NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Clomipramine MR Discontinuation

Novartis is discontinuing the production of Anafranil MR tablets. This discontinuation is due to the manufacturing plant closure and the lack of a suitable alternative site with the ability to produce the medicine to the same specification.  It is expected that stock within the UK will be depleted by June 2015.

 

Clomipramine is a tricyclic antidepressant but is most often used in the treatment of severe obsessional compulsive disorder (OCD) and generally as a second line option after selective serotonin reuptake inhibitors prove ineffective or are not tolerated. Consequently there is a small but important group of patients who rely on this drug.

 

Having considered this issue, the Prescribing Management Group – Mental Health, recommend clinicians take the following actions for patients affected:

 

  • Review the on-going need for treatment
  • Where on-going treatment is required consider changing to an equivalent dose using clomipramine standard-release capsules (10mg, 25mg and 50mg capsules are available), given using the same dosing frequency ie once daily, twice daily etc.
  • If a change of treatment is required, the table below highlights licensed alternatives to clomipramine in OCD & panic disorder
  • If switching from clomipramine – stop the clomipramine then, 24 hours later add fluoxetine, paroxetine or sertraline, taking care to increase dose gradually. Be aware of the risk of serotonin syndrome, cholinergic rebound & tricyclic withdrawal. (Sources – Maudsley Prescribing Guidelines 11th Edition & Psychotropic Drug Directory 2012)

 

 

Drug

OCD dose

Panic Disorder dose

Fluoxetine

20mg initially increased gradually to 60mg daily

n/a

Paroxetine

20mg increased gradually in 10mg steps to 40mg daily

10mg increased gradually in 10mg steps to 40mg daily

Sertraline

50mg increased if necessary in weekly steps of 50mg to 200mg daily

25mg increased to 50mg after 1 week then if necessary in weekly steps of 50mg to 200mg daily