Oxycodone and aspirin (Oral route)

Pronunciation:

AS-pir-in, ox-i-KOE-done hye-droe-KLOR-ide

Brand Names:

  • Endodan
  • Percodan

Dosage Forms:

  • Tablet

Warnings:

Oral route(Tablet)

Addiction, Abuse, and MisuseOxycodone hydrochloride/aspirin exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing oxycodone hydrochloride/aspirin, and monitor all patients regularly for the development of these behaviors or conditions.Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse and misuse, the Food and Drug Administration (FDA) has required a REMS for these products. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers. Healthcare providers are strongly encouraged to: complete a REMS-compliant education program, counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products, emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacists, and consider other tools to improve patient, household, and community safety.Life-Threatening Respiratory DepressionSerious, life-threatening, or fatal respiratory depression may occur with use of oxycodone hydrochloride/aspirin. Monitor for respiratory depression, especially during initiation of oxycodone hydrochloride/aspirin or following a dose increase.Accidental IngestionAccidental ingestion of even one dose of oxycodone hydrochloride/aspirin, especially by children, can result in a fatal overdose of oxycodone hydrochloride.Neonatal Opioid Withdrawal SyndromeProlonged use of oxycodone hydrochloride/aspirin during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.Cytochrome P450 3A4 InteractionThe concomitant use of oxycodone hydrochloride/aspirin with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in oxycodone plasma concentration. Monitor patients receiving oxycodone hydrochloride/aspirin and any CYP3A4 inhibitor or inducer.Risks from Concomitant Use with Benzodiazepines or Other CNS DepressantsReserve concomitant prescribing of oxycodone hydrochloride/aspirin and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation .

Classifications:

Therapeutic—

Opioid/Salicylate, Aspirin Combination

Pharmacologic—

NSAID

Chemical—

Salicylate, Aspirin

Uses of This Medicine:

Oxycodone and aspirin combination is used to relieve pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated. Oxycodone belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

Aspirin is used to relieve pain and reduce fever in patients. Aspirin belongs to the group of medicines known as salicylates and acts on the immune system to reduce inflammation. It is also known as an antiinflammatory analgesic.

When oxycodone is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only under a restricted distribution program called the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of oxycodone and aspirin combination in the pediatric population. Because of aspirin's toxicity, use in children is not recommended. Do not give aspirin to a child who has chickenpox or flu symptoms, unless approved by a doctor. Aspirin can cause a life-threatening reaction called Reye syndrome.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of oxycodone and aspirin combination in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or lung problems, which may require caution and an adjustment in the dose for patients receiving oxycodone and aspirin combination.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Defibrotide
  • Dichlorphenamide
  • Influenza Virus Vaccine, Live
  • Ketorolac
  • Nalmefene
  • Naltrexone
  • Safinamide

