DESVENLAFAXINE NORMON 100 mg PROLONGED-RELEASE TABLETS

2. What you need to know before you take Desvenlafaxine Normon

Do not take Desvenlafaxine Normon:

• if you are allergic to desvenlafaxine, venlafaxine or any of the other ingredients of this medicine (listed in section 6).
• if you are also taking or have taken within the last 14 days, any medicines known as monoamine oxidase inhibitors (MAOIs) used to treat depression, infections or Parkinson's disease. Taking an MAOI (e.g. linezolid or methylene blue) with other medicines like desvenlafaxine can cause serious or potentially life-threatening side effects. Also, you must wait at least 7 days after you stop taking desvenlafaxine before you take any MAOI (see also sections "Serotonin syndrome" and "Other medicines").

Warnings and precautions

Tell your doctor if you have had any of the following conditions before starting to take desvenlafaxine or if they appear during treatment with desvenlafaxine:

• if you or someone in your family has a history of or has had mania (a state of abnormally elevated or irritable mood) or bipolar disorder (extreme mood swings, e.g. from depression to mania).
• 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 (fits).
• 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 medicines 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 (hyponatraemia).
• 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 condition that can be serious and, in rare cases, potentially life-threatening).
• if treatment is stopped abruptly, withdrawal symptoms may occur (e.g. mood changes, irritability, agitation, dizziness, anxiety, confusion, headache, sleep disturbances, ringing in the ears (tinnitus), seizures, vision problems and hypertension). Therefore, it is important to gradually reduce the dose of desvenlafaxine and under medical supervision, whenever you and your doctor decide to stop treatment.

Some medicines in the same group as desvenlafaxine (called SSRIs/SNRIs) may cause sexual dysfunction symptoms (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 an anxiety disorder, you may sometimes have thoughts of harming or killing yourself. These thoughts may increase when you first start taking antidepressants, as these medicines take time to work, usually around 2 weeks, but sometimes longer.

You may be more likely to think this way:

• If you have previously had 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 (less than 25 years of age) with psychiatric disorders who were treated with antidepressants.

If you have thoughts of self-harm or suicide at any time, contact your doctor or go to a hospital directly.

You may find it helpful to tell a relative or close friendthat you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried 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. Also, you should know that in patients under 18 years of age, there is an increased risk of side effects such as suicidal attempts, hostility (mainly aggression, confrontational behavior, and irritability) when taking this type of medicine. Despite this, your doctor may prescribe this medicine to patients under 18 years of age when they decide it is the most suitable for the patient. If your doctor has prescribed this medicine to a patient under 18 years of age and you wish to discuss this decision, please go back to 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.

Additionally, the long-term effects on safety and those related to growth, maturity, and cognitive and behavioral development of this medicine have not yet been demonstrated.

Other medicines and Desvenlafaxine Normon

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

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

• monoamine oxidase inhibitors (MAOIs), e.g. medicines that contain linezolid (an antibiotic used to treat infections) and methylene blue (see section "Do not take Desvenlafaxine Normon").
• other medicines that contain venlafaxine or desvenlafaxine (also used to treat depression).
• triptans (used for migraine).
• medicines for depression, e.g. tricyclic antidepressants, amphetamines, lithium, selective serotonin reuptake inhibitors (SSRIs) or serotonin and noradrenaline reuptake inhibitors (SNRIs).
• medicines that contain sibutramine (used for weight loss).
• medicines for pain, e.g. opioids such as those that contain tramadol, fentanyl and its analogs, tapentadol, meperidine, methadone (also used for treatment of narcotic withdrawal syndrome and opioid dependence) and pentazocine.
• medicines that contain dextromethorphan (used for cough).
• products that contain St. John's Wort (also known as "Hypericum perforatum", a natural or herbal remedy used to treat mild depression).
• products that contain tryptophan (used for problems such as sleep and depression).
• medicines that contain ketoconazole (an antifungal).
• also, 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 condition called serotonin syndrome or reactions similar to NMS that can cause significant changes in the functioning of the brain, muscles, and digestive system due to high levels of serotonin in the body may occur. This potentially life-threatening condition can occur when taking medicines like desvenlafaxine, particularly when taken with other medicines mentioned above.

See 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, withdrawal symptoms from the initial antidepressant have occurred. Your doctor may gradually reduce the dose of your initial antidepressant medication to help decrease these symptoms.

Interactions with laboratory tests

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

Taking Desvenlafaxine Normon with food, drinks, and alcohol

Desvenlafaxine tablets can be taken with or without food. You should avoid drinking alcohol while using desvenlafaxine.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

If you take desvenlafaxine in the late stage of pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking desvenlafaxine so they can advise you. When similar medicines (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 during the first 24 hours after the baby is born. If your baby has these symptoms, you should contact your doctor and/or midwife immediately.

