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ANAFRANIL SR 75MG TABLETS
Active substance(s): CLOMIPRAMINE HYDROCHLORIDE
ANAFRANIL® SR 75mg tablets
The name of your medicine is Anafranil SR 75mg tablets it will be
referred to as Anafranil throughout the remainder of this leaflet.
This product is available in multiple strengths and all strengths will be
referred to throughout this leaflet
What you need to know about Anafranil
Your doctor has decided that you need this medicine to help treat your
Please read this leaflet carefully before you start to take your
medicine. It contains important information. Keep the leaflet in a safe
place because you may want to read it again.
If you have any other questions, or if there is something you don’t
understand, please ask your doctor or pharmacist.
This medicine has been prescribed for you. Never give it to someone
else. It may not be the right medicine for them even if their symptoms
seem to be the same as yours.
If any of the side effects gets serious, or if you notice any side effects not
listed in this leaflet, please tell your doctor or pharmacist.
In this leaflet:
1. What Anafranil is and what it’s used for
2. Things to consider before you start to take Anafranil
3. How to take Anafranil
4. Possible side effects
5. How to store Anafranil
6. Further information
What Anafranil is and what it’s used for
Anafranil is available either as capsules in three different strengths or as
sustained release tablets. Clomipramine hydrochloride, the active
ingredient in Anafranil, is one of a group of medicines called tricyclic
antidepressants. It is thought to work either by increasing the amount of
chemical "messengers" in the brain or by making their effects last longer.
Anafranil is used to treat depression, obsessions and phobias (irrational
fears). It is also used to treat muscular weakness (cataplexy) associated
with repeat attacks of extreme sleepiness (narcolepsy) in adults.
Things to consider before you start to take Anafranil
Some people MUST NOT take Anafranil. Talk to your doctor if:
you think you may be allergic to clomipramine or to any of the other
ingredients of Anafranil tablets or capsules. (These are listed in
you have ever had a rash or other allergic reaction to any other
you have had a heart attack within the last 3 months
you have any heart disease
you have any serious liver disease
you have any other mental illness apart from depression, obsessions
you have glaucoma (increased eye pressure)
you have difficulty in passing urine
you are taking, or within the last 3 weeks have taken, any other
medicines for depression, particularly monoamine oxidase inhibitors
(MAOIs) or fluoxetine
you are breast-feeding
you are aged under 18.
You should also ask yourself these questions before taking
Do you find yourself thinking about suicide?
Do you have epilepsy (fits)?
Have you had a head injury and suffered brain damage?
Are you going to have ECT (electroconvulsive therapy)?
Do you have irregular heartbeat or other problems with your heart?
Have you been diagnosed as having a low level of potassium in your
Do you have kidney disease?
Do you have schizophrenia or other mental disorders?
Are you pregnant?
Do you have a blood disorder?
Do you have an overactive thyroid gland?
Have you had severe constipation for a long time?
Do you have a tumour (cancer) of the adrenal gland (such as
phaeochromocytoma or neuroblastoma)?
Do you have low blood pressure?
Do you wear contact lenses?
Are you elderly?
Do you have an inherited intolerance to some sugars such as
lactose? The capsules contain lactose.
If the answer to any of these questions is YES, tell your doctor or
pharmacist because Anafranil might not be the right medicine for you.
Are you taking other medicines?
Anafranil interacts with a large number of other medicines. Make sure
your doctor or pharmacist knows if you are taking any of the following:
Medicines for depression particularly MAOIs e.g. tranylcypromine,
phenelzine; SSRIs e.g. fluoxetine, paroxetine, sertraline,
fluvoxamine; tricyclic and tetracyclic antidepressants e.g.
