Supranil vs Anafranil: Which Is More Suitable for Treatment?

The difference between Supranil and Anafranil is smaller than many think; they aren’t fundamentally different medicines, but two trade names for the same active substance: clomipramine, which is a tricyclic antidepressant. Anafranil is the original trade name under which clomipramine was launched worldwide decades ago, and Supranil is a generic product made by an Egyptian company. That is why the differences between them don’t concern the strength of treatment, but the manufacturer, the form of the product, the inactive ingredients, the existence of an extended-release form of Anafranil, and price and availability. As for “which is more suitable”, that is a question the doctor answers, and replacing one with the other isn’t done without consulting them.

The active substance is the same: clomipramine

When reading the two packs you will find the same scientific name. This means that the effect on the brain, the indications, the side effects, the warnings and the drug interactions are all the same in principle. The common idea that one is “stronger” or “milder” has no basis as long as the patient takes the same substance in the way the doctor specified. The only real difference in effect may come from a difference in the way it is released, as we will explain.

This phenomenon isn’t specific to clomipramine; many medicines in Egyptian pharmacies have an original trade name and several generic names. Knowing this fact protects the patient from a common mistake: taking both names together thinking they are two different medicines, and so doubling the amount without realizing.

The Anafranil alternative in Egypt: Supranil with the same active substance

When a patient looks for an Anafranil alternative in Egypt, the intended alternative is usually Supranil, because it contains the same clomipramine. The numbers that recur in the question, such as “Anafranil 75 alternative” or “Anafranil 25 alternative”, mean the amount of the active substance in milligrams in the tablet, so the question in practice is about a product carrying the same amount of clomipramine.

But matching the number alone isn’t enough for switching. Anafranil is available in some strengths in an extended-release form, and if the way of release differs between what the doctor prescribed and what the patient will take, the timing of doses, the feeling of the effect and the side effects may change. That is why substitution is done after asking the doctor or pharmacist, while being careful not to take both names together. To learn about the medicine itself in detail see the guide to Anafranil and Supranil, and if clomipramine doesn’t suit the patient at all, the alternatives are different medicines the doctor discusses, as we explain later.

What is clomipramine and what is it used for?

Clomipramine is among the oldest antidepressants, and is distinguished among the members of its tricyclic family as having the strongest effect on serotonin, with an effect on noradrenaline too. It is used to treat depression in many countries, and is known especially for its effectiveness in obsessive-compulsive disorder, which is its officially approved use in the United States. Doctors may prescribe it in other conditions according to their judgment, including conditions in which it is used outside its original indications, such as premature ejaculation, and this doesn’t make its use safe without a prescription.

Its therapeutic effect in depression or OCD doesn’t appear immediately, but needs weeks of regular use, which pushes some patients to the mistaken conclusion that “Supranil didn’t work, so let’s try Anafranil”, when the problem is the short duration, not the trade name.

The actual differences between Supranil and Anafranil

Available forms and prices may change from time to time in the Egyptian market, so refer to the pharmacist for current details.

Is the Egyptian generic as effective as the original?

Generic products are registered only after the producing company proves to the regulatory authority, which in Egypt is the Egyptian Drug Authority, that its product contains the same active substance, and that it reaches the blood in an amount and speed equivalent to the original within scientifically defined limits, which is known as bioequivalence. That is why the generic is expected to give the same result. Small differences remain possible in the inactive ingredients that may matter to someone with an allergy to a particular substance, or in the personal feeling of some effects, and these are discussed with the doctor.

Which is more suitable for treatment?

Since the substance is the same, the choice between them depends on practical considerations determined by the doctor with the patient:

• Does the plan need an extended-release form taken in a different way?
• Does the patient have a known allergy to one of the inactive ingredients?
• Which of the two products is regularly available in the patient’s area, so treatment isn’t interrupted?
• Is the monthly cost a factor affecting long-term adherence?

And the important rule: don’t move from one product to another in the middle of treatment without going back to the doctor or pharmacist, especially between a regular and an extended-release form, because the method of use may differ.

When does Supranil or Anafranil start working?

The effect of clomipramine doesn’t appear from the first days. In depression some patients start to notice an improvement in sleep and energy within about two weeks, while improvement in mood usually needs four to six weeks. In obsessive-compulsive disorder, judging the medicine needs a longer time, which may reach ten or twelve weeks, with gradual dose adjustment by the doctor. At the start side effects may appear before the benefit, such as dry mouth, drowsiness and constipation, and this doesn’t mean the medicine isn’t working. Don’t stop it or replace one trade name with another on your own, and discuss any change with the doctor who follows you.

