Anafranil SR (clomipramine)

What is it used for?

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- Depressive illness
- Phobic or obsessional disorders
- Sudden muscle weakness (cataplexy), associated with a disorder in which there are repeated attacks of extreme sleepiness (narcolepsy).

Warning!

- Depression is associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression has got worse, or if you have any distressing thoughts or feelings, particularly about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.
- This medicine may cause drowsiness and could reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
- It is recommended that you avoid drinking alcohol while taking this medicine because it may enhance drowsiness.
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
- Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine so that your blood sodium level can be checked if necessary.
- People who wear contact lenses should be aware that this medicine can cause dry eyes, and that wearing contact lenses during treatment may therefore irritate the surface of the eye. If you experience this, consult your doctor.
- This medicine can cause a dry mouth, which may increase the risk of tooth decay with long-term use of the medicine. It is therefore important to visit your dentist regularly for check-ups.
- You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as nausea, vomiting, loss of appetite, headache, giddiness, chills, insomnia, restlessness or anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation.

Use with caution in

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- Elderly people
- Liver disease
- Heart disease
- Low blood pressure (hypotension)
- History of epilepsy
- People at risk of seizures (fits), eg due to alcohol/drug withdrawal, brain damage, other medicines
- History of increased pressure within the eye, eg glaucoma
- History of difficulty passing urine (urinary retention)
- Enlarged prostate gland
- Long-term ongoing constipation
- Psychotic illness, eg schizophrenia
- People receiving electroconvulsive therapy (ECT)
- Bipolar affective disorder
- Overactive thyroid gland
- People taking thyroid medication for an underactive thyroid gland
- Tumour of the adrenal gland (phaeochromocytoma)
- Hereditary blood disorders called porphyrias.

Not to be used in

- Allergy to other tricyclic antidepressants
- People who have recently had a heart attack
- Defect of the heart's electrical message pathways resulting in decreased function of the heart (heart block)
- Irregular heart beats (arrhythmias)
- Low level of potassium in the blood (hypokalaemia)
- Severe liver disease
- Mania
- Closed angle glaucoma
- Difficulty in passing urine (urinary retention)
- People who have taken a monoamine oxidase inhibitor antidepressant (MAOI) in the last three weeks
- This medicine is not recommended for treating children under 18 years of age (see warning above).

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby.

- The safety of this medicine during pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor. This is particularly important in the first and third trimesters. Seek medical advice from your doctor.
- This medicine passes into breast milk. The manufacturer recommends that mothers should either avoid using this medicine while breastfeeding, or if they need to keep taking the medicine, avoid breastfeeding. It is important to seek medical advice from your doctor.

Label warnings

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- This medication is to be swallowed whole, not chewed.
- This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.