amitriptyline, dothiepin, maprotiline, barbiturates, benzodiazepines
Medicines for other mental illnesses such as schizophrenia or manic
depression e.g. thioridazine, lithium
Medicines for high blood pressure
Medicines to treat heart disorders, particularly those used to treat an
abnormal heart rhythm
Betablockers e.g. atenolol
Diuretics e.g. bendroflumethiazide, furosemide
Anticoagulants (blood thinning tablets like warfarin)
Medicines for Parkinson's Disease
Nicotine, e.g. if you smoke or are using nicotine replacement therapy
Anticonvulsants (used to stop seizures or fits. e.g. barbiturates,
phenytoin, carbamazepine or valproate)
Cold and flu drugs such as antihistamines and decongestants
Cimetidine, used to treat ulcer/heartburn
Methylphenidate (Ritalin®) prescribed for children with ADHD
Rifampicin, used to treat some infections including tuberculosis (TB)
Quinine (for cramp or malaria treatment)
Strong painkillers such as morphine or morphine related substances
e.g. codeine, dihydrocodeine
Drugs of abuse including Ecstasy
Atropine or similar medicines (including eye drops)
Oestrogens (e.g. contraceptive pill or hormone replacement therapy)
Medicines, called protease inhibitors, used to treat Human
Immunodeficiency Virus e.g. ritonavir, indinavir
Medicine called terbinafine used orally to treat skin, hair or nail
infections due to fungus
Colestipol, cholestyramine, used to treat high cholesterol levels
St. John’s wort (Hypericum perforatum), a herbal product used to
treat depression and other conditions
Always tell your doctor or pharmacist about all the medicines you are
taking. This means medicines you have bought yourself as well as
medicines on prescription from your doctor.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are
planning to have a baby, ask your doctor or pharmacist for advice before
taking this medicine.
Anafranil should not be used during pregnancy unless specifically
prescribed by your doctor. Your doctor will discuss with you the potential
risk of taking Anafranil during pregnancy.
The active ingredient of Anafranil passes into the breast milk. Mothers
are advised not to breast-feed their babies while taking Anafranil.
The following symptoms may occur in newborn babies, of mothers that
have used Anafranil during pregnancy: breathlessness, tiredness, lack of
energy, colic, irritability, dizziness, headache, trembling. If your baby
develops any of these symptoms you may need to contact your doctor.
Will there be any problems with driving or using machinery?
If you feel dizzy, tired, have blurred vision, have difficulty concentrating,
or have other effects such as confusion or disorientation when you start
to take Anafranil, do not drive or work with machinery until these effects
have worn off.
Taking Anafranil with food and drink
Take care when eating grapefruit, or drinking grapefruit juice and
cranberry juice as this may increase your chance of experiencing side
Other special warnings
Be careful when drinking alcohol - it may affect you more than usual.
Tell your doctor or dentist if you are planning to have an operation of
any kind, as Anafranil may interact with local or general
Your doctor may want to do blood tests and check your heart while
you are taking Anafranil.
Your doctor may want to do blood tests to check your liver function
and kidney function.
You should go to the dentist regularly if you take Anafranil for a long
time, because it can cause a dry mouth which may increase the
chance of tooth decay.
If you think your symptoms are getting worse, go and see your
Thoughts of suicide and worsening of your depression or anxiety
If you are depressed and/or have anxiety disorders you can sometimes
have thoughts of harming or killing yourself. These may be increased
when first starting antidepressants, since these medicines all take time
to work, usually about two weeks but sometimes longer.
You may be more likely to think like this:
If you have previously had thoughts about killing or harming
If you are a young adult. Information from clinical trials has
shown an increased risk of suicidal behaviour in adults aged less
than 25 years with psychiatric conditions who were treated with
If you have thoughts of harming or killing yourself at any time, contact
your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend that you are
depressed or have an anxiety disorder, and ask them to read this leaflet.
You might ask them to tell you if they think your depression or anxiety is
getting worse, or if they are worried about changes in your behaviour.
Information for families, and caregivers
You should monitor whether your depressed patient shows signs of
behavioural changes such as unusual anxiety, restlessness, sleeping
problems, irritability, aggressiveness, over-excitedness or other unusual
changes in behaviour, worsening of depression or thinking about suicide.
You should report any such symptoms to the patient’s doctor, especially
if they are severe, start suddenly, or were not part of the patient’s
presenting symptoms before. You should evaluate the emergence of
such symptoms on a day-day basis, especially during anti-depressant
treatment and when the dose is increased or decreased, since changes
may be abrupt.
Symptoms such as these may be associated with an increased risk for
suicidal thinking and behaviour and indicate a need for very close
monitoring and possibly changes in medication.
How to take Anafranil
The doctor will tell you how much Anafranil to take and when to take it.
Always follow his/her instructions carefully. The dose will be on the
pharmacist’s label. Check the label carefully. If you are not sure, ask
your doctor or pharmacist.
Swallow your Anafranil tablets whole with a drink of water.
Keep taking your medicine until your doctor tells you to stop. Do not
stop because you do not feel any better. This medicine may take up
to 4 weeks to work.