Paroxetine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Paroxetine affects chemicals in the brain that may become unbalanced.

Paroxetine is used to treat depression, obsessive-compulsive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

Paroxetine may also be used for purposes other than those listed in this medication guide.

The most important information You should know about paroxetine.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are a child or young adult. Talk with your doctor about this risk. While you are taking paroxetine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Paroxetine may cause heart defects or serious, life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking paroxetine, do not stop taking the medication without first talking to your doctor.

Do not take paroxetine together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Discuss with your healthcare provider.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are a child or young adult. Talk with your doctor about this risk. While you are taking paroxetine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks.

Do not use paroxetine if you are using pimozide (Orap), thioridazine (Mellaril), or an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).

Serious and sometimes fatal reactions can occur when these medicines are taken with paroxetine. You must wait at least 14 days after stopping an MAO inhibitor before you can take paroxetine. After you stop taking paroxetine, you must wait at least 14 days before you start taking an MAOI.

Before taking paroxetine, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• seizures or epilepsy;
• bipolar disorder (manic depression), or a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use paroxetine, or you may need a dosage adjustment or special tests.

FDA pregnancy category D. Paroxetine may cause heart defects or serious, life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking paroxetine, do not stop taking the medication without first talking to your doctor.

Paroxetine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should You take paroxetine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

Do not crush, chew, or break a controlled-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Shake the liquid form of paroxetine well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment.

You may have withdrawal symptoms (such as agitation, dizziness, numbness or tingling, ringing in your ears, confusion, or behavior changes) after you stop taking paroxetine. Do not stop taking this medication suddenly without first talking to your doctor.

Store paroxetine at room temperature away from moisture and heat.

Fluvoxamine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors. Fluvoxamine affects chemicals in the brain that may become unbalanced and cause obsessive-compulsive symptoms.

Fluvoxamine is used to treat obsessive-compulsive disorders involving recurring thoughts or actions.

What is the most important information I should know about fluvoxamine?

Do not take fluvoxamine together with thioridazine (Mellaril), terfenadine (Seldane), astemizole (Hismanal), cisapride (Propulsid), pimozide (Orap), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take fluvoxamine. After you stop taking fluvoxamine, you must wait at least 14 days before you can start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Fluvoxamine is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluvoxamine, do not stop taking the medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking fluvoxamine?

Do not use fluvoxamine if you are using any of the following drugs:

• thioridazine (Mellaril);
• terfenadine (Seldane);
• astemizole (Hismanal);
• cisapride (Propulsid); or
• pimozide (Orap); or
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).
• Serious and sometimes fatal reactions can occur when these medicines are taken with fluvoxamine. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluvoxamine. After you stop taking fluvoxamine, you must wait at least 14 days before you can start taking an MAOI.Before taking fluvoxamine, tell your doctor if you have:
• liver disease;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

You may not be able to take fluvoxamine, or you may need a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluvoxamine, do not stop taking the medication without first talking to your doctor.

Fluvoxamine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give fluvoxamine to anyone younger than 18 years old without the advice of a doctor. Fluvoxamine is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children.

How should I take fluvoxamine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Take each dose with water.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

It may take 4 weeks or more for you to start feeling better. Do not stop using fluvoxamine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store fluvoxamine at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a fluvoxamine overdose may include nausea, vomiting, blurred vision, rapid heartbeat, lack of coordination, trouble breathing, drowsiness, fainting, and coma.

What should I avoid while taking fluvoxamine?

Do not take fluvoxamine together with thioridazine (Mellaril), terfenadine (Seldane), astemizole (Hismanal), cisapride (Propulsid), pimozide (Orap), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Avoid drinking alcohol, which can increase some of the side effects of fluvoxamine.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by fluvoxamine.

