Package leaflet: Information for the patient Other medicines and Clomipramine Tell your doctor if you are taking, have recently Clomipramine 10 mg Capsules, Hard taken or might take any other medicines. Clomipramine 25 mg Capsules, Hard Some medicines may increase the side effects of Clomipramine 50 mg Capsules, Hard Clomipramine and may sometimes cause very clomipramine hydrochloride serious reactions. Do not take any other medicines whilst taking Clomipramine without first talking to Read all of this leaflet carefully before you your doctor, especially: start taking this medicine because it contains - medicines for depression, particularly MAOIs (see important information for you. section “Do not take” above) e.g. tranylcypromine, - Keep this leaflet. You may need to read it again. phenelzine, moclobemide; SSRIs e.g. fluoxetine (or - If you have any further questions, ask your have taken within the last 3 weeks), fluvoxamine, doctor or pharmacist. paroxetine, sertraline; SNaRIs e.g. venlafaxine; - This medicine has been prescribed for you only. tricyclic and tetracyclic antidepressants e.g. Do not pass it on to others. It may harm them, amitriptyline, dothiepin, maprotiline even if their signs of illness are the same as yours. - diuretics, also known as ‘water tablets’, e.g. - If you get any side effects, talk to your doctor bendroflumethiazide, furosemide or pharmacist. This includes any possible side - anaesthetics, used for the temporary loss of effects not listed in this leaflet. See section 4. bodily sensation - antihistamines e.g. terfenadine What is in this leaflet - medicines for other mental health conditions 1. What Clomipramine is and what it is used for. such as schizophrenia or manic depression 2. What you need to know before you e.g. thioridazine, lithium, clozapine, pimozide, take Clomipramine. benzodiazepines e.g. alprazolam 3. How to take Clomipramine. - medicines for high blood pressure e.g. 4. Possible side effects. guanethidine, betanidine, reserpine, clonidine or 5. How to store Clomipramine. alpha methyldopa or norepinephrine 6. Contents of the pack and other information. - norepinephrine (noradrenaline), used to treat low blood pressure 1. What Clomipramine is and what it is used for - medicines to treat heart disorders, particularly Clomipramine is available as capsules in three those used to treat an abnormal heart rhythm, different strengths. e.g. disopyramide, procainamide, epinephrine (adrenaline), isoprenaline, amiodarone, quinidine, Clomipramine belongs to a group of medicines diltiazem and verapamil called tricyclic antidepressants. Clomipramine is - beta-blockers e.g. atenolol, sotalol believed to work by increasing the levels of two - anticoagulants (blood thinning tablets) e.g. warfarin naturally occurring chemicals within the brain, - aspirin and similar pain killing non-steroidal anti- noradrenaline and 5-hydroxytryptamine (also inflammatory drugs (NSAIDs) called serotonin). - medicines for Parkinson's Disease, e.g. levodopa, biperiden, entacapone or selegiline Clomipramine is used to treat depression - nicotine e.g. if you smoke or are using nicotine (especially if you also need to be sedated), replacement therapy obsessions and phobias (irrational fears). It is - anticonvulsants, used to stop seizures or fits e.g. also used along with other medications to treat barbiturates such as phenobarbital, phenytoin, cataplexy. Cataplexy is a disorder which causes carbamazepine or valproate muscle weakness and symptoms such as sagging - decongestants used for colds and flu such as jaw, drooping head and weakness at the knees. ephedrine, phenylephrine Attacks of cataplexy are triggered by strong or phenylpropanolamine emotions. Cataplexy often affects people who have - cimetidine, used to treat stomach ulcers narcolepsy (a sleep disorder). or heartburn This medicine is for adults only. - methylphenidate used to treat for ADHD - rifampicin, used to treat some infections 2. What you need to know before you including tuberculosis (TB) take Clomipramine - quinine, for cramp or malaria treatment - strong painkillers such as tramadol, nefopam, Do NOT take Clomipramine if you: morphine or morphine related substances e.g. - are allergic to clomipramine or any of the other codeine, dihydrocodeine ingredients of this medicine (listed in section 6) - drugs of abuse including Ecstasy - have ever had a rash or other allergic reaction to - atropine or similar medicines (including eye drops) any other antidepressants - medicines containing oestrogens e.g. contraceptive - have had a heart attack within the last 3 months pill or hormone replacement therapy - have problems with your heart beat - medicines called protease inhibitors, used to - have any serious liver disease treat Human Immunodeficiency