Anafranil

clomiPRAMINE

Anafranil

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• seizures (life-threatening)
• suicidal thoughts (life-threatening)
• lethargy (most frequent)
• sedation (most frequent)
• weakness (most frequent)
• aggressive behavior

Ear, Eye, Nose, Throat

• blurred vision (most frequent)
• dry eyes (most frequent)
• dry mouth (most frequent)
• vestibular disorder

Cardiovascular

• arrhythmias (life-threatening)
• ECG changes
• orthostatic hypotension

Gastrointestinal

• constipation (most frequent)
• nausea (most frequent)
• vomiting (most frequent)
• weight gain
• eructation

Genitourinary

• male sexual dysfunction (most frequent)
• urinary retention

Dermatologic

• dry skin
• photosensitivity

Endocrinologic

• gynecomastia

Hematologic

• anemia

Musculoskeletal

• muscle weakness

Neurologic

• extrapyramidal reactions

Miscellaneous

• hyperthermia

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor mental status (orientation, mood, behanior) frequently. Assess patient for frequency of OCD. Note degree to which these thoughts and behaviors interfere with daily functioning.
• Monitor BP and pulse before and during initial therapy. Notify physician or other health care professional of decreases in BP (10–20 mmHg) or sudden increase in pulse rate. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically during therapy.
• Assess weight and BMI initially and throughout treatment. Assess FBS and cholesterol levels in obese individuals. Refer as appropriate for nutritional/weight management and medical management.
• Observe for onset of extrapyramidal parkinsonian side effects (difficulty speaking or swallowing, loss of balance control, pill rolling with hands, mask-like face, shuffling gait, rigidity, tremors). Notify physician or other health care professional if these symptoms occur; reduction in dose or discontinuation of medication may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms.
• Assess for suicidal tendencies, especially during early therapy and dose changes. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for the next 4 wk, and on advice of health care professional thereafter.
• Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).
• Lab Test Considerations: Serum glucose may be ↑ or ↓.
  • Monitor CBC and differential during chronic therapy. May rarely cause bone marrow suppression.
  • In chronic therapy, periodically monitor hepatic and renal function.

Potential Nursing Diagnoses

Implementation

• Do not confuse clomipramine with clomiphene or desipramine.
• Oral: Administer medication with or immediately after a meal to minimize gastric irritation. After titration of dose, total daily dose may be given at bedtime.

Patient/Family Teaching

• Instruct patient to take medication exactly as directed. Abrupt discontinuation may cause nausea, headache, and malaise.
• May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known.
• Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in geriatric patients. Protect patient from falls and advise patient to change positions slowly.
• Advise patient to avoid alcohol or other CNS depressant drugs during course of therapy and for 3–7 days after cessation of therapy.
• Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
• Instruct patient to notify health care professional if dry mouth or constipation persists or if urinary retention, uncontrolled movements, or rigidity occurs. Sugarless candy or gum may diminish dry mouth, and an increase in fluid intake or bulk may prevent constipation. If these symptoms persist, dosage reduction or discontinuation may be necessary. Consult health care professional if dry mouth persists for more than 2 wk.
• Advise patient to inform health care professional if sexual dysfunction occurs. Inform male patients that sexual dysfunction is common with this medication.
• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
• Inform patient of need to monitor dietary intake because possible increase in appetite may lead to undesired weight gain.
• Advise patient to notify health care professional of medication regimen before treatment or surgery.
• Instruct female patients to inform health care professional if pregnancy is planned or suspected, or if they plan to breastfeed.
• Emphasize the importance of follow-up exams to monitor effectiveness and side effects and to improve coping skills.
• Inform patients taking high doses (250–300 mg/day) that risk of seizures is increased.

Evaluation/Desired Outcomes

• Diminished obsessive compulsive behavior.