Anafranil

¿What is Anafranil (Clomipramine)?

Anafranil is a tricyclic antidepressant. It affects chemicals in the brain that may become unbalanced. Anafranil is used to treat symptoms of obsessive-compulsive disorder (OCD) such as recurrent thoughts or feelings and repetitive actions. Anafranil may also be used for purposes other than those listed in this medication guide.

¿What is the most important information I should know about Anafranil (Clomipramine)?

Do not use this medication if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Do not use Anafranil if you are allergic to it or to similar drugs such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil). You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

¿What should I discuss with my healthcare provider before taking Anafranil (Clomipramine)?

Do not use this medication if you are allergic to Anafranil or to similar drugs such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil). Do not use Anafranil if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take Anafranil before the MAO inhibitor has cleared from your body. Before taking Anafranil, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease or a history of heart attack, stroke, or seizures;
• bipolar disorder (manic-depression), schizophrenia or other mental illness;
• kidney or liver disease;
• overactive thyroid or adrenal gland tumor (pheochromocytoma);
• glaucoma; or problems with urination.
  

If you have any of these conditions, you may not be able to use Anafranil, or you may need a dosage adjustment or special tests during treatment. You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed. Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment. FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Anafranil can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give Anafranil to anyone younger than 18 years old without the advice of a doctor.

¿How should I take Anafranil (Clomipramine)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label. Take Anafranil with food to reduce stomach upset. If you need to have any type of surgery, tell the surgeon ahead of time that you are taking Anafranil. You may need to stop using the medicine for a short time. Do not stop using Anafranil without first talking to your doctor. You may need to use less and less before you stop the medication completely. It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Store Anafranil at room temperature away from moisture and heat.

¿What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

¿What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Anafranil can be fatal. Symptoms may include fast or uneven heart rate, extreme drowsiness, confusion, agitation, vomiting, blurred vision, sweating, muscle stiffness, increased or decreased urination, swelling, shortness of breath, blue lips or fingernails, feeling light-headed, fainting, seizure (convulsions), or coma.

¿What should I avoid while taking Anafranil (Clomipramine)?

Avoid drinking alcohol. It can cause dangerous side effects when taken together with Anafranil. Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). They can add to sleepiness caused by Anafranil. Grapefruit and grapefruit juice may interact with Anafranil. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet. Anafranil can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Anafranil can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun. Anafranil (Clomipramine) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have any of these serious side effects:

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
• sudden numbness or weakness, especially on one side of the body;
• sudden headache, confusion, problems with vision, speech, or balance;
• feeling light-headed, fainting;
• fever, confusion, muscle stiffness, sweating, fast or uneven heartbeats;
• pale skin, easy bruising or bleeding, unusual weakness; or
• urinating more than usual.
  

Less serious side effects may be more likely to occur, such as:

• nausea, vomiting, stomach pain, loss of appetite, constipation or diarrhea;
• dry mouth, unpleasant taste;
• increased appetite, weight changes;
• feeling anxious, restless, dizzy, drowsy, or tired;
• blurred vision, trouble concentrating;
• sleep problems (insomnia), nightmares;
• blurred vision;
• increased sweating; or
• decreased sex drive, impotence, or difficulty having an orgasm.
  

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

¿What other drugs will affect Anafranil (Clomipramine)?

Before taking Anafranil, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Before taking Anafranil, tell your doctor if you are currently using any of the following drugs:

• cimetidine (Tagamet)
• guanethidine (Ismelin)
• methylphenidate (Concerta, Ritalin, Daytrana)
• phenytoin (Dilantin)
• warfarin (Coumadin)
• heart or blood pressure medication such as clonidine (Catapres) or digoxin (Lanoxin);
• heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute); or
• anti-psychotic medications such as chlorpromazine (Thorazine), haloperidol (Haldol), thioridazine (Mellaril), clozapine (Clozaril), olanzapine (Zyprexa, Zydis), quetiapine (Seroquel), risperidone (Risperdal), or ziprasidone (Geodon).
  

If you are using any of these drugs, you may not be able to use Anafranil, or you may need dosage adjustments or special tests during treatment. There are many other medicines that can interact with Anafranil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

¿Where can I get more information?

• Your pharmacist has information about Anafranil written for health professionals that you may read.