DESVENLAFAXINE ALTER 50 mg PROLONGED-RELEASE TABLETS

2. What you need to know before taking Desvenlafaxine Alter

Do not take Desvenlafaxine Alter:

• if you are allergic to desvenlafaxine, venlafaxine, or any of the other ingredients of this medication (listed in section 6).
• if you are also taking or have taken within the last 14 days a medication known as a monoamine oxidase inhibitor (MAOI) used to treat depression, infections, or Parkinson's disease. Taking an MAOI (e.g., linezolid or methylene blue) with other medications like Desvenlafaxine can cause serious or potentially life-threatening side effects. Additionally, you should wait at least 7 days after stopping Desvenlafaxine before taking any MAOI (see also the sections "Serotonin Syndrome" and "Other Medications").

Warnings and Precautions

Consult your doctor if you have had any of the following conditions before taking Desvenlafaxine or if they appear during treatment with this medication:

• if you or a family member have a history of or have had mania (a state of excitement, feeling of euphoria, or hyperirritability) or bipolar disorder (extreme mood changes, e.g., from depression to euphoria).
• if you have a history of aggressive behavior.
• if you have eye problems, such as certain types of glaucoma (increased pressure in the eye).
• if you have a history of high blood pressure or hypertension.
• if you have a history of heart problems or heart attack.
• if you have a history of seizures (convulsions).
• if you have a history of bleeding disorders (tendency to develop bruises), or if you are pregnant (see section Pregnancy, Breastfeeding, and Fertility), or if you are using non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and other medications that may increase the risk of bleeding when used at the same time as desvenlafaxine.
• if you have a history of kidney problems.
• if you have a history of low sodium levels in the blood (hyponatremia).
• if you have a history of high cholesterol, or if your cholesterol levels increase.
• if you experience the following side effects: agitation (excitability and restlessness), altered consciousness, confusion, coma, palpitations, increased blood pressure, elevated body temperature, excessive sweating, lack of coordination, muscle spasms or stiffness, tremors, nausea, vomiting, and diarrhea. Contact your doctor immediately, as you may be suffering from serotonin syndrome (a disorder that can be serious and, in rare cases, potentially life-threatening).
• if you stop treatment abruptly, you may experience withdrawal symptoms (e.g., mood changes, irritability, agitation, dizziness, anxiety, confusion, headache, sleep disturbances, tinnitus (ringing in the ears), and seizures). Therefore, it is essential to gradually reduce the dose of Desvenlafaxine under medical supervision, whenever you and your doctor decide to stop treatment.

Some medications in the same group as Desvenlafaxine (called SSRIs/SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after stopping treatment.

Suicidal thoughts and worsening of your depression or anxiety disorder

If you are depressed and/or have anxiety disorders, you may have had thoughts of harming yourself or committing suicide. These thoughts may increase when you start taking antidepressants, as these medications take time to work, usually a few weeks, but sometimes longer.

You may be more likely to think this way:

• If you have had previous thoughts of suicide or self-harm.
• If you are a young adult. Clinical trial data have shown an increased risk of suicidal behavior in young adults (under 25 years of age) with psychiatric disorders who were treated with antidepressants.

If you have thoughts of harming yourself or committing suicide at any time, contact your doctor or go to a hospital immediately.

You may find it helpful to tell a family member or close friendthat you are depressed or have an anxiety disorder, and ask them to read this package leaflet. You could also ask them to tell you if they think your depression or anxiety is getting worse, or if they are concerned about changes in your behavior.

Dry Mouth

Dry mouth has been reported in 18% of patients treated with desvenlafaxine. This may increase the risk of tooth decay. Therefore, you should be careful with your oral hygiene.

Elderly Patients

In some elderly patients, it may not be possible to rule out increased sensitivity to desvenlafaxine.

