Clomipramine (patient information)

# IMPORTANT WARNING
Studies have shown that children and teenagers who take antidepressants ('mood elevators') such as clomipramine may be more likely to think about harming or killing themselves or to plan or try to do so than children who do not take antidepressants.
If your child's doctor has prescribed clomipramine for your child, you should watch his or her behavior very carefully, especially at the beginning of treatment and any time his or her dose is increased or decreased. Your child may develop serious symptoms very suddenly, so it is important to pay attention to his or her behavior every day. Call your child's doctor right away if he or she experiences any of these symptoms: new or worsening depression; thinking about harming or killing him- or herself or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; irritability; aggressive behavior; acting without thinking; severe restlessness; frenzied abnormal excitement, or any other sudden or unusual changes in behavior.
Your child's doctor will want to see your child often while he or she is taking clomipramine, especially at the beginning of his or her treatment.Your child's doctor may also want to speak with you or your child by telephone from time to time. Be sure that your child keeps all appointments for office visits or telephone conversations with his or her doctor.
Your child's doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when your child begins treatment with clomipramine. Read the information carefully and ask your child's doctor or pharmacist if you have any questions. You also can obtain the Medication Guide from the FDA website: .
Talk to your child's doctor about the risks of giving clomipramine to your child.

# Why this medication is prescribed
Clomipramine is used to treat patients with obsessive-compulsive disorder.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How this medication should be used
Clomipramine comes as a capsule to take by mouth. It usually is taken one to three times a day with meals or once a day at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take clomipramine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Continue to take clomipramine even if you feel well. Do not stop taking clomipramine without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.

# Special precautions
Before taking clomipramine:
- tell your doctor and pharmacist if you are allergic to clomipramine or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially MAO inhibitors , even if you stopped taking them in the last 2 weeks; anticoagulants ('blood thinners') such as warfarin (Coumadin); benztropine (Cogentin); cimetidine (Tagamet); clonidine (Catapres); dicyclomine (Bentyl); digoxin (Lanoxin); disulfiram; flecainide (Tambocor); guanethidine (Ismelin); haloperidol (Haldol); levodopa (Sinemet, Dopar); medications for nausea, dizziness, or schizophrenia; oral contraceptives; propafenone (Rythmol); quinidine (Quinidex); secobarbital (Seconal); sedatives; selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), and paroxetine (Paxil); tranquilizers; trihexyphenidyl (Artane); and vitamins. You must wait at least 5 weeks after stopping to take fluoxetine before beginning to take clomipramine.
- tell your doctor if you or anyone in your family has or has ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), or mania (frenzied, abnormally excited mood), or if you or anyone in your family has thought about or attempted suicide. Also tell your doctor if you have or have ever had a heart attack, seizures, problems with your urinary system or prostate, glaucoma, irregular heartbeat, problems with your blood pressure, thyroid problems, or heart, kidney, or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking clomipramine, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking clomipramine.
- you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
- remember that alcohol can add to the drowsiness caused by this drug.
- tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this drug.
- plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Clomipramine may make your skin sensitive to sunlight.
- you should know that your mental health may change in unexpected ways, especially at the beginning of your treatment and any time that your dose is increased or decreased. These changes may occur at any time if you have depression or another mental illness, whether or not you are taking clomipramine or any other medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied, abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor when you are unable to seek treatment on your own.

# Special dietary instructions
Clomipramine may cause an upset stomach. Take clomipramine with food or milk.

# What to do if you forget a dose
If you take clomipramine several times a day, take the missed dose as soon as you remember it and take any remaining doses for that day at evenly spaced intervals. However, if you remember a missed dose when it is almost time for your next scheduled dose, skip the missed dose.
If you take clomipramine once a day at bedtime and do not remember it until the next morning, skip the missed dose. Do not take a double dose to make up for a missed one.

# Side effects

## Minor side effects
Clomipramine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- drowsiness
- dry mouth
- upset stomach
- vomiting
- diarrhea
- constipation
- nervousness
- decreased sexual ability
- decreased memory or concentration
- headache
- stuffy nose
- change in appetite or weight

## Severe side effects
If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
- tremor
- seizures
- fast, irregular, or pounding heartbeat
- difficulty urinating or loss of bladder control
- depression
- delusions or hallucinations
- eye pain
- shakiness
- difficulty breathing or fast breathing
- severe muscle stiffness
- unusual tiredness or weakness
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 .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to clomipramine.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Anafranil