Fluvoxamine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of fluvoxamine?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• tremors, shivering, muscle stiffness or twitching;
• seizure (convulsions);
• problems with balance or coordination;
• unusual thoughts or behavior; or
• agitation, confusion, sweating, fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• feeling nervous, restless, or unable to sit still;
• sleep problems (insomnia);
• drowsiness, weakness;
• urinating more than usual;
• loss of appetite, weight gain or loss;
• nausea, vomiting, diarrhea, gas, constipation, or upset stomach;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry mouth, unpleasant taste in your mouth.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

You may have some side effects after you stop using fluvoxamine, including headache, nausea, vomiting, sleepiness or insomnia, nervousness, or agitation.

Aripiprazole is an antipsychotic medication. It works by changing the actions of chemicals in the brain.

Aripiprazole is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression).

What is the most important information I should know about aripiprazole?

Aripiprazole is not for use in psychotic conditions that are related to dementia. Aripiprazole has caused fatal heart attack and stroke in older adults with dementia-related conditions.

Stop using aripiprazole and call your doctor at once if you have the following symptoms: fever with stiff muscles and rapid heart rate; uncontrolled muscle movements; symptoms that come on suddenly such as numbness or weakness, severe headache, and problems with vision, speech, or balance.

Aripiprazole can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which can increase some of the side effects of aripiprazole.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by aripiprazole.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking aripiprazole.

What should I discuss with my healthcare provider before taking aripiprazole?

Aripiprazole is not for use in psychotic conditions that are related to dementia. Aripiprazole has caused fatal heart attack and stroke in older adults with dementia-related conditions.

Before taking aripiprazole, tell your doctor if you have:

• liver disease;
• kidney disease;
• heart disease, high blood pressure, heart rhythm problems;
• a history of heart attack or stroke;
• a history of breast cancer;
• seizures or epilepsy;
• a personal or family history of diabetes; or
• trouble swallowing.

If you have any of these conditions, you may not be able to use aripiprazole, or you may need a dosage adjustment or special tests during treatment.

The liquid form (oral solution) of this medication may contain up to 15 grams of sugar per dose. Before taking aripiprazole oral solution, tell your doctor if you have diabetes.

The orally disintegrating tablet form of this medication may contain over 3 milligrams of phenylalanine per tablet. Before taking Abilify Discmelt, tell your doctor if you have phenylketonuria.

Aripiprazole may cause you to have high blood sugar (hyperglycemia). Talk to your doctor if you have any signs of hyperglycemia such as increased thirst or urination, excessive hunger, or weakness. If you are diabetic, check your blood sugar levels on a regular basis while you are taking aripiprazole.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Aripiprazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take aripiprazole?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Do not take aripiprazole for longer than 6 weeks unless your doctor has told you to.

Take each dose with a full glass of water.

Aripiprazole can be taken with or without food.

Aripiprazole is usually taken once a day. Follow your doctor ’s instructions.

Measure the liquid form of aripiprazole with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

To take aripiprazole orally disintegrating tablets (Abilify Discmelt):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.
• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
• Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

It is important to take aripiprazole regularly to get the most benefit.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store aripiprazole tablets at room temperature away from moisture and heat.

Aripiprazole oral solution should be stored in the refrigerator and can be used for up to 6 months after opening.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of an aripiprazole overdose may include drowsiness, vomiting, agitation, aggression, confusion, tremors, fast or slow heart rate, seizure (convulsions), trouble breathing, feeling light-headed, or fainting.

What should I avoid while taking aripiprazole?

Aripiprazole can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

Avoid drinking alcohol, which can increase some of the side effects of aripiprazole.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by aripiprazole.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking aripiprazole.

What are the possible side effects of aripiprazole?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using aripiprazole and call your doctor at once if you have any of these serious side effects:

• fever, stiff muscles, confusion, sweating, fast or uneven heartbeats;
• jerky muscle movements you cannot control;
• sudden numbness or weakness, especially on one side of the body;
• sudden headache, confusion, problems with vision, speech, or balance;
• increased thirst, frequent urination, excessive hunger, or weakness;
• feeling light-headed, fainting; or
• urinating less than usual or not at all.

