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DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: anticholinergics (e.g., atropine, belladonna alkaloids), clonidine, certain drugs for high blood pressure (e.g., guanadrel, guanethidine, reserpine), drugs affecting liver enzymes that remove this medication from your body (e.g., cimetidine, haloperidol, protease inhibitors such as fosamprenavir/ritonavir, drugs that affect heart rhythm such as flecainide/quinidine/propafenone), drugs for motion sickness (e.g., meclizine, scopolamine), thyroid medication.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Some MAO inhibitors should also not be taken for two weeks before or after treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Also report the use of drugs which might increase seizure risk (decrease seizure threshold) when combined with this medication such as isoniazid (INH), phenothiazines (e.g., thioridazine), theophylline, tricyclic antidepressants (e.g., amitriptyline) or tramadol, among others. Consult your doctor or pharmacist for details.

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine, phenytoin), medicines for sleep or anxiety (e.g., alprazolam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, trazodone)

Check the labels on all your medicines (e.g., cough-and-cold products, diet aids, motion sickness) because they may contain drowsiness-causing ingredients, drying agents (anticholinergics) or stimulants/nasal decongestants that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Overdose of this medication may be fatal, and symptoms include seizures, delirium and loss of consciousness.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (e.g., blood counts, kidney function, liver function) may be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.

Keep all medical appointments so your doctor can monitor your progress closely or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised December 2013. Copyright(c) 2013 First Databank, Inc.

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