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Elavil vs Anafranil
Introduction
For individuals struggling with major depressive disorder (MDD) or other forms of depression, certain medications that modify the levels of mood-associated compounds in the brain, known as neurotransmitters, can assist in stabilizing depressive lows and managing symptoms. Elavil and Anafranil are two such drugs often prescribed for depression. Both impact differing neurotransmitters within the brain but share a common goal: to stabilize moods in patients wrestling with depression. Elavil is classified as a tricyclic antidepressant (TCA), primarily affecting levels of norepinephrine and serotonin by inhibiting their reuptake into nerve cells. On the flip side, Anafranil also falls under TCAs; however, it has more potent effects on serotonin reuptake inhibition compared to its influence on norepinephrine.
Elavil vs Anafranil Side By Side
| Attribute | Elavil | Anafranil |
|---|---|---|
| Brand Name | Elavil | Anafranil |
| Contraindications | Should not be taken with or within two weeks of taking monoamine oxidase (MAO) inhibitors. | Should not be taken with or within two weeks of taking monoamine oxidase (MAO) inhibitors. |
| Cost | For brand name, around $80 for 30 tablets of 25 mg. For generic amitriptyline, costs range from $0.15 to $0.60 per day. | For brand name, about $200 for 30 capsules of 25 mg. For generic clomipramine, starting as low as about $1/day to $4/day. |
| Generic Name | Amitriptyline | Clomipramine |
| Most Serious Side Effect | Thoughts about suicide or self-harm, severe skin reactions, visual disturbances, rapid heartbeats, symptoms of low sodium levels, severe nervous system reactions. | Signs of an allergic reaction, experiencing suicidal thoughts or a worsening depression, seizures, changes in behavior or experiencing confusion, vision changes, irregular heartbeats, symptoms of serotonin syndrome. |
| Severe Drug Interactions | Monoamine oxidase (MAO) inhibitors. | Monoamine oxidase (MAO) inhibitors. |
| Typical Dose | Oral dosages range from 25-150 mg/day, starting with a lower dose at bedtime, such as 10-50 mg/day. | Typically initiated at a lower dose of 25 mg/day, gradually increased to an average effective dose of 100 mg/day, up to a maximum of 250 mg/day. |
What is Elavil?
Amitriptyline (the generic name for Elavil) was among the first drugs of the tricyclic antidepressants (TCAs) class, which marked a significant advancement in mental health medications. Amitriptyline received FDA approval in 1961. It increases levels of free serotonin and norepinephrine by preventing them from being reabsorbed, effectively "trapping" them in the brain for longer than usual. This medication is prescribed primarily to treat depression but can also manage other conditions like chronic pain and migraines.
In contrast, Clomipramine (Anafranil's generic name), another member of the TCA family, has a more specific focus on serotonin reuptake inhibition with relatively less influence on norepinephrine. This provides it with an edge when managing obsessive-compulsive disorder (OCD), a condition where serotonin plays a pivotal role. Both these drugs have similar side effect profiles as they belong to the same drug class; however, individual responses may vary.
What conditions is Elavil approved to treat?
Elavil is approved for the treatment of various mental/mood disorders, including:
- Major depressive disorder (MDD)
- Anxiety in certain patients
- Bipolar disorder as an off-label use
- Chronic pain conditions such as migraines or neuropathic pain
On the other hand, Anafranil has been primarily approved for:
- Obsessive-compulsive disorder (OCD)
- Certain types of chronic pain.
How does Elavil help with these illnesses?
Elavil, also known as amitriptyline, is a medication that can help manage depression by increasing the amount of serotonin and norepinephrine in the synapses of the brain. Like Prozac, it prevents these neurotransmitters from being reabsorbed by neurons, thereby maintaining higher levels for longer periods of time. Both serotonin and norepinephrine are chemicals that act as messengers in the brain and throughout the body, playing crucial roles in mood regulation, cognition, memory, sleep patterns and more. It's thought that people with depression have relatively lower levels of both neurotransmitters. Therefore Elavil can limit depressive symptoms by increasing their availability.
Anafranil (clomipramine), on the other hand helps manage depression mainly through its actions on serotonin but to a lesser extent also affects norepinephrine levels; it blocks these neurotransmitters' reuptake into nerve cells which increases their concentration at nerve endings enhancing neurotransmission. Anafranil has been particularly noted for its effectiveness in treating obsessive-compulsive disorder (OCD), a condition often characterized by intrusive thoughts and repetitive behaviors where it seems to exert potent effects likely due to its strong influence on serotonergic functioning.
What is Anafranil?
Anafranil, the brand name for clomipramine, works as a tricyclic antidepressant (TCA) by increasing levels of serotonin and norepinephrine in the brain while also blocking certain acetylcholine receptors, which can lead to some of its side effects. It was first approved by the FDA in 1989. Unlike Elavil (amitriptyline), another TCA that acts on multiple neurotransmitters including histamine and dopamine, Anafranil is more selective in its action and primarily increases serotonin levels. This selectivity can result in fewer side effects such as weight gain or sedation seen with other TCAs like Elavil. However, it might still cause sexual dysfunction due to increased serotonin activity - a common effect among drugs increasing this particular neurotransmitter's level. The potent serotonergic effect of Anafranil makes it particularly effective for treating obsessive-compulsive disorder (OCD), an area where many SSRIs fall short.