Continue taking aripiprazole and talk to your doctor if you have any of these less serious side effects:

• dizziness, drowsiness, or weakness;
• constipation;
• nausea, vomiting, upset stomach;
• headache, anxiety;
• sleep problems (insomnia); or
• weight gain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Citalopram is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Citalopram affects chemicals in the brain that may become unbalanced and cause depression.

Citalopram is used to treat depression.

What is the most important information I should know about citalopram?

Do not take citalopram together with a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take citalopram. After you stop taking citalopram, you must wait at least 14 days before you start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Some antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking citalopram, do not stop taking the medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking citalopram?

Do not use citalopram if you are using an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with citalopram. You must wait at least 14 days after stopping an MAO inhibitor before you can take citalopram. After you stop taking citalopram, you must wait at least 14 days before you start taking an MAOI.

Before taking citalopram, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use citalopram, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking citalopram, do not stop taking the medication without first talking to your doctor.

Citalopram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give citalopram to anyone younger than 18 years old without the advice of a doctor.

How should I take citalopram?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

To be sure you get the correct dose of liquid citalopram, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before you start feeling better. Do not stop using citalopram without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store citalopram at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a citalopram overdose may include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, dizziness, seizures, and coma.

What should I avoid while taking citalopram?

Do not take citalopram together with escitalopram (Lexapro), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Avoid drinking alcohol, which can increase some of the side effects of citalopram.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by citalopram.

Citalopram can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of citalopram?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• seizure (convulsions);
• tremors, shivering, muscle stiffness or twitching;
• problems with balance or coordination; or
• agitation, confusion, sweating, fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• feeling nervous, restless, or unable to sit still;
• drowsiness, dizziness, trouble concentrating;
• sleep problems (insomnia);
• nausea, gas, upset stomach, loss of appetite;
• weight changes;
• urinating more than usual;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry or watery mouth, yawning, or ringing in your ears.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Chlordiazepoxide is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens).

Chlordiazepoxide affects chemicals in the brain that may become unbalanced and cause anxiety.

Chlordiazepoxide is used to treat anxiety disorders or alcohol withdrawal.

Chlordiazepoxide may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking chlordiazepoxide?

Do not use this medication if you are allergic to chlordiazepoxide or to other benzodiazepines, such as alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

Before taking chlordiazepoxide, tell your doctor if you are allergic to any drugs, or if you have:

• glaucoma;
• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
• porphyria;
• kidney or liver disease;
• a history of depression or suicidal thoughts or behavior; or
• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use chlordiazepoxide, or you may need a dosage adjustment or special tests during treatment.

Chlordiazepoxide can cause birth defects in an unborn baby. Do not use chlordiazepoxide without your doctor’s consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Chlordiazepoxide may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The sedative effects of chlordiazepoxide may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking chlordiazepoxide.

How should I take chlordiazepoxide?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Chlordiazepoxide should be used for only a short time. Do not take this medication for longer than 4 months without your doctor’s advice.

Chlordiazepoxide may be habit-forming and should be used only by the person it was prescribed for. Chlordiazepoxide should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Contact your doctor if this medicine seems to stop working as well in treating your symptoms.

Do not stop using chlordiazepoxide suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Your symptoms may return when you stop using chlordiazepoxide after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using chlordiazepoxide. Withdrawal symptoms may include tremor, sweating, trouble sleeping, muscle cramps, stomach pain, vomiting, diarrhea, irritability, memory problems, confusion, unusual thoughts or behavior, and seizure (convulsions).

To be sure this medication is not causing harmful effects, your blood and liver function may need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Store chlordiazepoxide at room temperature away from moisture, heat, and light.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of chlordiazepoxide can be fatal.

Symptoms of a chlordiazepoxide overdose may include extreme drowsiness, confusion, excitation, muscle weakness, loss of balance or coordination, feeling light-headed, fainting, or coma.

What should I avoid while taking chlordiazepoxide?

