Ellen Campbell-Grizzle
ON THE streets of Jamaica they call Clomipramine 'the bomb', aka 'pigeon peas'. It's brand name is Anafranil. Its notoriety is legend.
There are powerful myths surrounding the bomb's potency. There are those who claim that it improves sex drive, makes them 'cool, fearless and deadly'. However, it is classified as a prescription-only drug - by law, patients require a written order from a registered medical practitioner to a registered pharmacy to obtain supplies.
Anafranil is a well-established antidepressant used to treat people who suffer from obsessions and compulsions. It is taken with meals, at first, to avoid stomach upset. After a regular dose has been established, it is best taken at bedtime to avoid sleepiness. In some patients, the drug has helped with premature ejaculation.
Always take as prescribed. However, if you miss a dose, do not take two doses at the same time. If it is almost time for your next dose, skip the one you missed and go back to your regular time. If you are taking two or more doses per day, take the missed dose as soon as you remember. This drug may cause dry mouth. Hard candy, chewing gum or a bit of ice can relieve this problem.
CONCERN ABOUT ABUSE
There is good reason for the current concern about its availability on the streets. Clomipramine, like its other chemical cousins, stays around in the body for a long time and this allows for once-a-day administration. Therefore, taking several and irregular doses can be lethal. It has several side effects including abnormal dreaming, faster heart beat, constipation, ringing in the ears and sex drive changes.
Less common side effects in children include abnormal skin odour, aggression, bad breath and eye allergy. Gradual introduction to treatment is important, particularly in the elderly, as they are more prone to experience the dizziness that lowered blood pressure causes. When it is time to stop taking Anafranil, do not stop abruptly. Your doctor will have you taper off gradually to avoid withdrawal symptoms such as dizziness, fever, headache, irritability, worsening emotional or mental problems.
It is important to know that Clomipramine poses a risk of seizures and, because it may impair mental or physical ability to perform complicated tasks, your pharmacist will advise you to take special precautions if you need to drive a car, operate complicated machinery or take part in activities in which suddenly losing consciousness can be dangerous. If you suffer from increased pressure in the eye or difficulty urinating, these conditions could worsen. You should avoid this drug if you have recently had a heart attack.
LITTLE BUT TALLAWAH
There are those who are deceived by the size of the drug. Anafranil looks like a tiny pebble which some relate to small effect. This perception has caused persons to overuse the drug for all sorts of purposes. Physicians usually prescribe limited amounts at any one time because the drug is dangerous in over dosages. This is considered a medical emergency and requires hospitalisation. However, activated charcoal may be reasonably given in the home before transfer to a hospital. You can call the Poison Information Centre at 1-888-POISONS for information about the critical signs and symptoms of overdose.
It is never wise to buy any medication on the streets. Under these circumstances, there is a greater risk that you are receiving a drug of compromised quality. Despite what you might have heard on the streets, the size of a drug is not related to its effect.
Ellen Campbell-Grizzle, president, Caribbean Association of Pharmacists; director, Information and Research, National Council on Drug Abuse; email: yourhealth@gleanerjm.com.