What conditions is Anafranil approved to treat?
Anafranil, also known as clomipramine, is approved by the FDA for treating:
- Obsessive-compulsive disorder (OCD)
- Certain types of chronic pain While it's not its primary use, Anafranil has also been found to be effective in treating panic attacks and certain personality disorders.
How does Anafranil help with these illnesses?
Serotonin is a neurotransmitter that plays significant roles in various bodily processes, including mood regulation, digestion, and sleep. Like norepinephrine, lower levels of serotonin have been associated with depression. Anafranil operates by raising the availability of serotonin in the brain, thereby alleviating some depressive symptoms. This drug's impact on other neurotransmitters such as norepinephrine may also contribute to its effectiveness as an antidepressant. Since it doesn't mainly focus on increasing dopamine levels like Elavil does, it is often prescribed when a patient has not responded well to typical TCAs (Tricyclic Antidepressants) or can be used in combination with them for more comprehensive treatment.
How effective are both Elavil and Anafranil?
Both amitriptyline (Elavil) and clomipramine (Anafranil) have been utilized for several decades in the treatment of various psychiatric conditions. They were initially approved by the FDA in 1961 and 1989 respectively, which highlights their long-standing presence in the medical field. Both are tricyclic antidepressants, but they act on different neurotransmitters, so they may be prescribed under differing circumstances. A direct comparison study conducted in 1992 showed that both drugs demonstrated similar efficacy in managing symptoms of depression as well as similar safety profiles.
A review published in The Lancet Journal indicated that amitriptyline has been effective at reducing symptoms of depression starting from the first week of treatment, with a side effect profile comparable to many other antidepressants. This review also stated that amitriptyline is widely used worldwide due to its affordability and effectiveness. Its optimal dose varies between individuals but it's typically administered at an initial dose of 50-75 mg/day depending on tolerance and clinical response.
In contrast, according to a meta-analysis report published by Cochrane Database Systematic Review, clomipramine seems to be more effective than placebo for treating obsessive-compulsive disorder rather than just depression alone. Despite this advantage over other common treatments for OCD like SSRIs or CBTs (Cognitive Behavioral Therapies), it is often considered only after these first-line treatments primarily because it has more potential side effects such as dry mouth or constipation compared to newer medications.
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At what dose is Elavil typically prescribed?
Oral dosages of Elavil generally range from 25-150 mg/day, but studies have indicated that starting with a lower dose at bedtime, such as 10-50 mg/day is often effective for treating depression in most patients. Children and adolescents' dosage should be determined by the doctor. For either population, the dosage can be increased gradually over several weeks if there is no response. The maximum dosage that should not be exceeded in any case is 300 mg/day.
On the other hand, oral dosages of Anafranil typically start at 25 mg per day and are gradually increased to an average daily dose of between 100 to 250mg. In some cases for severe obsessive-compulsive disorder (OCD), doses up to a maximum of 3mg/kg body weight or approximately up to around 200mg may be prescribed after gradual increase over several weeks under close physician supervision due to potential side effects.
At what dose is Anafranil typically prescribed?
Anafranil treatment is typically initiated at a lower dose of 25 mg/day. The dosage can then be gradually increased over a period of weeks to an average effective dose of 100 mg/day, divided into two or three doses throughout the day depending on patient tolerance. If necessary, and under medical supervision, the maximum dose may be raised to 250 mg/day split into multiple doses with intervals in between. Such increase should only be considered if there is no significant improvement in symptoms at the standard daily dosage after several weeks.
What are the most common side effects for Elavil?
When comparing Elavil to Anafranil, one may experience potential side effects such as:
- Dry mouth
- Drowsiness or sleepiness
- Constipation
- Blurred vision
- Increased heart rate
- Urinary retention (difficulty passing urine)
- Nervousness and confusion
- Disorientation or forgetfulness
- Delirium or hallucinations in severe cases
- Weight gain
-Nausea and vomiting
-Tremors and restlessness
-Dizziness, especially when standing up from a sitting position
-Skin rash
-Sweating excessively
-Decreased libido (sex drive)
-Impotence.
Always remember that each person's reaction to medication can vary, so it's essential to monitor any changes during treatment.
Are there any potential serious side effects for Elavil?
Elavil and Anafranil are both tricyclic antidepressants with potential side effects that you need to be aware of. These may include:
- Thoughts about suicide or self-harm
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- Symptoms indicating a severe skin reaction such as fever, sore throat, burning in the eyes, skin pain followed by a red or purple rash that spreads (particularly in the face or upper body) causing blistering and peeling
- Visual disturbances including blurred vision, tunnel vision, eye pain or swelling
- Rapid heartbeats which might make you feel like passing out
- Indicators of low sodium levels - headache, confusion, slurred speech accompanied by vomiting and loss of coordination can make one feel unsteady.