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone
  • Acarbose
  • Aceclofenac
  • Acemetacin
  • Acepromazine
  • Alfentanil
  • Alipogene Tiparvovec
  • Almotriptan
  • Alprazolam
  • Alteplase, Recombinant
  • Alvimopan
  • Amifampridine
  • Amiloride
  • Amineptine
  • Amiodarone
  • Amisulpride
  • Amitriptyline
  • Amitriptylinoxide
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Amprenavir
  • Amtolmetin Guacil
  • Anagrelide
  • Anileridine
  • Anisindione
  • Apixaban
  • Aprepitant
  • Argatroban
  • Aripiprazole
  • Armodafinil
  • Asenapine
  • Atazanavir
  • Baclofen
  • Bendroflumethiazide
  • Benperidol
  • Benzhydrocodone
  • Benzphetamine
  • Benzthiazide
  • Betrixaban
  • Bivalirudin
  • Boceprevir
  • Bosentan
  • Bromazepam
  • Bromfenac
  • Bromopride
  • Brompheniramine
  • Bufexamac
  • Bumetanide
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Caplacizumab-yhdp
  • Carbamazepine
  • Carbinoxamine
  • Carisoprodol
  • Carphenazine
  • Celecoxib
  • Ceritinib
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpromazine
  • Chlorpropamide
  • Chlorthalidone
  • Chlorzoxazone
  • Choline Salicylate
  • Cilostazol
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clonixin
  • Clopamide
  • Clopidogrel
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Cyclopenthiazide
  • Cyclosporine
  • Dabigatran Etexilate
  • Danaparoid
  • Darunavir
  • Delavirdine
  • Desipramine
  • Desirudin
  • Desmopressin
  • Desvenlafaxine
  • Dexamethasone
  • Dexibuprofen
  • Dexketoprofen
  • Dexmedetomidine
  • Dextroamphetamine
  • Dextromethorphan
  • Dezocine
  • Diazepam
  • Diazoxide
  • Dibenzepin
  • Dichloralphenazone
  • Diclofenac
  • Dicumarol
  • Difenoxin
  • Diflunisal
  • Digoxin
  • Dihydrocodeine
  • Diltiazem
  • Diphenhydramine
  • Diphenoxylate
  • Dipyrone
  • Dolasetron
  • Donepezil
  • Dothiepin
  • Doxepin
  • Doxylamine
  • Dronedarone
  • Droperidol
  • Droxicam
  • Duloxetine
  • Edoxaban
  • Efavirenz
  • Eletriptan
  • Enflurane
  • Enzalutamide
  • Eplerenone
  • Eptifibatide
  • Erdafitinib
  • Erythromycin
  • Escitalopram
  • Esketamine
  • Eslicarbazepine Acetate
  • Estazolam
  • Eszopiclone
  • Ethacrynic Acid
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Etravirine
  • Felbinac
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Feverfew
  • Flibanserin
  • Floctafenine
  • Fluconazole
  • Flufenamic Acid
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Flurbiprofen
  • Fluspirilene
  • Fluvoxamine
  • Fondaparinux
  • Fosamprenavir
  • Fosaprepitant
  • Fosnetupitant
  • Fosphenytoin
  • Fospropofol
  • Frovatriptan
  • Furazolidone
  • Furosemide
  • Ginkgo
  • Glimepiride
  • Glipizide
  • Glyburide
  • Gossypol
  • Granisetron
  • Halazepam
  • Haloperidol
  • Halothane
  • Heparin
  • Hexobarbital
  • Hydrochlorothiazide
  • Hydrocodone
  • Hydroflumethiazide
  • Hydromorphone
  • Hydroxytryptophan
  • Hydroxyzine
  • Ibrutinib
  • Ibuprofen
  • Idelalisib
  • Imatinib
  • Imipramine
  • Indapamide
  • Indinavir
  • Indomethacin
  • Inotersen
  • Iproniazid
  • Isocarboxazid
  • Isoflurane
  • Itraconazole
  • Ivacaftor
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Ketoconazole
  • Ketoprofen
  • Lanreotide
  • Lepirudin
  • Levomilnacipran
  • Levorphanol
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofepramine
  • Lofexidine
  • Lomitapide
  • Lopinavir
  • Lorazepam
  • Lorcaserin
  • Lorlatinib
  • Lornoxicam
  • Loxapine
  • Loxoprofen
  • Lumacaftor
  • Lumiracoxib
  • Macimorelin
  • Meclizine
  • Meclofenamate
  • Mefenamic Acid
  • Melitracen
  • Meloxicam
  • Melperone
  • Meperidine
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Metformin
  • Methadone
  • Methamphetamine
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrexate
  • Methotrimeprazine
  • Methyclothiazide
  • Methylene Blue
  • Methylnaltrexone
  • Metoclopramide
  • Metolazone
  • Mibefradil
  • Midazolam
  • Mifepristone
  • Milnacipran
  • Mirtazapine
  • Mitotane
  • Moclobemide
  • Modafinil
  • Molindone
  • Moricizine
  • Morniflumate
  • Morphine
  • Morphine Sulfate Liposome
  • Nabumetone
  • Nafcillin
  • Nalbuphine
  • Nalorphine
  • Naloxone
  • Naproxen
  • Naratriptan
  • Nateglinide
  • Nefazodone
  • Nelfinavir
  • Nepafenac
  • Netupitant
  • Nevirapine
  • Nialamide
  • Nicomorphine
  • Nicorandil
  • Niflumic Acid
  • Nilotinib
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Nitrazepam
  • Nitrous Oxide
  • Nortriptyline
  • Olanzapine
  • Ondansetron
  • Opipramol
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxaprozin
  • Oxazepam
  • Oxcarbazepine
  • Oxymorphone
  • Oxyphenbutazone
  • Palbociclib
  • Palonosetron
  • Papaveretum
  • Parecoxib
  • Paregoric
  • Paroxetine
  • Pemetrexed
  • Pentazocine
  • Pentobarbital
  • Pentosan Polysulfate Sodium
  • Pentoxifylline
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Phenindione
  • Phenobarbital
  • Phenprocoumon
  • Phenylbutazone
  • Phenytoin
  • Piketoprofen
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piracetam
  • Piritramide
  • Piroxicam
  • Polythiazide
  • Posaconazole
  • Pralatrexate
  • Pranoprofen
  • Prasugrel
  • Prazepam
  • Prednisone
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Proglumetacin
  • Promazine
  • Promethazine
  • Propofol
  • Propyphenazone
  • Proquazone
  • Protein C
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Ranitidine
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Remoxipride
  • Repaglinide
  • Reteplase, Recombinant
  • Ribociclib
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Rivaroxaban
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Samidorphan
  • Saquinavir
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Sertindole
  • Sertraline
  • Sibutramine
  • Sodium Oxybate
  • Sodium Salicylate
  • Spironolactone
  • Sufentanil
  • Sulindac
  • Sulpiride
  • Sumatriptan
  • Suvorexant
  • Tacrolimus
  • Tapentadol
  • Telaprevir
  • Telithromycin
  • Temazepam
  • Tenofovir Disoproxil Fumarate
  • Tenoxicam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Tianeptine
  • Tiaprofenic Acid
  • Ticagrelor
  • Ticlopidine
  • Tilidine
  • Tirofiban
  • Tizanidine
  • Tolazamide
  • Tolbutamide
  • Tolfenamic Acid
  • Tolmetin
  • Tolonium Chloride
  • Topiramate
  • Torsemide
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Triamterene
  • Triazolam
  • Trichlormethiazide
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
  • Tryptophan
  • Valdecoxib
  • Varicella Virus Vaccine, Live
  • Venlafaxine
  • Verapamil
  • Vilazodone
  • Voriconazole
  • Vortioxetine
  • Warfarin
  • Xipamide
  • Zaleplon
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zopiclone
  • Zotepine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Atenolol
  • Betamethasone
  • Betaxolol
  • Bisoprolol
  • Captopril
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Cortisone
  • Delapril
  • Dexamethasone
  • Enalaprilat
  • Enalapril Maleate
  • Esmolol
  • Imidapril
  • Labetalol
  • Levobunolol
  • Lisinopril
  • Methylprednisolone
  • Metipranolol
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Nitroglycerin
  • Oxprenolol
  • Paramethasone
  • Penbutolol
  • Pindolol
  • Practolol
  • Prednisolone
  • Prednisone
  • Probenecid
  • Propranolol
  • Sotalol
  • St John's Wort
  • Streptokinase
  • Tamarind
  • Temocapril
  • Tenecteplase
  • Timolol
  • Triamcinolone
  • Valproic Acid