Do not drink alcohol while taking chlordiazepoxide. This medication can increase the effects of alcohol.

Chlordiazepoxide can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can increase some of the side effects of chlordiazepoxide.

What are the possible side effects of chlordiazepoxide?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• confusion;
• depressed mood, thoughts of suicide or hurting yourself;
• restless muscle movements in your eyes, tongue, jaw, or neck;
• hyperactivity, agitation, hostility;
• hallucinations; or
• jaundice (yellowing of the skin or eyes).

Less serious side effects are more likely to occur, such as:

• drowsiness, tiredness;
• swelling;
• skin rash;
• nausea, vomiting, constipation; or
• irregular menstrual periods.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.

Your symptoms may return when you stop using alprazolam after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using alprazolam. Withdrawal symptoms may include blurred vision, trouble concentrating, loss of appetite, diarrhea, muscle twitching, numbness or tingling, or increased sensations.

Do not stop using alprazolam suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.

Store alprazolam at room temperature away from moisture, heat, and light. Remove any cotton from the bottle of disintegrating tablets, and keep the bottle tightly closed.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of alprazolam can be fatal.

Symptoms of an alprazolam overdose may include extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, fainting, or coma.

What should I avoid while taking alprazolam?

Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol.

Alprazolam can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can increase some of the side effects of alprazolam.

Grapefruit and grapefruit juice may interact with alprazolam and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

What are the possible side effects of alprazolam?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• unusual risk-taking behavior, decreased inhibitions, no fear of danger;
• depressed mood, thoughts of suicide or hurting yourself;
• hyperactivity, agitation, hostility, hallucinations;
• feeling light-headed, fainting;
• seizure (convulsions);
• urinating less than usual or not at all;
• muscle twitching, tremor; or
• jaundice (yellowing of the skin or eyes).

Less serious side effects are more likely to occur, such as:

• drowsiness, dizziness, feeling irritable;
• amnesia or forgetfulness, trouble concentrating;
• sleep problems (insomnia);
• muscle weakness, lack of balance or coordination, slurred speech;
• blurred vision;
• nausea, vomiting, constipation, appetite or weight changes;
• dry or watery mouth, increased sweating; or
• loss of interest in sex.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Alprazolam is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). Alprazolam affects chemicals in the brain that may become unbalanced and cause anxiety.

Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.

What should I discuss with my healthcare provider before taking alprazolam?

Do not use this medication if you have:

• narrow-angle glaucoma;
• if you are also taking itraconazole (Sporanox) or ketoconazole (Nizoral); or
• if you are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

Before taking alprazolam, tell your doctor if you are allergic to any drugs, or if you have:

• asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
• glaucoma;
• kidney or liver disease (especially alcoholic liver disease);
• a history of depression or suicidal thoughts or behavior; or
• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use alprazolam, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. Alprazolam can cause birth defects in an unborn baby. Do not use alprazolam without your doctor’s consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Alprazolam can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The sedative effects of alprazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking alprazolam.

Do not give this medication to anyone under 18 years old.

How should I take alprazolam?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Alprazolam may be habit-forming and should be used only by the person it was prescribed for. Alprazolam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of alprazolam with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

To take alprazolam orally disintegrating tablets (Niravam):

• Using dry hands, remove a tablet from the bottle and place the tablet on your tongue. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
• Swallow several times as the tablet dissolves. If desired, you may drink liquid after the tablet has completely dissolved.

While you are taking nefazodone you may need to be monitored for worsening symptoms of depression and/or suicidal thoughts at the start of therapy or when doses are changed. This concern about the increased risk of suicidal thoughts or behaviors may be greater if you are 18 years of age or younger and are taking nefazodone. In patients younger than 18 years, the period of risk may extend beyond start of therapy or when doses are changed. Your doctor may want you to monitor for the following symptoms: anxiety, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, severe restlessness, and mania (mental and/or physical hyperactivity). These symptoms may be associated with the development of worsening symptoms of depression and/or suicidal thoughts or actions. Contact your healthcare provider if you develop any new or worsening mental health symptoms during treatment with nefazodone. Do not stop taking nefazodone.

