This medicine is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat depression, generalized or social anxiety disorder, or panic disorder. It may also be used for other conditions as determined by your doctor.
Follow the directions for taking this medicine provided by your doctor. This medicine comes with a MEDICATION GUIDE approved by the U.S. Food and Drug Administration. Read it carefully each time you refill this medicine. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine. Take this medicine by mouth with food. Take this medicine with a full glass of water (8 oz/240 mL). SWALLOW THIS MEDICINE WHOLE. Do not break, crush, or chew before swallowing. DO NOT SUDDENLY STOP TAKING THIS MEDICINE without checking with your doctor. Side effects may occur. They may include mental or mood changes, numbness or tingling of the skin, dizziness, drowsiness, confusion, headache, increased sweating, loss of coordination or balance, flu-like symptoms, nausea, ringing in the ears, seizures, tremor, trouble sleeping, or unusual tiredness. You will be closely monitored when you start this medicine and whenever a change in dose is made. STORE THIS MEDICINE at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. This medicine works best if it is taken at the same time each day. Continue to take this medicine even if you feel well. Do not miss any doses. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
WARNING: Antidepressants may increase the risk of suicidal thoughts or actions in children, teenagers, and young adults. However, depression and certain other mental problems may also increase the risk of suicide. Talk with the patient's doctor to be sure that the benefits of using this medicine outweigh the risks. Families and caregivers must closely watch patients who take this medicine. It is important to keep in close contact with the patient's doctor. Tell the doctor right away if the patient has symptoms like worsened depression, suicidal thoughts, or changes in behavior. Discuss any questions with the patient's doctor. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if you are taking a fenfluramine derivative (eg, dexfenfluramine), nefazodone, sibutramine, tramadol, or tryptophan. DO NOT TAKE THIS MEDICINE if you are taking or have taken linezolid, a monoamine oxidase inhibitor (MAOI) (eg, phenelzine), selegiline, or St. John's wort within the last 14 days. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking certain diet medicines (eg, phentermine), lithium, metoclopramide, rasagiline, selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine), serotonin and norepinephrine reuptake inhibitors (SNRIs) (eg, duloxetine), serotonin 5-HT1 receptor agonists (eg, sumatriptan), trazodone, tricyclic antidepressants (eg, amitriptyline), anticoagulants (eg, warfarin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), diuretics (eg, furosemide, hydrochlorothiazide), azole antifungals (eg, ketoconazole), cimetidine, cyproheptadine, aripiprazole, clozapine, haloperidol, phenothiazines (eg, chlorpromazine, thioridazine), risperidone, metoprolol, or a medicine that contains methylene blue. DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions, including a history of seizures, heart problems (eg, heart failure, irregular heartbeat), abnormal electrocardiogram (ECG), recent heart attack, high blood pressure, high cholesterol, overactive thyroid, liver problems, lung problems, kidney problems, stomach or bowel bleeding, blood or bleeding problems, increased eye pressure (eg, glaucoma), nervous system problems, metabolism problems, allergies, pregnancy, or breast feeding. TELL YOUR DOCTOR if you or a family member has a history of bipolar disorder (manic-depression), other mental or mood problems, suicidal thoughts or attempts, or alcohol or substance abuse. TELL YOUR DOCTOR if you are dehydrated, have low blood sodium levels, or drink alcohol. Tell your doctor if you will be having electroconvulsive therapy (ECT). Contact your doctor or pharmacist if you have questions or concerns about using this medicine.
SIDE EFFECTS that may occur while taking this medicine include abnormal dreams; blurred vision; changes in taste; constipation; decreased sexual desire or ability; dizziness; drowsiness; dry mouth; flushing; headache; increased sweating; loss of appetite; nausea; nervousness; stomach upset; trouble sleeping; vomiting; weakness; weight loss; yawning. If they continue or are bothersome, check with your doctor. CONTACT YOUR DOCTOR IMMEDIATELY if you experience bizarre behavior; blood in the stool; chest pain or discomfort; confusion; decreased urination; fast or irregular heartbeat; fever, chills, or sore throat; memory problems; new or worsening aggressiveness, agitation, anxiety, hostility, impulsiveness, inability to sit still, irritability, panic attacks, or restlessness; persistent or severe ringing in the ears; prolonged painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety, nervousness, or trouble sleeping; severe or persistent cough; severe or persistent headache, dizziness, stomach pain, or weakness; shortness of breath; significant weight loss; suicidal thoughts or attempts; tremor; trouble concentrating; unsteadiness or loss of coordination; unusual bruising or bleeding; unusual or severe mental or mood changes; vision problems; or worsening of depression. AN ALLERGIC REACTION to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your healthcare provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms may include coma; dilated pupils; fainting; fast, slow, or irregular heartbeat; muscle pain or weakness; new or worsening mental or mood problems; seizures; severe or persistent dizziness, drowsiness, or vomiting; trouble breathing; yellowing of the eyes or skin.
SEVERAL WEEKS MAY PASS before your symptoms improve. If your symptoms do not improve or if they become worse, check with your doctor. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS MEDICINE out of the reach of children. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out.