Children and Adolescents

Desvenlafaxine should not normally be used in children and adolescents. Additionally, you should be aware that in patients under 18 years of age, there is a greater risk of side effects such as suicidal attempts, hostility (mainly aggression, confrontational behavior, and irritability) when taking this class of medications. Nevertheless, your doctor may prescribe this medication to patients under 18 years of age when they decide it is appropriate for the patient. If your doctor has prescribed this medication to a patient under 18 years of age and you wish to discuss this decision, please consult your doctor. You should inform your doctor if any of the above symptoms develop or worsen when these patients under 18 years of age are taking Desvenlafaxine.

Furthermore, the long-term effects on safety, growth, maturity, and cognitive and behavioral development of this medication have not yet been demonstrated.

Other Medications and Desvenlafaxine Alter

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medications.

It is especially important that you inform your doctor if you are taking any of the following medications:

• monoamine oxidase inhibitors (MAOIs), e.g., medications containing linezolid (an antibiotic used to treat infections) and methylene blue (see the section "Do not take Desvenlafaxine Alter").
• other medications containing venlafaxine or desvenlafaxine (also used to treat depression).
• triptans (used for migraines).
• medications for treating depression, e.g., tricyclic antidepressants, amphetamines, lithium, selective serotonin reuptake inhibitors (SSRIs), or serotonin and norepinephrine reuptake inhibitors (SNRIs).
• medications containing sibutramine (used for weight loss).
• medications for pain, e.g., those containing tramadol, fentanyl, and its analogs, tapentadol, meperidine, methadone (also used for treatment of narcotic withdrawal and opioid dependence), and pentazocine.
• medications containing dextromethorphan (used for coughs).
• products containing St. John's Wort (also known as "Hypericum perforatum", a natural or herbal remedy used to treat mild depression).
• products containing tryptophan (used for problems such as sleep and depression).
• medications containing ketoconazole (an antifungal).
• Additionally, if you are being treated by other healthcare professionals, inform them that you are taking Desvenlafaxine.

Serotonin Syndrome or Reactions Similar to Neuroleptic Malignant Syndrome (NMS)

Rarely, a disorder called serotonin syndrome or reactions similar to NMS may occur, which can cause significant changes in brain, muscle, and digestive system function due to high levels of serotonin in the body. This potentially life-threatening condition may occur when taking medications like Desvenlafaxine, particularly when taken with other medications mentioned above.

See the section "Warnings and Precautions" or possible side effects related to serotonin syndrome or reactions similar to NMS.

Switching Antidepressants

When switching treatment from another antidepressant to desvenlafaxine, symptoms of withdrawal from the initial antidepressant have occurred. Your doctor may gradually reduce the dose of your initial antidepressant medication to help minimize these symptoms.

Interactions with Laboratory Tests

False positives for certain substances, such as phencyclidine (PCP) and amphetamines, may occur in urine analyses of patients taking or who have taken desvenlafaxine, even several days after stopping treatment.

Taking Desvenlafaxine Alter with Food, Drinks, and Alcohol

Desvenlafaxine Alter tablets can be taken with or without food. You should avoid taking alcohol while using this medication.

Pregnancy, Breastfeeding, and Fertility

If you are pregnant, breastfeeding, or think you may be pregnant, or plan to become pregnant, consult your doctor before using this medication.

If you take desvenlafaxine during the late stages of pregnancy, there may be an increased risk of excessive vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should be aware that you are taking this medication to advise you accordingly. When similar medications (SSRIs) are taken during pregnancy, there may be an increased risk of a serious condition in the baby called persistent pulmonary hypertension of the newborn (PPHN), causing the baby to breathe faster and turn blue. These symptoms usually start within the first 24 hours after birth. If your baby has these symptoms, you should contact your doctor and/or midwife immediately.

If you take Desvenlafaxine during pregnancy, inform your doctor and/or midwife, as your baby may experience withdrawal symptoms when born. These symptoms may appear shortly after birth and may require hospitalization. The symptoms include difficulty feeding or breathing problems. If your baby has these or other symptoms when born and you are concerned, contact your doctor and/or midwife.