Do not take nefazodone if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days, or if you are taking cisapride (Propulsid), pimozide (Orap), triazolam (Halcion), or carbamazepine (Tegretol, Tegretol XR, Epitol, Carbatrol).

In rare cases, treatment with nefazodone has been associated with serious liver problems, sometimes resulting in liver transplant or death. Contact your doctor immediately if you experience yellowing of the skin or eyes; unusually dark urine; loss of appetite that lasts several days or longer; severe nausea; or stomach pain. These may be early signs of liver problems.

Use caution when driving, operating machinery, or performing other hazardous activities. Nefazodone may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

Avoid alcohol during treatment with nefazodone. Alcohol may increase drowsiness and dizziness while taking nefazodone.

Do not take nefazodone if you are taking any of the following drugs:

• a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate);
• cisapride (Propulsid);
• pimozide (Orap);
• triazolam (Halcion); or
• carbamazepine (Tegretol, Tegretol XR, Epitol, Carbatrol).

These drugs can cause very serious interactions with nefazodone that could lead to seizures, heart damage, and even death.

Before taking this medication, tell your doctor if you have

• heart disease, high or low blood pressure, or irregular heartbeats;
• seizures;
• had manic episodes (extreme agitation or excitability);
• kidney disease; or
• liver disease.

You may not be able to take nefazodone, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Nefazodone is in the FDA pregnancy category C. This means that it is not known whether nefazodone will harm an unborn baby. Do not take nefazodone without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether nefazodone passes into breast milk. Do not take nefazodone without first talking to your doctor if you are breast-feeding.

If you are over 60 years of age, you may be more likely to experience side effects from nefazodone.

How should I take nefazodone?

Take nefazodone exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain the instructions to you.

Take each dose with a full glass of water.

It is important to take nefazodone regularly to get the most benefit.

Do not stop taking nefazodone without first talking to your doctor. It may be several weeks before you begin to feel better, and you may require continuous treatment for quite some time.

Your doctor may want you to have blood tests or other medical evaluations during treatment with nefazodone to monitor progress and side effects.

Store nefazodone at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a nefazodone overdose include drowsiness, nausea, vomiting, and seizures.

What should I avoid while taking nefazodone?

Use caution when driving, operating machinery, or performing other hazardous activities. Nefazodone may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.

Dizziness may be more likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall.

Avoid alcohol during treatment with nefazodone. Alcohol may increase drowsiness and dizziness while taking nefazodone.

What are the possible side effects of nefazodone?

If you experience any of the following uncommon but serious side effects, stop taking nefazodone and seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
• fainting; or
• prolonged, painful, or inappropriate erections (this could lead to a serious condition requiring surgery).

Other, less serious side effects may be more likely to occur. Continue to take nefazodone and talk to your doctor when it is convenient if you experience:

• dizziness, lightheadedness, or drowsiness;
• upset stomach;
• insomnia;
• dry mouth;
• constipation; or
• blurred or abnormal vision.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect nefazodone?

Do not take nefazodone if you are taking any of the following drugs:

• a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate);
• cisapride (Propulsid);
• carbamazepine (Tegretol, Tegretol XR, Epitol, Carbatrol);
• triazolam (Halcion); or
• pimozide (Orap).

These drugs can have very serious interactions with nefazodone that could lead to seizures, heart damage, and even death.

Many other drugs may interact with nefazodone. Talk to your doctor before taking any other medications during treatment with nefazodone, especially any of the following:

• haloperidol (Haldol);
• alprazolam (Xanax);
• lorazepam (Ativan);
• cyclosporine (Neoral, Sandimmune);
• tacrolimus (Prograf);
• digoxin (Lanoxin, Lanoxicaps);
• phenytoin (Dilantin);
• warfarin (Coumadin); or
• atorvastatin (Lipitor), lovastatin (Mevacor), or simvastatin (Zocor).

