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The following safety information provides crucial details about the use of clomipramine (Anafranil), an antidepressant medication. It is essential to understand these warnings and consult with your healthcare provider if you have any questions or concerns.

• Risk of Suicidal Thoughts or Behavior: Using clomipramine can increase the likelihood of suicidal thoughts or behavior, particularly in individuals aged 24 or younger, those with a history of depression or mood disorders, or when starting the medication or changing doses. It is vital to monitor for signs of worsening depression or unusual mood changes and report these to your healthcare provider promptly.

• Potential for Mania: Clomipramine may trigger manic episodes in individuals with bipolar disorder. Symptoms of mania include extreme excitement, euphoria, and hyperactivity. If you have a history of bipolar disorder or are at risk, discuss this with your healthcare provider before starting treatment.

• Serotonin Syndrome Risk: This medication can contribute to serotonin syndrome, a serious condition that occurs when there is too much serotonin in the brain. The risk increases if combined with other serotonin-affecting drugs. Symptoms include rapid heartbeat, sweating, and confusion. Seek emergency medical care if you experience these symptoms.

• Seizure Risk: Clomipramine can increase the likelihood of seizures, especially in individuals with a seizure history or those taking other seizure-risk medications. Consult your healthcare provider regarding your medical history before using this medication.

• Dizziness and Fall Risk: This medication can cause dizziness and falls due to a sudden drop in blood pressure when changing positions. To minimize this risk, change positions slowly. If dizziness persists, consult your healthcare provider.

• Eye Issues (Angle-closure Glaucoma): Clomipramine may cause pupil dilation, potentially leading to angle-closure glaucoma in susceptible individuals. Symptoms include eye pain and vision changes. An eye exam may be necessary prior to starting the medication.

• Low Sodium Levels: Clomipramine can lower sodium levels, particularly in older adults or those taking diuretics. Symptoms of low sodium include headache and unsteadiness. Inform your healthcare provider if you experience these symptoms.

• Serious Skin Reactions: Although rare, serious skin reactions such as DRESS syndrome can occur. Watch for fever, rash, or organ involvement, and contact your provider immediately if these occur.

Contraindications: Clomipramine should not be used if you have used MAOIs in the past 14 days, are taking certain medications like linezolid or methylene blue, or are recovering from a heart attack. Always discuss your complete medical history with your healthcare provider before starting clomipramine.

When taking this medication, some common side effects may include dry mouth, drowsiness, dizziness, constipation, and stomach upset. These effects are generally mild, but if they persist, consult your healthcare provider. Other common reactions might include changes in appetite or weight, nausea, tiredness, and increased sweating. Anxiety symptoms can sometimes worsen initially. To manage dry mouth, stay hydrated and consider using sugarless gum or candies, while constipation may require dietary adjustments or a laxative.

More serious side effects, though less common, demand prompt medical attention. These include mood changes such as confusion or depression, irregular menstrual cycles, muscle stiffness, and sexual dysfunction. Ringing in the ears, numbness or tingling in the extremities, and unusual bruising should also be reported.

Rare but severe side effects warrant immediate medical help. These include serotonin syndrome, indicated by symptoms like a fast heartbeat, severe nausea, or hallucinations. Serious allergic reactions, although infrequent, need urgent care if symptoms such as rash, swelling, or trouble breathing occur. Additionally, symptoms like black stools, chest pain, or vision changes should not be ignored. Always inform your healthcare provider about any unusual or concerning effects.

When using Clomipramine, it's important to be aware of potential interactions with other medications. Certain drugs for high blood pressure, such as Clonidine and guanethidine, Digoxin, thyroid supplements, and Valproic Acid can interact with clomipramine. Additionally, medications that may increase bleeding risk, like antiplatelet drugs (e.g., Clopidogrel), NSAIDs (such as Ibuprofen or Naproxen), and anticoagulants like Dabigatran or Warfarin, should be used cautiously.

Avoid using MAO inhibitors (such as isocarboxazid, Linezolid, or phenelzine) with clomipramine, as this can lead to a serious and potentially fatal interaction. Your doctor should guide you on when to start or stop these medications in relation to clomipramine treatment.

The risk of serotonin syndrome may increase if clomipramine is taken with other serotonin-enhancing drugs, including certain antidepressants (like SSRIs and SNRIs) and substances like MDMA or St. John's wort. This risk is higher when starting or increasing doses of these drugs.

Clomipramine can also affect heart rhythm, so inform your healthcare provider of all the medications you are taking, especially those known to cause QT prolongation, such as Amiodarone or certain antibiotics like Erythromycin.

Some medications can alter the way clomipramine is metabolized in your body, affecting its efficacy. These include barbiturates, Cimetidine, and certain anti-seizure drugs. Additionally, drowsiness-inducing substances, such as alcohol, marijuana, or sedatives, should be used with caution.

If you're taking low-dose Aspirin for heart health, continue as advised by your doctor, but be aware that aspirin can increase bleeding risk when combined with clomipramine. Lastly, smoking can reduce the blood levels of clomipramine, so inform your doctor if you smoke or have recently quit. Always consult your healthcare provider for personalized advice regarding medication interactions.