More serious symptoms could indicate severe nervous system reactions - very stiff muscles (rigidity), high fever accompanied by sweating and confusion plus rapid erratic heartbeat.
Be sure to seek emergency medical attention if these occur.
Lastly watch for any symptoms signaling serotonin syndrome: agitation alongside hallucinations and fast heart rate; muscle stiffness combined with twitching; loss of coordination along with nausea/vomiting/diarrhea.
What are the most common side effects for Anafranil?
Anafranil, like any medication, can cause a variety of side effects. Some common ones include:
- Dry mouth or throat
- Blurred vision
- Constipation or stomach upset
- Dizziness and drowsiness
- Nightmares or trouble sleeping (insomnia)
- Increased sweating
- Flushing and changes in appetite that may lead to weight changes
- Tremors or restlessness
- Confusion, agitation, increased nervousness -Rapid heartbeat. Please note that this list does not cover all possible side effects. Individuals should consult with their healthcare provider if they experience any unusual symptoms while taking Anafranil.
Are there any potential serious side effects for Anafranil?
Anafranil, while effective in managing symptoms of obsessive-compulsive disorder (OCD) and certain types of chronic pain, may also cause some serious side effects. These can include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Experiencing suicidal thoughts or a worsening depression
- Encountering seizures (convulsions)
- Changes in behavior or experiencing confusion
- Vision changes including blurred vision, eye pain or swelling, and seeing halos around lights
- Irregular heartbeats that are unusually fast
- Symptoms indicative of serotonin syndrome: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness or twitching If you experience any such symptoms while on Anafranil treatment regime it is highly recommended to seek immediate medical attention.
Contraindications for Elavil and Anafranil?
Both Elavil and Anafranil, like most other antidepressant medications, may exacerbate symptoms of depression in some individuals. If you notice your depression worsening or an increase in thoughts or behaviors related to suicide, please seek immediate medical help.
Neither Elavil nor Anafranil should be taken if you are currently using, or have recently used monoamine oxidase (MAO) inhibitors. Always inform your physician about all the medications you are taking; MAOIs will require a period of approximately two weeks to clear from your system in order to prevent hazardous interactions with Elavil and Anafranil.
How much do Elavil and Anafranil cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Elavil (25 mg) averages around $80, which works out to approximately $2.66/day.
- The price of 30 capsules of Anafranil (25 mg) is about $200, working out to nearly $6.67/day.
In comparison between Elavil and Anafranil, if you are in a higher dosage range for Elavil (i.e., up to 150 mg/day), then brand-name Anafranil can be more expensive on a per-day treatment basis. However, cost should not be the primary consideration in determining which drug is right for you.
For the generic versions amitriptyline (Elavil) and clomipramine (Anafranil), costs are significantly lower:
- Amitriptyline is available in packs from 10 to above with approximate costs ranging from $0.15 to $0.60 per day depending on your daily dosage being at typical levels between 50 and 150mg/day.
- Clomipramine is available in packs from 10 up, with the cost starting as low as about $1/day for smaller packs but reducing significantly if larger quantities are purchased upfront; however it rarely exceeds about $4/day even when using higher doses within recommended limits.
Popularity of Elavil and Anafranil
Amitriptyline, in generic form as well as brand names such as Elavil, was estimated to have been prescribed to about 1.6 million people in the US in 2020. Amitriptyline accounted for just under 3% of antidepressant prescriptions in the US. However, it appears to be a widely-used tricyclic antidepressant (TCA) due to its efficacy against various types of pain and migraines, aside from its primary use for depression and anxiety disorders.
Clomipramine, including brand versions such as Anafranil, is another TCA but has more specialized usage mainly for obsessive-compulsive disorder (OCD), with an estimated prescription number around one-tenth that of amitriptyline's. Despite being less frequently prescribed overall than amitriptyline, clomipramine holds a significant role among TCAs because of its effectiveness on OCD symptoms where other drug classes fail or are not well tolerated by patients. The prevalence of both these medications has remained relatively steady over the last decade.
Conclusion
Both Elavil (amitriptyline) and Anafranil (clomipramine) have long-standing records of usage in patients with depression and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined under careful consideration by a physician due to their interaction potential. Due to their different mechanisms of action, with Elavil acting primarily on norepinephrine and serotonin, while Anafranil focuses mainly on the reuptake inhibition of serotonin, they tend to be prescribed under different circumstances. For instance, Elavil is often used for its strong sedative effect in treating insomnia associated with depression whereas Anafranil's potent serotonergic activity makes it particularly effective against obsessive-compulsive disorder symptoms.
Both these medications have generic equivalents available which can offer significant cost savings especially for those paying out-of-pocket. Both medicines may require an adjustment period where effects might not be immediately noticeable.
The side-effect profile is similar between the two drugs; however, both being tricyclic antidepressants carry certain side-effects such as dry mouth, blurred vision or urinary retention but Anafranil has been noted to cause more anticholinergic side effects like constipation compared to Elavil. It’s important that patients monitor their health closely when starting treatment and seek immediate medical help if experiencing worsening depressive symptoms or suicidal thoughts.
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Refrences
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