Instructions

Swallow the medicine without crushing or chewing it.

This medicine may be taken with or without food.

This medicine will work best if you take it at about the same time every day.

Store at room temperature away from heat, light, and moisture. Do not keep in the bathroom.

It may take several weeks for this medicine to fully work.

It is important that you keep taking each dose of this medicine on time even if you are feeling well.

If you forget to take a dose on time, take it as soon as you remember. If it is almost time for the next dose, do not take the missed dose. Return to your normal schedule. Do not take 2 doses at one time.

Drug interactions can change how medicines work or increase risk for side effects. Tell your health care providers about all medicines taken. Include prescription and over-the-counter medicines, vitamins, and herbal medicines. Speak with your doctor or pharmacist before starting or stopping any medicine.

Tell your doctor if symptoms do not get better or if they get worse.

If you need to stop this medicine, your doctor may wish to gradually reduce the dosage before stopping.

Keep all appointments for medical exams and tests while on this medicine.

Cautions

This medicine may rarely cause a very serious condition called serotonin syndrome/toxicity. Get medical help right away if you have a fast heartbeat, hallucinations, muscle trembling, or restlessness.

Tell your doctor and pharmacist if you ever had an allergic reaction to a medicine.

Do not use the medication any more than instructed.

If possible, avoid using with alcohol, marijuana, or other medicines that can cause dizziness or drowsiness. These include allergy/cold products, muscle relaxers, sleep aids, and pain relievers.

Your ability to stay alert or to react quickly may be impaired by this medicine. Do not drive or operate machinery until you know how this medicine will affect you.

Family should check on the patient often. Call the doctor if patient becomes more depressed, has thoughts of suicide, or shows changes in behavior.

It is unknown if this medicine passes into breast milk. Ask your doctor before breastfeeding.

During pregnancy, this medicine should be used only when clearly needed. Talk to your doctor about the risks and benefits.

Do not take St. John's wort while on this medicine.

Do not share this medicine with anyone who has not been prescribed this medicine.

Some patients have serious side effects from this medicine. Ask your pharmacist to show you the information from the Food and Drug Administration (FDA) and discuss it with you.

Side Effects

The following is a list of some common side effects from this medicine. Please speak with your doctor about what you should do if you experience these or other side effects.

• constipation
• dizziness
• nosebleeds
• high blood pressure
• sweating
• vomiting

Call your doctor or get medical help right away if you notice any of these more serious side effects:

• agitated feeling or trouble sleeping
• decreased awareness or responsiveness
• bleeding or bruising
• coughing up blood or vomit that looks like coffee grounds
• pain in the eye
• hallucinations (unusual thoughts, seeing or hearing things that are not real)
• fast or irregular heart beats
• muscle trembling
• restlessness
• seizures
• problems with sexual functions or desire
• bloody or dark, tarry stools
• suicidal thoughts
• difficulty or discomfort urinating
• blurring or changes of vision
• seeing halos or colors around lights
• severe or persistent vomiting

A few people may have an allergic reaction to this medicine. Symptoms can include difficulty breathing, skin rash, itching, swelling, or severe dizziness. If you notice any of these symptoms, seek medical help quickly.