What is the most important information I should know about desvenlafaxine extended-release tablets?

Desvenlafaxine extended-release tablets can cause serious side effects, including:

• Increased risk of suicidal thoughts or actions in some children and young adults within the first few months of treatment. Desvenlafaxine extended-release tablets are not for use in children.
• Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.

How can I watch for and try to prevent suicidal thoughts and actions?

• Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
• Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
• Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:

o thoughts about suicide or dying          o trouble sleeping (insomnia)

o attempts to commit suicide                 o new or worse irritability

o new or worse depression                    o acting aggressive, being angry, or violent

o new or worse anxiety                         o acting on dangerous impulses

o feeling very agitated or restless         o an extreme increase in activity and talking (mania)

o panic attacks                                      o other unusual changes in behavior or mood

What are desvenlafaxine extended-release tablets?

• Desvenlafaxine extended-release tablets are a prescription medicine used to treat adults with a certain type of depression called major depressive disorder (MDD). Desvenlafaxine extended-release tablets belongs to a class of medicines known as serotonin and norepinephrine reuptake inhibitors (SNRIs).

Do not take desvenlafaxine extended-release tablets if you:

• are allergic to desvenlafaxine succinate, venlafaxine hydrochloride, or any of the ingredients in desvenlafaxine extended-release tablets. See the end of this Medication Guide for a complete list of ingredients in desvenlafaxine extended-release tablets.
• take a monoamine oxidase inhibitor (MAOI).
• have stopped taking an MAOI in the last 14 days. Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI.
• are being treated with the antibiotic linezolid or the intravenous methylene blue.

Do not start taking an MAOI for at least 7 days after you stop treatment with desvenlafaxine extended-release tablets.

Before taking desvenlafaxine extended-release tablets tell your healthcare provider about all your medical conditions, including if you:

• have high blood pressure
• have heart problems
• have cerebrovascular problems or had a stroke
• have or had bleeding problems
• have, or have a family history of, bipolar disorder, mania or hypomania
• have high cholesterol or high triglycerides
• have or had depression, suicidal thoughts or behavior
• have kidney or liver problems
• have or had seizures or convulsions
• have low sodium levels in your blood
• are pregnant or plan to become pregnant. Talk to your healthcare provider about the risk to your unborn baby if you take desvenlafaxine extended-release tablets during pregnancy.
  • Tell your healthcare provider if you become pregnant or think you are pregnant during treatment with desvenlafaxine extended-release tablets.
  • If you become pregnant during treatment with desvenlafaxine extended-release tablets, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants. You can register by calling 1-844-405-6185.
• are breastfeeding or plan to breastfeed. Desvenlafaxine can pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with desvenlafaxine extended-release tablets.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Desvenlafaxine extended-release tablets and other medicines may affect each other causing possible serious side effects. Desvenlafaxine extended-release tablets may affect the way other medicines work and other medicines may affect the way desvenlafaxine extended-release tablets works.

Especially tell your healthcare provider if you take:

• other MAOIs
• medicines to treat migraine headaches known as triptans
• tricyclic antidepressants
• lithium
• tramadol, fentanyl, meperidine, methadone, or other opioids
• tryptophan
• buspirone
• amphetamines
• St. John’s Wort
• other medicines containing desvenlafaxine or venlafaxine
• medicines that can affect blood clotting such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin
• medicines used to treat mood, anxiety, psychotic, or thought disorders, including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs)

Ask your healthcare provider if you are not sure if you are taking any of these medicines. Your healthcare provider can tell you if it is safe to take desvenlafaxine extended-release tablets with your other medicines.

Do not start or stop any other medicines during treatment with desvenlafaxine extended-release tablets without talking to your healthcare provider first. Stopping desvenlafaxine extended-release tablets suddenly may cause you to have serious side effects. See, “What are the possible side effects of desvenlafaxine extended-release tablets?”

Know the medicines you take. Keep a list of them to show to your healthcare providers when you get a new medicine.

What should I avoid while taking desvenlafaxine extended-release tablets?

• Do not drive a car or operate heavy machinery until you know how desvenlafaxine extended-release tablets affects you.
• You should not drink alcohol while taking desvenlafaxine extended-release tablets.

• New or worsened high blood pressure (hypertension).Your healthcare provider should check your blood pressure before and during treatment with desvenlafaxine extended-release tablets. If you have high blood pressure, it should be controlled before you start treatment with desvenlafaxine extended-release tablets.
• Increased chance of bleeding or bruising.Taking desvenlafaxine extended-release tablets with aspirin, NSAIDs, or blood thinners may add to this risk. Tell your healthcare provider right away about any unusual bleeding or bruising.
• Eye problems (angle closure glaucoma).Many antidepressant medicines, including desvenlafaxine extended-release tablets, may cause a certain type of eye problem called angle-closure glaucoma. Call your healthcare provider if you have changes in your vision or eye pain.
• Discontinuation syndrome.Suddenly stopping desvenlafaxine extended-release tablets when you take higher doses may cause you to have serious side effects. Your healthcare provider may want to decrease your dose slowly. Symptoms may include the following, some of which can be severe and last for a long time:
  • dizziness                                                      o ringing in your ears                o headache
  • irritability and agitation                                   (tinnitus)                               o diarrhea
  • anxiety                                                         o nausea                                    o abnormal dreams
  • aggressiveness                                             o problems sleeping                 o changes in your mood
    (including hostility, rage)                            o tiredness              
  • tremor                                                          o confusion                              o hypomania
  • sweating                                                      o electric shock sensation         o problems with eyesight (such as    
  • Seizures                                                          (paresthesia)                             blurred vision and trouble focusing)
                                                                                                                          o increase in blood pressure

• Seizures (convulsions).
• Low sodium levels in your blood (hyponatremia).Low sodium levels can happen during treatment with desvenlafaxine extended-release tablets. Low sodium levels in your blood may be serious and may cause death. Signs and Symptoms of low sodium levels in your blood may include:
  • headache
  • difficulty concentrating
  • memory changes
  • confusion
  • weakness and unsteadiness on your feet which can lead to falls

       In severe or more sudden cases, signs and symptoms include:

• hallucinations (seeing or hearing things that are not real)
• fainting
• seizures
• coma
• Lung problems.Some people who have taken the medicine venlafaxine which is the same kind of medicine as the medicine in desvenlafaxine extended-release tablets have had lung problems. Symptoms of lung problems include difficulty breathing, cough, or chest discomfort. Tell your healthcare provider right away if you have any of these symptoms.
• Sexual Problems (dysfunction).Taking serotonin and norepinephrine reuptake inhibitors (SNRIs), including desvenlafaxine extended-release tablets, may cause sexual problems.

     Symptoms in males may include:

• Delayed ejaculation or inability to have an ejaculation
• Decreased sex drive
• Problems getting or keeping an erection

    Symptoms in females may include:

• Decreased sex drive
• Delayed orgasm or inability to have an orgasm

Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment with desvenlafaxine extended-release tablets. There may be treatments your healthcare provider can suggest.

The most common side effects of desvenlafaxine extended-release tablets include:

• nausea                                                         • dizziness
• problems sleeping                                        • sweating
• constipation                                                 • feeling sleepy
• decreased appetite                                      • anxiety
• sexual function problems

These are not all the possible side effects of desvenlafaxine extended-release tablets.

   Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.