You may require a dosage adjustment or special monitoring during treatment if you are taking any of these medicines.

What does my medication look like?

Nefazodone is available with a prescription generically. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Do not take Prozac (Fluoxetine) together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Prozac (Fluoxetine) is the only antidepressant that is FDA-approved for use in children with depression. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking Prozac (Fluoxetine), do not stop taking the medication without first talking to your doctor.

What is Prozac (Fluoxetine)?

Prozac (Fluoxetine) is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac (Fluoxetine) affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

Prozac (Fluoxetine) is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).

What should I discuss with my healthcare provider before taking Prozac (Fluoxetine)?

Do not use Prozac (Fluoxetine) if you are using any of the following drugs:

• pimozide (Orap);
• thioridazine (Mellaril); or
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).

Serious and sometimes fatal reactions can occur when these medicines are taken with Prozac (Fluoxetine). You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac (Fluoxetine). You must wait 5 weeks after stopping Prozac (Fluoxetine) before you can take thioridazine (Mellaril) or an MAOI.

Before taking Prozac (Fluoxetine), tell your doctor if you are allergic to any drugs, or if you have:

• cirrhosis of the liver;
• kidney disease;
• diabetes;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use Prozac (Fluoxetine), or you may need a dosage adjustment or special tests.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking Prozac (Fluoxetine), do not stop taking the medication without first talking to your doctor.

Prozac (Fluoxetine) can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give Prozac (Fluoxetine) to anyone younger than 18 years old without a doctor’s advice. Fluoxetine is the only antidepressant that is FDA-approved for use in children with depression.

How should I take fluoxetine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Do not break, chew, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of Prozac (Fluoxetine) with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

It may take 4 weeks or longer before you start feeling better. Do not stop using Prozac (Fluoxetine) without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

To treat premenstrual dysphoric disorder, the usual dose of Prozac (Fluoxetine) is once daily while you are having your period, or 14 days before you expect your period to start. Follow your doctor’s instructions.

Store Prozac (Fluoxetine) at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a Prozac (Fluoxetine) overdose may include nausea, vomiting, fever, sleepiness, rapid or uneven heartbeat, confusion, fainting, seizures, or coma.

What should I avoid while taking Prozac (Fluoxetine)?

Avoid drinking alcohol, which can increase some of the side effects of Prozac (Fluoxetine).

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by Prozac (Fluoxetine).

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Prozac (Fluoxetine). Tell your doctor if you regularly use any of these other medicines.

Prozac (Fluoxetine) can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of Prozac (Fluoxetine)?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• seizure (convulsions);
• tremors, shivering, muscle stiffness or twitching;
• a red, blistering, peeling skin rash;
• problems with balance or coordination; or
• agitation, confusion, sweating, fast heartbeat.

Less serious side effects may include:

• drowsiness, dizziness, weakness;
• runny nose, sore throat, headache, flu symptoms;
• nausea, diarrhea, changes in appetite;
• weight changes;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry mouth, increased sweating.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

Do not take escitalopram together with a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take escitalopram. After you stop taking escitalopram, you must wait at least 14 days before you start taking an MAOI.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking escitalopram, do not stop taking the medication without first talking to your doctor.

It is dangerous to try and purchase escitalopram on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of escitalopram purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

What should I discuss with my healthcare provider before taking escitalopram?

It is dangerous to try and purchase escitalopram on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of escitalopram purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

Do not use escitalopram if you are using an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with escitalopram. You must wait at least 14 days after stopping an MAO inhibitor before you can take escitalopram. After you stop taking escitalopram, you must wait at least 14 days before you start taking an MAOI.

Before taking escitalopram, tell your doctor if you are allergic to any drugs, or if you have:

• liver or kidney disease;
• seizures or epilepsy;
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use escitalopram, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking escitalopram, do not stop taking the medication without first talking to your doctor.

