Anafranil

What side effects are possible with this medication?

A side effect is an unwanted response to a medication when it is taken in normal doses. It can be mild or severe, temporary or permanent, but does not occur in everyone. The following side effects have been reported by at least 1% of people taking this medication. If you develop any of these side effects (or any other side effects not listed here) or they change in intensity, speak to your doctor or pharmacist for advice on managing them and on the risks and benefits of the medication.

blurred vision confusion or delirium constipation decreased sexual drive and ability diarrhea difficulty sleeping dizziness drowsiness dry mouth fast or irregular heartbeat headache heartburn

increased or decreased appetite increased sweating loss of balance control nausea nervousness problems urinating shakiness or trembling sleepiness tiredness or weakness unpleasant taste sensation vomiting weight gain

Click here to learn about serious side effects that can potentially occur with any medication. These examples are provided for information purposes only and are not meant to be exhaustive. Always consult your doctor for sound medical advice specific to your particular medication and treatment.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Alcohol and other CNS depressants: Avoid alcohol and other central nervous system (CNS) depressants while taking this medication. Clomipramine may exaggerate your response to alcohol or to these other medications.

Decreased white blood cells: Rarely, this medication can cause the levels of certain blood cells to drop. This may lead to problems with fighting infections. Contact your doctor immediately if you develop a fever, chills, sore throat or mouth or nose sores, or other signs of infection, while taking this medication.

Drowsiness/reduced alertness: Since clomipramine may cause drowsiness, especially at the beginning of treatment, caution should be used when engaging in activities requiring mental alertness, judgment, and physical coordination.

Medical conditions: Clomipramine should be taken with caution if you have:

• a history of heart disease
• a history of liver disease
• narrow-angle glaucoma
• increased pressure in the eye(s)
• pheochromocytoma or neuroblastoma (tumors of the adrenal glands)
• problems with urination
• severe kidney disease
• thyroid disorders

Neuroleptic malignant syndrome (NMS): This syndrome, which can be fatal, has been reported in people taking medications such as clomipramine. If you develop symptoms such as rigid muscles, changes in mental status, unsteady pulse and blood pressure, fever, sweating and abnormal heart rhythms, you should stop taking this medication and seek medical attention immediately.

Orthostatic hypotension (dizziness upon arising): Move slowly when rising from a sitting or lying position as clomipramine can cause sudden temporary low blood pressure resulting in dizziness.

Seizures: Clomipramine should be used with extreme caution by anyone with a history of seizures or conditions that lower the seizure threshold (such as alcoholism or withdrawal from alcohol).

Sexual side effects: Sexual side effects (including impotence and problems ejaculating) may occur in men taking clomipramine.

Suicidal thoughts or actions: Antidepressant medications, including clomipramine may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions. 

Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medication is started or when the dose is changed. Call your doctor right away to report new or sudden changes in mood, behavior, thoughts, or feelings. Keep all follow-up visits with your doctor as scheduled. Call your doctor between visits as needed, especially if you have concerns about symptoms.

Call your doctor right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

• acting aggressive
• acting on dangerous impulses
• an extreme increase in activity and talking (mania)
• attempts to commit suicide
• being angry or violent
• feeling very agitated or restless
• new or worse anxiety
• new or worse depression
• new or worse irritability
• panic attacks
• other unusual changes in behavior or mood
• thoughts about suicide or dying
• trouble sleeping (insomnia)

Surgery: If you are undergoing surgery and require general anesthetics you should tell your doctor about this medication. Clomipramine will need to be stopped several days prior to the planned surgery date.

Withdrawal: Withdrawal symptoms such as dizziness, nausea, headache, and sleep disturbance have occurred when clomipramine therapy is discontinued suddenly. This is not a sign of addiction. Check with your doctor before stopping this medication on your own.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking clomipramine, it may affect your baby. Talk to your doctor about whether you should stop breast-feeding or stop taking this medication.

Children: The safety and effectiveness of this medication have not been established for children less than 10 years of age.

What other drugs could interact with this medication?

There may be an interaction between clomipramine and any of the following:

alcohol anti-arrhythmic drugs (e.g., flecainide, propafenone, quinidine) anticholinergic medications (e.g., atropine, benztropine) barbiturates (e.g., phenobarbital) benzodiazepines (e.g., diazepam, lorazepam) carbamazepine cimetidine cisapride clonidine digoxin guanethidine haloperidol

MAO inhibitors (e.g., phenelzine, moclobemide) other antidepressants phenothiazines (e.g., chlorpromazine, thioridazine) phenytoin selective serotonin reuptake inhibitors (SSRIs; e.g., sertraline, fluoxetine, fluvoxamine, paroxetine) sympathomimetics (e.g., amphetamine, methylphenidate, ephedrine) thyroid medications (e.g., levothyroxine) warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.