reduced by a factor of two compared to non-smokers (but there was no change in the concentration of N-norcimipramine).
In addition, the combination of tricyclic antidepressants and phenytoin can cause an increase in serum phenytoin concentration. If necessary, the doses of the two drugs should be adjusted accordingly.
In vitro (Ki = 2.2 M) and in vivo, clomipramine is an inhibitor of CYP2D6 activity (spardin oxidation). Therefore, when using drugs that are mainly eliminated by CYP2D6 at the same time in strong metabolizers, it may be Causes an increase in the concentration of the drug.

Clomipramine hydrochloride overdose

Symptoms when ananafinil is overdose are similar to those reported for signs and other tricyclic antidepressants. Cardiac and neurological abnormalities are major complications. Children should be considered extremely serious and potentially fatal, regardless of the amount of medication they accidentally take.
The severity of tricyclic antidepressant poisoning depends on a variety of factors, such as the amount of drug absorbed, the time from overdose to the start of treatment, and the age of the patient.
Symptoms and signs Symptoms usually appear within 4 hours after taking the drug, and are most severe after 24 hours. Due to the delayed absorption (anticholinergic effect), longer half-life, and enterohepatic recirculation of the drug, patients are still at risk for 4-6 days.
The following symptoms and signs may appear:
Central nervous system lethargy, stiffness, coma, ataxia, anxiety, agitation, hyperreflexia, myotonia and choreography-like movements, convulsions. In addition, symptoms of serotonin syndrome (eg, fever, myoclonus, delirium, and coma) can still occur.
Cardiovascular system hypotension, tachycardia, arrhythmia, prolonged QTc interval, arrhythmia including tip torsional ventricular tachycardia, abnormal conduction, shock, heart failure; heart can occur in extremely rare cases Sudden stop.
Respiratory depression, cyanosis, vomiting, fever, dilated pupils, sweating, and oliguria or anuria may also occur.
There is no special antidote for overdose treatment. Overdose treatment is essentially symptomatic and supportive treatment.
Anyone who suspects an overdose of anafinil, especially children, should be hospitalized and under close supervision for at least 72 hours.
If the patient is awake, gastric lavage or vomiting should be performed as soon as possible. If the patient is not awake, a cuffed endotracheal tube needs to be used before lavage to ensure that the airway is unobstructed, and vomiting should not be performed at this time. Because the anticholinergic effect of the drug may delay gastric emptying, the above treatment is recommended for 12 hours or more of the overdose. Taking activated charcoal may help reduce drug absorption.
Symptoms should be managed with modern intensive care measures, such as continuous monitoring of heart function, blood gas, and electrolytes, and first aid measures such as anticonvulsant therapy, artificial respiration, and resuscitation if necessary. Due to reports that venomine may cause severe bradycardia, cardiac arrest and seizures, it is not recommended when anafinil is overdose. Because clomipramine has a low plasma concentration, neither hemodialysis nor peritoneal dialysis is effective.

Clomipramine Hydrochloride Tablets Pharmacology and Toxicology

This product has antidepressant effect and has a wide range of treatment. It can improve the various manifestations of depression syndrome, especially lack of motivation and depression, and also has an effect on persistent anxiety. The effect usually occurs within the first week of treatment. According to animal experiments, the main effect of this product may be to inhibit the reuptake of noradrenaline (NA) and serotonin (5-HT) released by neurons in the synaptic cleft, among which the inhibition of 5-HT Ingestion-based. Another feature of this product is that it has a broad spectrum of pharmacological effects, including 1 anti-adrenergic, anti-cholinergic, anti-histamine, and anti-serotoninergic (5-HT-receptor block) effects.

Pharmacokinetics of clomipramine hydrochloride tablets

Absorption of clomipramine is completely absorbed in the gastrointestinal tract. After the first-pass metabolism of the liver to produce the active metabolite N-norcimipramine, the systemic bioavailability of the clomipramine prototype decreased to 50%. Eating did not significantly affect the bioavailability of clomipramine. There may be a slight delay in the start of absorption, which increases the time to peak.
Anafinil was administered orally at a constant daily dose, and the steady-state plasma concentrations of clomipramine varied widely among patients. At a daily dosage of 75 mg (25 mg sugar-coated tablets, three times daily), the steady-state plasma concentrations obtained range from 20 to 175 ng / ml.
The steady-state plasma concentration of the active metabolite N-norcimipramine has similar characteristics. However, the steady-state plasma concentration of N-norcimipramine is 40-85% higher than that of clomipramine when anafinil 75 mg is used daily.
97.6% of clomipramine was bound to plasma proteins. The apparent distribution volume is about 12-17 liters / kg of body weight. The concentration of cerebrospinal fluid corresponds to about 2% of the plasma concentration. The concentration of clomipramine entering breast milk is similar to that in plasma.
The main metabolic pathway for the bioconversion of clomipramine is the formation of the active metabolite N-deslomipramine through demethylation. N-norcimipramine can be produced by a variety of P450 isoenzymes, mainly CYP3A4, CYP2C19 and CYP1A2. Clomipramine and N-norclomipramine are hydroxylated to form 8-hydroxyclomipramine or 8-hydroxy-N-norclomipramine. The activity of 8-hydroxylated metabolites in the body is not clear. Clomipramine can also be hydroxylated at the 2-position, and N-norclomipramine can be further demethylated to form dicloclomipramine. Metabolites that are hydroxylated at positions 2 and 8 are mainly excreted from urine as glucuronides. The active ingredients (clomipramine and N-norcimipramine) are removed by forming hydroxylated clomipramine at positions 2 and 8, which is catalyzed by CYP2D6.
The mean half-life of clomipramine clearance in the blood is 21 hours (range: 12-36 hours), while the average half-life of norclomipramine is 36 hours.
After a single dose of clomipramine, about two-thirds are excreted from the urine as water-soluble conjugates, and about one-third are excreted from the feces. The amount of clomipramine prototype and norclomipramine excreted from the urine accounted for 2% and 0.5% of the administered dose, respectively.
The effect of patient characteristics is due to the reduced metabolic clearance of elderly patients. When taking a certain dose of medicine, the plasma concentration of clomipramine is higher than that of young patients. The effect of impaired liver and renal function on the pharmacokinetics of clomipramine is unknown.

Clomipramine Hydrochloride Tablets Storage

Shaded and sealed.

Clomipramine Hydrochloride Tablets Packaging

Aluminum plastic packaging, 10 pcs / board, 3 pcs / box

Clomipramine Hydrochloride Validity Period

36 months

Clomipramine Hydrochloride Tablets

"Chinese Pharmacopoeia" 2005 edition two ^[1]