Do not use this medication if you have recently had a heart attack, or if you have used an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

Do not use Anafranil if you are allergic to it or to similar drugs such as:

• amitriptyline (Elavil®, Etrafon®)
• amoxapine (Ascendin®)
• desipramine (Norpramin®)
• doxepin (Sinequan®)
• imipramine (Janimine®, Tofranil®)
• nortriptyline (Pamelor®)
• protriptyline (Vivactil®)
• trimipramine (Surmontil®)

You may have suicidal thoughts or behavior when you start taking an antidepressant, especially if you are under 18 years old. You will need to be monitored for worsening symptoms of depression or suicidal thoughts. Your doctor should check you at regular visits during the first 12 weeks of treatment, or whenever your dose is changed.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

Take Anafranil with food to reduce stomach upset.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking Anafranil. You may need to stop using the medicine for a short time.

Do not stop using Anafranil without first talking to your doctor. You may need to use less and less before you stop the medication completely.

It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment.

Do not use this medication if you are allergic to Anafranil or to similar drugs such as:

• amitriptyline (Elavil®, Etrafon®)
• amoxapine (Ascendin®)
• desipramine (Norpramin®)
• doxepin (Sinequan®)
• imipramine (Janimine®, Tofranil®)
• nortriptyline (Pamelor®)
• protriptyline (Vivactil®)
• trimipramine (Surmontil®)

Do not use Anafranil if you have recently had a heart attack, or if you have used an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)
• tranylcypromine (Parnate®)

within the past 14 days. Serious, life-threatening side effects can occur if you take Anafranil before the MAO inhibitor has cleared from your body.

Before taking Anafranil, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease or a history of heart attack, stroke, or seizures
• bipolar disorder (manic-depression), schizophrenia or other mental illness
• kidney or liver disease
• overactive thyroid or adrenal gland tumor (pheochromocytoma)
• glaucoma
• problems with urination

If you have any of these conditions, you may not be able to use Anafranil, or you may need a dosage adjustment or special tests during treatment.

You may have suicidal thoughts or behavior when you first start taking an antidepressant, especially if you are under 18 years old. Watch for worsening symptoms of depression or suicidal thoughts. Your doctor should check you at regular visits during the first 12 weeks of treatment, or whenever your dose is changed.

In addition to you watching for changes in your own symptoms, your family or caregivers should be alert to changes in your mood or symptoms.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• mood changes
• anxiety
• panic attacks
• trouble sleeping
• irritability
• agitation
• aggressiveness
• severe restlessness
• mania (mental and/ or physical hyperactivity)
• thoughts of suicide or hurting yourself

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Anafranil can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Anafranil can be fatal. Symptoms may include:

• fast or uneven heart rate
• extreme drowsiness
• confusion
• agitation
• vomiting
• blurred vision
• sweating
• muscle stiffness
• increased or decreased urination
• swelling
• shortness of breath
• blue lips or fingernails
• feeling light-headed
• fainting
• seizure (convulsions)
• coma

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Call your doctor at once if you have any of these serious side effects:

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling
• sudden numbness or weakness, especially on one side of the body
• sudden headache, confusion, problems with vision, speech, or balance
• feeling light-headed, fainting
• fever, confusion, muscle stiffness, sweating, fast or uneven heartbeats
• pale skin, easy bruising or bleeding, unusual weakness
• urinating more than usual

Less serious side effects may be more likely to occur, such as:

• nausea, vomiting, stomach pain, loss of appetite, constipation or diarrhea
• dry mouth, unpleasant taste
• increased appetite, weight changes
• feeling anxious, restless, dizzy, drowsy, or tired
• blurred vision, trouble concentrating
• sleep problems (insomnia), nightmares
• blurred vision
• increased sweating
• decreased sex drive, impotence, or difficulty having an orgasm

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Before taking Anafranil, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as:

• citalopram (Celexa®)
• escitalopram (Lexapro®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)

Before taking Anafranil, tell your doctor if you are currently using any of the following drugs:

• cimetidine (Tagamet®)
• guanethidine (Ismelin®)
• methylphenidate (Concerta®, Ritalin®, Daytrana®)
• phenytoin (Dilantin®)
• warfarin (Coumadin®)
• clonidine (Catapres®)
• digoxin (Lanoxin®)
• flecainide (Tambocor®)
• propafenone (Rhythmol®)
• quinidine (Cardioquin®, Quinidex®, Quinaglute®)
• chlorpromazine (Thorazine®)
• haloperidol (Haldol®)
• thioridazine (Mellaril®)
• clozapine (Clozaril®)
• olanzapine (Zyprexa®, Zydis®)
• quetiapine (Seroquel®)
• risperidone (Risperdal®)
• ziprasidone (Geodon®)

If you are using any of these drugs, you may not be able to use Anafranil, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with Anafranil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.