Desvenlafaxine passes into breast milk. There is a risk of an effect on the baby. Therefore, do not use Desvenlafaxine during breastfeeding unless your doctor specifically instructs you to do so.

Driving and Using Machines

This medication may cause dizziness, drowsiness, and blurred vision. Do not drive or operate tools or machines until you know how this medication affects you.

3. How to Take Desvenlafaxine Alter

Follow your doctor's instructions for taking this medication exactly. If you are unsure, consult your doctor again.

The recommended dose is 50 mg once daily. Your doctor may increase your dose to 100 mg once daily or even up to a maximum of 200 mg once daily if necessary.

If you have kidney problems or a history of kidney problems, consult your doctor, as you may need to take a different dose of Desvenlafaxine.

This medication should be taken orally, approximately at the same time each day. The tablets should be swallowed whole with liquid, without dividing, crushing, chewing, or dissolving them.

Do not worry if you see the tablet structure in your stool after taking Desvenlafaxine Alter.As the tablet travels through your gastrointestinal tract, the active ingredient desvenlafaxine is slowly released. The tablet structure does not dissolve and is eliminated in the stool. Therefore, although you may see the tablet structure in your stool, you will have absorbed your dose of desvenlafaxine.

If you take more Desvenlafaxine Alter than you should

Contact your doctor or pharmacist immediately if you take more Desvenlafaxine than your doctor has prescribed.

In case of overdose or accidental ingestion, consult the Toxicology Information Service, Tel. 91 562 04 20, indicating the medication and the amount taken.

If you forget to take Desvenlafaxine Alter

If you miss a dose, take it as soon as you remember. However, if it is already time for your next dose, skip the missed dose and take only one dose, as usual. Do not take a double dose to make up for the missed dose.

If you stop taking Desvenlafaxine Alter

Do not stop taking Desvenlafaxine or change your dose without your doctor's advice, even if you feel better. Your doctor will prefer to gradually reduce the dose of Desvenlafaxine to avoid side effects. It is known that patients experience side effects when they stop taking this medication, especially if they have taken a high dose for a prolonged period. Some of these side effects are: dizziness, nausea, headache, fatigue, irritability, diarrhea, anxiety, nightmares, and excessive sweating. Therefore, the dose should be reduced slowly, whenever possible, and under medical supervision, in case you and your doctor decide to stop treatment with Desvenlafaxine.

If you experience any of these or other symptoms that bother you, consult your doctor (see the section "Warnings and Precautions").

If you have any further questions about the use of this medication, ask your doctor or pharmacist.

4. Possible Adverse Effects

Like all medicines, Desvenlafaxina can produce adverse effects, although not all people suffer from them.

Severe Adverse Effects

If you notice any of the following signs, inform your doctor immediately or go to the nearest hospital:

• Heart problems, such as rapid heart rate, increased blood pressure, or chest pain.
• Eye problems, such as blurred vision.
• Nervous system problems, such as dizziness, numbness, and tingling, movement disorder (e.g., involuntary muscle movements, restlessness), seizures, or attacks.
• Psychiatric problems, such as hyperactivity and euphoria.
• Drug allergy, such as skin rash, throat swelling, or breathing difficulties.

List of Possible Adverse Effects

The adverse effects and frequency (probability of occurrence) mentioned below have been observed in patients. In general, these adverse effects occurred more frequently during the first week of treatment.

Very common: affects more than 1 in 10 patients

Common: affects between 1 and 10 in 100 patients

Uncommon: affects between 1 and 10 in 1,000 patients

Rare: affects between 1 and 10 in 10,000 patients

Frequency not known: (cannot be estimated from available data)

Immune system disorders

Uncommon: allergic reaction

Metabolism and nutrition disorders

Common: loss of appetite

Rare: hyponatremia (decreased sodium concentration in blood)

Psychiatric disorders

Very common: insomnia

Common: withdrawal syndrome, anxiety, nervousness, strange dreams, irritability, decreased libido, absence of orgasm