Tell your doctor before stopping treatment with desvenlafaxine during pregnancy, as you may experience a relapse of depression.

If you take desvenlafaxine during the middle to late stage of pregnancy, there may be an increased risk of high blood pressure and protein in the urine (pre-eclampsia). There may also be an increased risk of bleeding after delivery (postpartum hemorrhage).

If you take desvenlafaxine during pregnancy, inform your doctor and/or midwife, as your baby may have withdrawal symptoms when born. These symptoms may appear soon 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 advises you to.

Driving and using machines

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

3. How to take Desvenlafaxine Normon

Take this medicine exactly as your doctor has told you. If you are not sure, ask your doctor again.

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

Desvenlafaxine 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.As the tablet travels through your gastrointestinal tract, the active substance desvenlafaxine is slowly released. The tablet structure does not dissolve and is eliminated in the stool. Therefore, even though you may see the tablet structure in your stool, you will have absorbed your dose of desvenlafaxine.

If you take more Desvenlafaxine Normon 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, contact the Toxicology Information Service, Tel. 91 562 04 20.

If you forget to take Desvenlafaxine Normon

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 you normally would. Do not take a double dose to make up for the missed dose.

If you stop taking Desvenlafaxine Normon

Do not stop taking desvenlafaxine, or change your dose, without talking to your doctor first, even if you feel better. Your doctor will probably want to gradually reduce the dose of desvenlafaxine to avoid side effects. It is known that patients experience side effects when they stop taking desvenlafaxine, especially if they have taken a high dose and for a long period of time. Some of these side effects are: dizziness, nausea, headache, fatigue, irritability, diarrhea, anxiety, nightmares, and excessive sweating. Therefore, the dose should be reduced, 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, contact your doctor (see section "Warnings and precautions"). In some patients, complete cessation of the medicine may require several months or even longer.

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

4. Possible Adverse Effects

Like all medicines, this medicine can cause 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), convulsions, or seizures.
• psychiatric problems, such as hyperactivity and euphoria.
• drug allergy, such as 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)

Disorders of the Immune System

Uncommon: allergic reaction.

Disorders of Metabolism and Nutrition

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: headache, dizziness, 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, 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), convulsions (seizures), movement disorders (e.g., involuntary muscle movements, restlessness).

Eye Disorders

Common: blurred vision, pupil dilation.

Ear and Labyrinth Disorders

Common: sensation of vertigo, tinnitus.

Cardiac Disorders

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

Rare: heart problems often caused by stressful situations (Takotsubo cardiomyopathy).

Vascular Disorders

Common: high blood pressure, hot flashes.

Uncommon: low blood pressure when changing position, peripheral coldness.

Respiratory Disorders

Common: yawning.

Uncommon: nasal bleeding.

Gastrointestinal Disorders

Very common: nausea, dry mouth, constipation.

Common: diarrhea, vomiting.

Rare: acute pancreatitis (inflammation of the pancreas).

Skin and Subcutaneous Tissue Disorders

Very common: excessive sweating.

Common: 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: urinary retention, difficulty urinating, protein in the urine.

Reproductive System and Breast Disorders

Common: erectile dysfunction, delayed ejaculation, ejaculatory failure.

Uncommon: ejaculation disorder, sexual dysfunction.

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 Examinations

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

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

Reporting of 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 leaflet. 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. Storage of Desvenlafaxina Normon

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiration date stated on the packaging 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 disposed of via wastewater or household waste. Deposit the packaging and any unused medicines in the pharmacy's SIGRE point. If in doubt, ask your pharmacist how to dispose of the packaging and any unused medicines. This will help protect the environment.

6. Packaging Contents and Additional Information

Composition of Desvenlafaxina Normon

The active ingredient is desvenlafaxine.

Each tablet contains 100 mg of desvenlafaxine.

The other ingredients are: hypromellose, microcrystalline cellulose, talc, magnesium stearate, alginic acid, citric acid monohydrate, and povidone.

The coating of the 100 mg tablets contains: hypromellose, titanium dioxide (E171), macrogol, red iron oxide (E172), and black iron oxide/ferrosoferric oxide (E172).

Appearance of the Product and Packaging Contents

Brown to red, diamond-shaped, biconvex tablet with "17I" on one side and flat on the other. Approximately 12 mm in length and 9 mm in width.

Desvenlafaxina Normon 100 mg prolonged-release tablets EFG are available in packs of 28 tablets.

Marketing Authorization Holder and Manufacturer

LABORATORIOS NORMON, S.A.

Ronda de Valdecarrizo 6, 28760 Tres Cantos, Madrid (Spain)

Date of Last Revision of this Leaflet: February 2024

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