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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Blurred Vision And Muscle Weakness After Using Anafranil?

My husband has started taking anafranil about 6-8 weeks ago for OCD, He has been ill for a few years with IBS and subsequently now has an anxiety disorder and panic attacks. (He is on klonopin .5 mg bid, and lisinoprilhe for BP Q day) He started the Anafranil at 25mg and has tried to increase to 100 mg per his MD. He is having terrible side effects like severe muscle cramping in his calves,legs, constant nausea, dry heaving, vomiting, blurred vision, times of confusion, muscle weakness, dry mouth, loss of appetite, fatigue. He has lost 10 lbs since (168-158. 6 ft) and was already depleted from battling IBS. He is now unable to even make it to work he is so weak and ill with these various side effects. His Dr says these side effects are common and will subside once he reaches his ordered dose of 100 in a steady state and really doesn t want to decrease the dosage. How long can this be? He is about to lose his job of 25 years due to this, all the while being assured these side effects will go away? He also has sensitivity to common SSRI s. Could this be seratonin syndrome? Or will these symptoms subside? Should we go to 50 mg as this dose didn t seem quite so bad? After reading side effects about muscle spasms/dystopia I am really getting concerned. Thank you
Mon, 14 Sep 2015
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Addiction Medicine Specialist,  's  Response
To say a drug is associated with a side effect there are several features that make it seem likely:
1) having the symptom come after taking it. Not a good indicator.
2) having lots of people report the same thing. Surprisingly bad. There have been epidemics of witch attacks, windshield cracks, and many others when people have heard about soemthing and convinced themselves it applies to them also.
3) The drug doing something that is known to cause those side effects. Much better and applies to blurred vision and to dry mouth with this drug... it blocks the nerves that work on digestion/secretion/bladder tone and also regulation of the muscular tone of the eye. It also causes sedation--it can cause sedation by several different effects of the drug so I cannot say why it does it.
and related 4) the symptoms all follow a particular pattern from a particular wiring pattern in the nervous system. It's acetylcholine blocking not serotonin, but still....
These are really common really well known effects of this drug
they are not going to go away unless the drug dose is decreased. Possibly to zero drug.
Muscle effects are not quite in the same wiring pattern, less associated with the drug and are not generally really serious. The other symptoms while not life threatening really really are annoying, don't fade with time, make a significant number of people choose another drug and are the second reason why serotonin specific drugs (these symptoms are NOT from serotonin; depression treatment IS from serotonin) are regarded as so very much better than older drugs like anafranil.
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What Causes Blurred Vision And Muscle Weakness After Using Anafranil?

To say a drug is associated with a side effect there are several features that make it seem likely: 1) having the symptom come after taking it. Not a good indicator. 2) having lots of people report the same thing. Surprisingly bad. There have been epidemics of witch attacks, windshield cracks, and many others when people have heard about soemthing and convinced themselves it applies to them also. 3) The drug doing something that is known to cause those side effects. Much better and applies to blurred vision and to dry mouth with this drug... it blocks the nerves that work on digestion/secretion/bladder tone and also regulation of the muscular tone of the eye. It also causes sedation--it can cause sedation by several different effects of the drug so I cannot say why it does it. and related 4) the symptoms all follow a particular pattern from a particular wiring pattern in the nervous system. It s acetylcholine blocking not serotonin, but still.... These are really common really well known effects of this drug they are not going to go away unless the drug dose is decreased. Possibly to zero drug. Muscle effects are not quite in the same wiring pattern, less associated with the drug and are not generally really serious. The other symptoms while not life threatening really really are annoying, don t fade with time, make a significant number of people choose another drug and are the second reason why serotonin specific drugs (these symptoms are NOT from serotonin; depression treatment IS from serotonin) are regarded as so very much better than older drugs like anafranil.