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol
  • Grapefruit Juice

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Addison disease (adrenal gland problem) or
  • Alcohol abuse, or history of or
  • Bleeding problems or
  • Brain tumor, history of or
  • Chronic obstructive pulmonary disease (COPD) or
  • Cor pulmonale (serious heart condition) or
  • Drug dependence, especially with narcotics, or history of or
  • Gallbladder disease or gallstones or
  • Head injury, history of or
  • Hypothyroidism (an underactive thyroid) or
  • Hypovolemia (low blood volume) or
  • Kyphoscoliosis (curvature of the spine with breathing problems) or
  • Peptic ulcer disease, active or history of or
  • Problems with passing urine or
  • Prostatic hypertrophy (enlarged prostate, BPH) or
  • Vitamin K deficiency—Use with caution. May increase risk for more serious side effects.
  • Hemophilia (blood disorder) or
  • Kidney disease, severe or
  • Liver disease, severe or
  • Lung disease or breathing problems (eg, asthma, respiratory depression), severe or
  • Stomach or bowel blockage (eg, paralytic ileus) or
  • Viral infection—Should not be used in patients with these conditions.
  • Hypotension (low blood pressure) or
  • Pancreatitis (swelling of the pancreas) or
  • Seizures, history of—Use with caution. May make these conditions worse.
  • Kidney disease, mild to moderate or
  • Liver disease, mild to moderate—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of this medicine is taken for a long time, it may become habit-forming (causing mental or physical dependence).