Virus (HIV) e.g. - have a mental health condition called mania ritonavir, indinavir - have glaucoma (increased eye pressure) - terbinafine, used orally to treat skin, hair or nail - have difficulty in passing urine infections due to fungus - are taking, or within the last 3 weeks have taken - colestipol, cholestyramine, used to treat high medicines for depression called monoamine cholesterol levels oxidase inhibitors (MAOI) - St. John’s wort (Hypericum perforatum), - are taking medicines called selective, reversible a herbal product used to treat depression monoamine oxidase-A (MAO-A) inhibitors such and other conditions as moclobemide - disulfiram, used to help you stop drinking alcohol - altretamine, used to treat cancer If you are unsure if any of the above applies to you, - baclofen, used in the treatment of multiple please talk to your doctor or pharmacist. sclerosis and spinal damage Warnings and precautions - pentamidine, an antibiotic used to treat pneumonia Talk to your doctor or pharmacist before taking - levacetylmethadol, used to treat addiction to Clomipramine if you: opioid drugs such as heroin. - have ever had suicidal thoughts - buprenorphine/ opioids (used to treat opioid - suffer from epilepsy (fits) overdose). These medicines may interact - have had a head injury or have suffered with Clomipramine and you may experience brain damage symptoms such as involuntary, rhythmic - are going to have electric shock therapy (ECT) contractions of muscles, including the muscles - have other problems with your heart that control movement of the eye, agitation, - have been told you have a low level of potassium hallucinations, coma, excessive sweating, tremor, in your blood (hypokalaemia). The doctor will need exaggeration of reflexes, increased muscle to treat this before you start taking clomipramine tension, body temperature above 38°C. Contact - have kidney disease your doctor when experiencing such symptoms. - suffer from schizophrenia or other mental Clomipramine with food, drink and alcohol health conditions Take care when eating grapefruit, or drinking - have a blood disorder grapefruit juice or cranberry juice as this may - have an overactive thyroid gland increase your chance of experiencing side effects. - have had severe constipation for a long time Be careful when drinking alcohol - it may affect you - have a tumour (cancer) of the adrenal gland (such more than usual. as phaeochromocytoma or neuroblastoma) - liver disease Pregnancy and breast-feeding - have low blood pressure Clomipramine should not be taken if you are - wear contact lenses pregnant unless your doctor has told you to do so. - are elderly Clomipramine may harm your unborn child. - The use of Buprenorphine together with Clomipramine can lead to serotonin syndrome, a Clomipramine may reach your baby through potentially life-threatening condition (see “Other the breast milk. Therefore, you should not take medicines and Clomipramine”). Clomipramine if you are breast-feeding. Thoughts of suicide and worsening of your If you are pregnant or breast-feeding, think you depression or anxiety disorder: may be pregnant or are planning to have a baby, If you are depressed and/or have anxiety disorders ask your doctor or pharmacist for advice before you can sometimes have thoughts of harming or taking this medicine. killing yourself. These may be increased when first Driving and using machines starting antidepressants, since these medicines all If you feel dizzy, tired, have blurred vision, have take time to work, usually about two weeks but difficulty concentrating, or have other effects such sometimes longer. as confusion, disorientation or your depression You may be more likely to think like this: gets worse when you start to take Clomipramine - If you have previously had thoughts about killing do not drive or work with machinery until these or harming yourself. effects have worn off. - If you are a young adult. Information from clinical Alcohol and other medicines may make these trials has shown an increased risk of suicidal side effects worse (see ‘Other medicines behaviour in young adults (less than 25 years old) and Clomipramine’) with mental health conditions who were treated with an antidepressant. The medicine can affect your ability to drive as it may make you sleepy or dizzy. If you have thoughts of harming or killing yourself • Do not drive while taking this medicine until you at any time, contact your doctor or go to a know how it affects you. hospital straight away. You may find it helpful • It is an offence to drive if this medicine affects to tell a relative or close friend that you are your ability to drive. depressed or have an anxiety disorder, and ask • However, you would not be committing an them to read this leaflet.