Uncommon: distortion of self-image and reality, abnormal orgasm

Rare: mania (state of overexcitement, feeling of euphoria or hyperirritability), hypomania (state of excitement and excessive activity), and hallucinations

Nervous system disorders

Very common: dizziness, headache, somnolence

Common: tremors, numbness, and tingling, attention deficit, alteration of taste

Uncommon: loss of consciousness, abnormal movements (dyskinesia)

Rare: serotonin syndrome (characterized by symptoms such as agitation (excitability and restlessness), altered consciousness, confusion, coma, palpitations, increased blood pressure, elevated body temperature, excessive sweating, lack of coordination, muscle spasms or rigidity, tremors, nausea, vomiting, and diarrhea), seizures (attacks), movement disorders (e.g., involuntary muscle movements, restlessness)

Eye disorders

Common: pupil dilation, blurred vision

Ear and labyrinth disorders

Common: tinnitus, sensation of vertigo

Cardiac disorders

Common: rapid heart rate, palpitations (sensation of rapid, irregular, or strong heartbeat)

Vascular disorders

Common: high blood pressure, hot flashes

Uncommon: peripheral coldness, low blood pressure when changing position

Respiratory disorders

Common: yawning

Uncommon: nasal bleeding

Gastrointestinal disorders

Very common: nausea, dry mouth, constipation

Common: vomiting, diarrhea

Rare: acute pancreatitis (inflammation of the pancreas)

Skin and subcutaneous tissue disorders

Very common: excessive sweating

Common: skin rash

Uncommon: total or partial hair loss

Rare: Stevens-Johnson syndrome (erythema multiforme consisting of a hypersensitivity reaction affecting the skin and mucous membranes), swelling under the skin, sensitivity to light

Musculoskeletal disorders

Common: muscle stiffness

Renal and urinary disorders

Uncommon: difficulty urinating, urinary retention, protein in urine

Reproductive system disorders

Common: erectile dysfunction, delayed ejaculation, ejaculatory failure

Uncommon: sexual dysfunction, ejaculation disorder

Frequency not known: heavy vaginal bleeding shortly after childbirth (postpartum hemorrhage), see "Pregnancy, Lactation, and Fertility" in section 2 for more information

General disorders

Common: fatigue, weakness, chills, feeling of restlessness

Investigations and medical tests

Common: alteration of liver tests, weight gain, weight loss, blood pressure

Uncommon: increased cholesterol levels in blood, increased triglyceride values in blood, increased prolactin hormone values in blood

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that does not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: www.notificaRAM.es.

By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Conservation of Desvenlafaxina Alter

Keep this medicine out of sight and reach of children.

Do not use this medicine after the expiration date (CAD) that appears on the packaging and blister, after CAD. The expiration date is the last day of the month indicated.

This medicine does not require special storage conditions.

Medicines should not be thrown down the drain or into the trash. Deposit the packaging and medicines you no longer need at the SIGRE point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This way, you will help protect the environment.

6. Package Contents and Additional Information

Composition of Desvenlafaxina Alter

• The active ingredient is desvenlafaxina (as desvenlafaxina benzoate).

• Each tablet contains 50 mg of desvenlafaxina (as desvenlafaxina benzoate).

• The other components are: hypromellose, microcrystalline cellulose, talc, stearic acid, magnesium stearate, anhydrous colloidal silica.

The coating film of the 50 mg tablets contains: poly (vinyl alcohol), titanium dioxide (E171), macrogol, talc, and yellow and red iron oxides (E172).

Appearance of the Product and Package Contents

Light pink, biconvex, round tablet. The tablet dimensions are 9.6 ± 0.2 mm.

Desvenlafaxina Alter 50 mg is available in a package of 28 tablets.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Laboratorios Alter, S.A.

Mateo Inurria 30

28036 Madrid

Spain

Manufacturer

PharOS MT Ltd.

HF62X, Hal Far Industrial Estate

BBG3000 Birzebbugia (Malta)

Date of the Last Revision of this Prospectus: March 2022

Detailed and updated information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/