It is very important that you understand the rules of the Opioid Analgesic REMS program to prevent addiction, abuse, and misuse of oxycodone and aspirin combination. This medicine should come with a Medication Guide. Read and follow the instructions carefully. Read and follow these instructions carefully. Read it again each time you refill your prescription in case there is new information. Ask your doctor if you have any questions.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For moderate to moderately severe pain:
      • Adults—One tablet every 6 hours as needed. Your doctor may adjust your dose as needed. However, the dose is usually not more than 12 tablets per day.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a safe and secure place. Do not throw unused medicine in the trash. Flush any unused tablets down the toilet. Ask your pharmacist about the best way to dispose of medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress while you are using this medicine, especially within the first 24 to 72 hours of treatment. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Do not use this medicine if you are using or have used an MAO inhibitor (MAOI) such as isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Check with your doctor before using Percodan® with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with Percodan® may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Do not use more of this medicine or take it more often than your doctor tells you to. This can be life-threatening. Symptoms of an overdose include: extreme dizziness or weakness, slow heartbeat or breathing, seizures, trouble breathing, and cold, clammy skin. Call your doctor right away if you notice these symptoms.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Check with your doctor right away if you have the following symptoms while using this medicine: bloody or black, tarry stools, heartburn, nausea, vomiting, stomach pain, or vomiting of blood or material that looks like coffee grounds.

This medicine may cause a serious type of allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn baby. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

For nursing mothers:

  • Talk to your doctor if you have any questions about taking oxycodone or about how this medicine may affect your baby.
  • Call your doctor if you become extremely tired and have difficulty caring for your baby.
  • Your baby should generally nurse every 2 to 3 hours and should not sleep for more than 4 hours at a time.
  • Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention.

Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known
Agitation
bleeding gums
bloating
blood in the urine or stools
bloody, black, or tarry stools
blue lips, fingernails, or skin
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in consciousness or confusion
chest pain or discomfort
chills
clay-colored stools
confusion
constipation
cough
coughing or vomiting blood
dark urine
darkening of the skin
decrease in urine volume or frequency
decreased appetite
depression
difficult, fast, noisy breathing
difficulty in passing urine (dribbling)
difficulty swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
dry mouth
fainting
fast, slow, irregular, pounding, or racing heartbeat or pulse
feeling of hostility or irritability
feeling of warmth
feeling that something terrible will happen
fever
headache, sudden, severe
heartburn
hives, itching, or skin rash
increased menstrual flow or vaginal bleeding
increased sweating
indigestion
irregular, fast, slow, or shallow breathing
large, flat, blue or purplish patches on the skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of consciousness
muscle cramping, weakness, or tremors
muscle pain or stiffness
nausea
nosebleeds
numbness or tingling in the hands, feet, or lips
overactive reflexes
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
pale skin
pinpoint red or purple spots on the skin
poor coordination
prolonged bleeding from cuts
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red or black, tarry stools or dark urine
restlessness
seizures
shivering
sleepiness
sunken eyes
sweating
swelling of the face, ankles, hands, feet, or lower legs
stomach pain, cramping, or tenderness
talking or acting with excitement you cannot control
thirst
tightness in the chest
trembling or shaking
twitching
unusual bleeding or bruising
unusual tiredness or weakness
vomiting
vomiting of material that looks like coffee grounds, severe and continuing
weak or feeble pulse
weakness or heaviness of the legs
weight gain
wrinkled skin
yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Continuing ringing or buzzing or other unexplained noise in the ears
decreased awareness or responsiveness
diarrhea
drowsiness
enlarged pupils
extremely high fever or body temperature
fast, weak heartbeat
hearing loss
increase in heart rate
restlessness
severe sleepiness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Relaxed and calm feeling
sleepiness
Incidence not known
Belching
bloated, full feeling
blurred or loss of vision
change in color perception
cold sweats
constricted, pinpoint, or small pupils (black part of the eye)
cool, pale skin
double vision
excess air or gas in the stomach
false or unusual sense of well-being
flushed, dry skin
fruit-like breath odor
halos around lights
increased hunger or thirst
increased urination
lack or loss of strength
night blindness
nightmares
overbright appearance of lights
red eyes
redness of the skin
seeing, hearing, or feeling things that are not there
shakiness
slurred speech
trouble sleeping
tunnel vision
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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


Last Updated: 9/5/2019

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
All rights reserved.

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