Common side effects of clomipramine

Because the effects follow the active substance, they are similar in both names, and among the best known are:

• Dry mouth, constipation, blurred vision and difficulty urinating.
• Drowsiness and dizziness, especially on standing suddenly.
• Increased sweating and mild tremor.
• Weight gain.
• Effects on sexual function.

Many of these effects ease after the first weeks, and the doctor deals with those that persist by adjusting the plan, not by stopping the medicine suddenly. It is preferable to avoid driving or operating machinery in the first days until the patient knows how the medicine affects their alertness, and to tell the doctor about any severe constipation or real difficulty urinating, especially in older people.

Important warnings before using either

Before prescribing clomipramine the doctor needs to know whether the patient has heart disease or a rhythm disorder, has had a recent heart attack, has narrow-angle glaucoma, an enlarged prostate, epilepsy, or a history of bipolar disorder.

It isn’t combined with monoamine oxidase inhibitors, and needs great caution with medicines that raise serotonin, including tramadol, because of the risk of serotonin syndrome, and with alcohol and sedatives. Also, an overdose of tricyclic antidepressants is dangerous to the heart, so the medicine is kept away from children, and the family takes charge of keeping it when the patient is going through a period of severe depression.

Does Supranil or Anafranil cause addiction?

Clomipramine doesn’t cause the euphoria or craving that characterize addiction, and the patient doesn’t seek it as an addict seeks a substance. But stopping it suddenly after regular use may cause discontinuation symptoms, such as nausea, headache, anxiety and disturbed sleep, which is why it is reduced gradually according to a plan set by the doctor. These symptoms usually calm down within a short period if the reduction is done correctly, and they are completely different from the dependence caused by sedatives.

Patients’ experiences with Supranil: why do some feel worse before improving?

What recurs most in the experiences of those who started Supranil or Anafranil is that the first two weeks carry the side effects before the benefit: dry mouth, constipation, drowsiness or dizziness, sweating, and sometimes delayed ejaculation or reduced desire. This is what pushes some patients to stop early thinking the medicine doesn’t suit them, while many of these effects ease with time or with an adjustment decided by the doctor.

Improvement comes later, especially in obsessive-compulsive disorder, where clomipramine usually needs longer than in depression for its effect to appear clearly. Those who continued describe that the obsessions didn’t disappear suddenly, but became less insistent and easier to resist, especially when accompanied by behavioral therapy.

That is why you shouldn’t base your decision on the experience of someone who stopped in the first week, nor on the experience of someone taking it for premature ejaculation, as these are different goals for which different amounts are used. And if you decide to stop, let it be gradual with the doctor, because stopping suddenly may cause unpleasant symptoms.

Common mistakes with clomipramine

• Buying it from the pharmacy without a prescription on a friend’s advice, especially for premature ejaculation.
• Believing that the extended-release form is “stronger”, when the difference is in the method of release, not the substance.
• Switching between the two trade names without consultation, or taking them together thinking they are different.
• Stopping it suddenly on feeling better or when a side effect appears.
• Combining it with tramadol or alcohol.

Alternatives the doctor may discuss

In treating depression and obsessive-compulsive disorder, doctors usually start with selective serotonin reuptake inhibitors because they are easier to tolerate and safer, and clomipramine is reserved for those who didn’t respond to them or for cases the doctor sees as suitable. You will find an explanation of how the classes of medicines are weighed against each other in the article on medicines for depression and anxiety.

How does Riviera Life help you?

If you are taking Supranil or Anafranil and feel troublesome effects, or are unsure whether to continue or change, you can review your plan with a psychiatry consultant at Riviera Life in a free first consultation, to determine what suits your case and set a clear plan for any adjustment. And if clomipramine was prescribed for you to treat OCD or depression and you haven’t improved after a sufficient period, there are other medication and psychological options that can be discussed calmly.

More from the depression guide

• Depression: the comprehensive guide
• Medicines for depression and anxiety
• Depression treatment and steps to recovery
• OCD and depression
• Anafranil (clomipramine): uses, side effects and warnings
• Imipramine (Tofranil): depression, panic and bedwetting in children