Escitalopram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give escitalopram to anyone younger than 18 years old without the advice of of a doctor.

How should I take escitalopram?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Take each dose with a full glass of water.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

To be sure you get the correct dose of liquid escitalopram, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take 4 weeks or longer before you start feeling better. Do not stop using escitalopram without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

Store escitalopram at room temperature away from moisture and heat.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of an escitalopram overdose may include nausea, vomiting, tremor, sweating, rapid heartbeat, confusion, dizziness, seizures, and coma.

What should I avoid while taking escitalopram?

Do not take escitalopram together with citalopram (Celexa), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

Avoid drinking alcohol, which can increase some of the side effects of escitalopram.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by escitalopram.

Escitalopram can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of escitalopram?

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• seizure (convulsions);
• tremors, shivering, muscle stiffness or twitching;
• problems with balance or coordination; or
• agitation, confusion, sweating, fast heartbeat.

Other less serious side effects are more likely to occur, such as:

• feeling nervous, restless, or unable to sit still;
• headache, trouble concentrating;
• drowsiness, dizziness;
• sleep problems (insomnia);
• nausea, diarrhea, heartburn;
• weight changes;
• decreased sex drive, impotence, or difficulty having an orgasm; or
• dry mouth, ringing in your ears.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

• For moderate to severe PPD, experts recommend an antidepressant combined with support and counseling.
• Some experts recommend starting an antidepressant for prevention, but so far no studies have shown this to be effective.

Breast-feeding is good for you and your baby, both physically and emotionally. For this reason, experts have studied which antidepressants seem safest for breast-feeding babies. So, you need not stop breast-feeding while taking an antidepressant for postpartum depression.

Whether or not you are breast-feeding, your health professional is likely to recommend a selective serotonin reuptake inhibitor (SSRI). This class of medication is highly effective for most women, with fewer side effects than tricyclics. Most tricyclic antidepressants can be used while breast-feeding with minimal risk, but for the mother, side effects are sometimes a problem.

Your health professional may start you out with a low dose to help you adjust to the medication.

Medication Choices

Selective serotonin reuptake inhibitors (SSRIs) are usually the first-choice medication for treating postpartum depression. Most SSRIs are thought to be safe for use while breast-feeding because in general they pass into the breast milk at low levels. (But fluoxetine (Prozac) and citalopram (Celexa) have been found in higher levels in breast-feeding babies, and are linked to some reports of side effects in babies.)

Tricyclics have not caused any known breast-feeding baby problems and are not passed on to a breast-feeding baby in measurable amounts (with the exception of doxepin [Adapin, Sinequan], which is not considered safe while breast-feeding).

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

What To Think About

Antidepressants are typically used for at least 6 months, first to treat postpartum depression and then to prevent a relapse of symptoms. To prevent a relapse, your health professional may recommend that you take medication for up to a year before thinking about discontinuing it. Experts recommend long-term antidepressant treatment for women who have had three or more depressive episodes in the past.¹

Never suddenly stop taking an SSRI. An SSRI should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping SSRI medication can cause flu-like symptoms, headaches, nervousness, anxiety, or insomnia.

If you are breast-feeding and taking an antidepressant or any other medication, let your baby’s pediatric health professional know.

Taking an antidepressant you’ve taken before. After having your baby, talk to your health professional before taking any medication, especially if you are breast-feeding. You may be more sensitive to medication side effects during your postpartum period, and may need a lower dose than before. Some medications are considered safer than others when a woman is breast-feeding.

Hormone therapy.Estrogen treatment for PPD has been studied on a limited basis. While women taking estrogen have shown improvement, many were also taking an antidepressant, making it difficult to know whether estrogen was responsible. Estrogen therapy is unlikely to become a common treatment for PPD, because it increases the risk of blood clots (deep vein thrombosis) and of cancer in the uterine lining (endometrium). Adding progestin eliminates estrogen’s endometrial cancer risk but is known to trigger PPD when taken after childbirth.