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clomipramine - oral, Anafranil (cont.)

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first. (See also the How to Use section.)This drug should not be used with the following medications because very serious interactions may occur: arbutamine, cisapride, sibutramine.Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) within 2 weeks before, during, and after treatment with this medication. In some cases a serious, possibly fatal drug interaction may occur.If you are currently using any of the medications listed above, tell your doctor or pharmacist before starting clomipramine.Many drugs besides clomipramine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, quinidine, sotalol, pimozide, procainamide, macrolide antibiotics (such as erythromycin), among others. Therefore, before using clomipramine, report all medications you are currently using to your doctor or pharmacist.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: anticholinergics (e.g., atropine, belladonna alkaloids, scopolamine), inhaled bronchodilators (e.g., albuterol, salmeterol), certain drugs for high blood pressure (e.g., clonidine, guanethidine, reserpine), digoxin, nasal decongestants (e.g., epinephrine, phenylephrine), levodopa, lithium, stimulants (e.g., amphetamine, epinephrine, methylphenidate), thyroid supplements, valproic acid, drugs that can cause bleeding/bruising (e.g., "blood thinners" such as warfarin/heparin, anti-platelet drugs including aspirin or NSAIDs such as ibuprofen), drugs affecting liver enzymes that remove clomipramine from your body (e.g., alcohol, barbiturates such as phenobarbital, cimetidine, haloperidol, certain drugs for heart rhythm such as flecainide/propafenone, certain HIV protease inhibitors such as amprenavir/fosamprenavir, phenothiazines such as thioridazine, certain anti-seizure drugs such as carbamazepine/phenytoin, antidepressants such as fluoxetine/fluvoxamine/paroxetine, St. John's wort, terbinafine), drugs that may increase serotonin levels/activity (e.g., alprazolam, bromocriptine, buspirone, dextromethorphan, certain narcotic pain relievers such as fentanyl/meperidine/pentazocine, antidepressants such as amitriptyline/trazodone/venlafaxine, certain stimulants, S-adenosylmethionine, street drugs such as MDMA/"ecstasy," tramadol, "triptans" such as sumatriptan, tryptophan).Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with this medication such as bupropion, isoniazid (INH), phenothiazines (e.g., thioridazine), theophylline, or tricyclic antidepressants (e.g., desipramine), among others. Consult your doctor or pharmacist for details.Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-anxiety drugs (e.g., diazepam), anti-seizure drugs (e.g., levetiracetam), drugs for motion sickness (e.g., meclizine).Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as aspirin, ibuprofen, naproxen) that, if taken together with this drug, may increase your risk for bleeding. Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually at dosages of 81-325 milligrams per day), should be continued. Consult your doctor or pharmacist for more details.Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-containing ingredients or decongestants that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.



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