Clomipramine (By mouth)

Brand Name(s)

Anafranil

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Change in how much or how often you urinate, or painful or difficult urination.
• Changes in behavior, or thoughts of hurting yourself or others.
• Chest pain.
• Ear pain or discharge, or ringing in the ears.
• Fast, pounding heartbeat.
• Fever, chills, cough, sore throat, runny or stuffy nose, and body aches.
• Lightheadedness or dizziness when getting up suddenly from a lying or sitting position.
• Memory problems, confusion, or depression.
• Nervousness, anxiety, agitation, or irritability.
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet.
• Tremors, or muscle twitching or stiffness.
• Trouble sleeping, unusual dreams.
• Trouble swallowing.
• Unusual bleeding, bruising, or weakness.

If you notice these less serious side effects, talk with your doctor:

• Changes in appetite.
• Changes in taste.
• Changes in vision.
• Dry mouth or tooth problems.
• Headache or drowsiness.
• Menstrual cramps or change in monthly periods.
• Muscle, joint, or back pain.
• Nausea, vomiting, diarrhea, constipation, or stomach pain or upset.
• Problems with sex.
• Skin rash or itching.
• Sweating.
• Tiredness.
• Warmth or redness in your face, neck, arms, or upper chest.
• Weight changes.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

How to Use This Medicine

Capsule, Tablet

• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to.
• Your doctor may tell you to take the medicine at bedtime, because clomipramine can make you sleepy.
• You may take the tablet with or without food. It is best to take the oral capsules with food to decrease stomach upset.
• Do not break or chew the capsules. You may open the capsule and mix the medicine beads with soft food (applesauce, pudding). Swallow the mixture without chewing.
• It may be 2 to 3 weeks after you start clomipramine before you notice an improvement in your symptoms.
• Do not stop taking clomipramine suddenly without asking your doctor.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.
• If you take one dose a day at bedtime, you should not use the missed dose the next morning without asking your doctor.

How to Store and Dispose of This Medicine

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are using cimetidine (Tagamet®), clonidine (Catapres®), digoxin (Lanoxin®), guanethidine (Ismelin®), haloperidol (Haldol®), methylphenidate (Ritalin®), or phenothiazine medicine (such as prochlorperazine, Compazine®, Mellaril®, Phenergan®, Thorazine®, or Trilafon®). Tell your doctor if you are also using other medicines to treat depression (such as fluoxetine, sertraline, paroxetine, fluvoxamine, Prozac®, Zoloft®, Paxil®, or Luvox®), medicine to treat seizures (such as phenytoin, phenobarbital, Dilantin®, or Luminal®), certain medicine for heart rhythm problem (such as quinidine, flecainide, propafenone, Quinaglute®, Tambocor®, or Rythmol®), or a blood thinner (such as warfarin or Coumadin®).
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, thyroid problems, glaucoma, high blood pressure, heart problems, trouble going to the bathroom (urinating), adrenal gland tumor (such as pheochromocytoma or neuroblastoma), or a history of seizure disorder.
• For some children, teenagers, and young adults, this medicine can increase thoughts of suicide. Tell your doctor or your child's doctor right away if you or your child start to feel more depressed and have thoughts about hurting yourselves. Report any unusual thoughts or behaviors that trouble you or your child, especially if they are new or are getting worse quickly. Make sure the doctor knows if you or your child have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you, your child, or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
• This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.

When This Medicine Should Not Be Used

Introduction

Clomipramine (kloe-MIP-ra-meen)

Treats obsessive-compulsive disorder, depression, chronic pain, bulimia, sleep disorders, and panic disorder. This medicine is a tricyclic antidepressant (TCA).