Comparative Pharmacology
Head-to-head clinical analysis: AMITRIL versus ANAFRANIL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: AMITRIL versus ANAFRANIL.
AMITRIL vs ANAFRANIL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Amitriptyline inhibits the reuptake of serotonin and norepinephrine, thereby increasing their synaptic concentrations. It also blocks histamine H1, alpha-1 adrenergic, and muscarinic receptors.
Clomipramine is a tricyclic antidepressant (TCA) that inhibits the reuptake of serotonin and norepinephrine, with a higher potency for serotonin reuptake inhibition. It also has anticholinergic, antihistaminergic, and alpha-adrenergic blocking properties.
Adults: Initial 25 mg PO once daily at bedtime, increase by 25 mg every 3-7 days as tolerated to typical maintenance 75-150 mg/day PO divided doses or single dose at bedtime. Maximum 300 mg/day.
Initial: 25 mg PO tid; increase gradually to 100-150 mg/day. Maximum: 250 mg/day. Maintenance: lowest effective dose.
None Documented
None Documented
Terminal elimination half-life: 15–25 hours (mean 20 h); may extend to >40 h in elderly or hepatic impairment.
Terminal elimination half-life of clomipramine is approximately 21-26 hours; its active metabolite, desmethylclomipramine, has a half-life of approximately 36-42 hours. Steady-state is achieved within 7-14 days.
Renal: ~70% as metabolites, <5% unchanged; fecal: ~30% via bile.
Renal (primarily as conjugated metabolites, ~60-70% over 72 hours); fecal (biliary excretion of ~10-20%); <2% excreted unchanged in urine.
Category C
Category C
Tricyclic Antidepressant
Tricyclic Antidepressant