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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), or 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), or 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; or
* 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 thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. 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. Do not give Anafranil to anyone younger than 18 years old without the advice of a doctor.

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