Do NOT use Anafranil if:

• you are allergic to any ingredient in Anafranil or to similar medicines
• you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days, or you are taking astemizole or terfenadine
• you are recovering from a recent heart attack.

Contact your doctor or health care provider right away if any of these apply to you.

Some medical conditions may interact with Anafranil. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you drink alcohol-containing beverages daily or have a history of alcohol abuse
• if you take thyroid medicine or have a history of an overactive thyroid
• if you have a history of adrenal gland problems, glaucoma, heart problems, kidney or liver problems, diabetes, seizures, trouble urinating, the blood disease porphyria, or other blood problems
• if you have a history of suicidal thoughts or behavior, bipolar disorder, or any other mental disorders
• if you are undergoing electroshock therapy or you are scheduled to have any surgery.

Some medicines may interact with Anafranil. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Azole antifungals (eg, fluconazole), cimetidine, duloxetine, haloperidol, methylphenidate, mibefradil, phenothiazines (eg, chlorpromazine), selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), terbinafine, or valproic acid because they may increase the risk of Anafranil's side effects
• Astemizole, furazolidone, ketolide antibiotics (eg, telithromycin), macrolide antibiotics (eg, erythromycin), MAOIs (eg, phenelzine), pimozide, or terfenadine because the risk of high blood pressure, serious heart problems (eg, irregular heartbeat), or seizures may be increased
• Barbiturates (eg, phenobarbital) or phenytoin because they may decrease Anafranil's effectiveness
• Anticoagulants (eg, warfarin), carbamazepine, or sympathomimetics (eg, phenylephrine) because the risk of their side effects may be increased by Anafranil
• Clonidine, guanethidine, or guanfacine because their effectiveness may be decreased by Anafranil.

This may not be a complete list of all interactions that may occur. Ask your health care provider if Anafranil may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Important safety information:

• Anafranil may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Anafranil with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Anafranil; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
• Anafranil may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
• Do not become overheated in hot weather or while you are being active; heatstroke may occur.
• Children, teenagers, and young adults who take Anafranil may be at increased risk for suicidal thoughts or actions. Watch all patients who take Anafranil closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.
• Anafranil may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Anafranil. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
• Tell your doctor or dentist that you take Anafranil before you receive any medical or dental care, emergency care, or surgery.
• Lab tests, including complete blood cell counts, may be performed while you use Anafranil. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Use Anafranil with caution in the elderly; they may be more sensitive to its effects, especially those with heart problems.
• Anafranil should be used with extreme caution in children younger than 10 years old; safety and effectiveness in these children have not been confirmed.
• Pregnancy and breast-feeding: It is not known if Anafranil can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Anafranil while you are pregnant. Anafranil is found in breast milk. Do not breast-feed while taking Anafranil.

If you suddenly stop taking Anafranil, you may have withdrawal symptoms. Symptoms may include dizziness, headache, irritability, nausea, tiredness, trouble sleeping, and vomiting.

All medicines may cause side effects, but many people have no, or minor, side effects.

Check with your doctor if any of these most common side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; irritability; loss of appetite; nausea; nightmares; sweating; tiredness; upset stomach; vomiting; weakness; weight loss or gain.

Seek medical attention right away if any of these severe side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision changes; changes in sex drive; chest pain; confusion; decreased sexual ability; fainting; fast, slow, or irregular heartbeat; fever; flushing; frequent or difficult urination; impulsive behavior or other unusual changes in behavior; mental or mood changes (eg, increased anxiety, mood swings, agitation, irritability, nervousness, restlessness); numbness or tingling of the skin; panic attacks; ringing in the ears; seizures; severe dizziness or drowsiness; sore throat; stomach pain; suicidal thinking or behavior; swelling of the testicles; tremor; trouble sleeping; trouble walking or keeping your balance; twitching of the face or tongue; uncontrolled movements or stiffness of arms and legs; unusual bleeding or bruising; worsening of depression; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects.