Common side effects

• Abnormal sexual function
• Disorder of ejaculation
• Xerostomia
• Drowsy
• Insomnia
• Hyperhidrosis
• Nausea
• Acute cognitive impairment
• Symptoms of anxiety
• Libido changes
• Agitation
• Orthostatic hypotension
• Rhinitis
• Sinusitis
• Sialorrhea
• Dyspepsia
• Dysmenorrhea
• Erectile dysfunction
• Menstrual disorder
• Pruritus of skin

If any of these effects persist or worsen, tell your doctor or pharmacist promptly

• Nausea
• Dry mouth
• Loss of appetite
• Tiredness
• Drowsiness
• Sweating
• Blurred vision
• Yawning

Tell your doctor right away if you have any serious side effects, including

• Shaking
• Decreased interest in sex
• Changes in sexual ability
• Easy bruising/bleeding

Get medical help right away if you have any very serious side effects, including

• Fainting
• Fast/irregular heartbeat
• Black stools
• Vomit that looks like coffee grounds
• Seizures
• Eye pain/swelling/redness
• Widened pupils
• Vision changes

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take . Get medical help right away if you develop some of the following symptoms

• Fast heartbeat
• Hallucinations
• Loss of coordination
• Severe dizziness
• Severe nausea/vomiting/diarrhea
• Twitching muscles
• Unexplained fever
• Unusual agitation/restlessness

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including

• Rash
• Itching/swelling
• Severe dizziness
• Trouble breathing

Other things to note

• See also Warning and Precautions sections.
• Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.

• Immediately report to MD any thoughts of suicide.
• Discuss risk vs benefits of use during pregnancy.
• May make you drowsy or dizzy. Drive with caution
• Avoid alcohol/other drugs that make you sleepy
• Tell doctor if fainting or faintness occurs.
• Inform doctor about all the medicines you use
• For solution, oral products : Before use, important to read the Medication Guide. Measure dose using a dosing spoon/cup/syringe.
• For tablet products : Important to read patient package insert & med guide. MD may need to reduce the dose before you stop it.

• May cause drowsiness. Alcohol and marijuana may intensify this effect. Use care when operating a vehicle, vessel (e.g., boat), or machinery. ; Use during the 3rd trimester of pregnancy may cause serious health problems or withdrawal symptoms in the newborn. Discuss with your doctor or pharmacist. ; Call your doctor immediately if you have mental/mood changes like confusion, new/worsening feelings of sadness/fear, thoughts of suicide, or unusual behavior. ; Consult your doctor or pharmacist before breastfeeding. ; Do not drink alcoholic beverages when using this medication. ; Patients regularly using NSAIDs (e.g. ibuprofen) and this drug may be at a greater risk for stomach bleeding and should consult their physician. ; Herbal/dietary supplement products may interact with this medication. Discuss any such product with your doctor or pharmacist before taking. ;

Before taking this medication, tell your doctor if you've had:

• Personal or family history of bipolar/manic-depressive disorder
• Personal or family history of suicide attempts
• Liver disease
• Seizures
• Low sodium in the blood
• Intestinal ulcers/bleeding (peptic ulcer disease) or bleeding problems
• Personal or family history of glaucoma (angle-closure type)

Products that may interact with this drug include:

• Other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, blood thinners such as warfarin)