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APCLAVEN XL 37.5 MG PROLONGED RELEASE CAPSULE
Active substance(s): VENLAFAXINE HYDROCHLORIDE
Apclaven XL 37.5 mg, 75 mg and 150 mg Prolonged release capsule
Read all of this leaflet carefully before you start taking this medicine.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even
if their symptoms are the same as yours.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet:
What Apclaven XL Capsules are and what they are used for
Before you take Apclaven XL Capsules
How to take Apclaven XL Capsules
Possible side effects
How to store Apclaven XL Capsules
WHAT APCLAVEN XL CAPSULES ARE AND WHAT THEY ARE USED FOR
Apclaven XL is an antidepressant and one of a group of medicines called serotonin noradrenaline
reuptake inhibitors (SNRIs). This group of medicines is used to treat depression. It is thought that
people who are depressed may have lower levels of serotonin and noradrenaline in their brain. Whilst
it is not fully understood how antidepressants work, Apclaven XL prolonged release capsule may help
to relieve the symptoms of depression by increasing the levels of these substances in the brain.
Apclaven XL capsule is a treatment for adults with depression. Apclaven XL capsule is also a
treatment for adults with the following anxiety disorders: generalised anxiety disorder, social anxiety
disorder (fear or avoidance of social situations) and panic disorder (panic attacks). Treating depression
or anxiety disorders properly is important to help you get better. If it is not treated, your condition may
not go away and may become more serious and more difficult to treat.
BEFORE YOU TAKE APCLAVEN XL CAPSULES
Do not take Apclaven XL
if you are allergic (hypersensitive) to venlafaxine or any of the other ingredients of Apclaven
if you are also taking or have taken any time within the last 14 days any medicines known as
irreversible monoamine oxidase inhibitors (MAOIs), used to treat depression or Parkinson‟s
disease. Taking an irreversible MAOI together with other medicines, including Apclaven XL
can cause serious or even life-threatening side effects. Also, you must wait at least 7 days after
you stop taking Apclaven XL before you take any MAOI (see also the sections “Serotonin
syndrome” and “Taking other medicines”).
Take special care with Apclaven XL
if you use other medicines that taken at the same time as Apclaven XL could increase the risk
of developing serotonin syndrome (see the section “Taking other medicines”)
if you have eye problems, such as certain kinds of glaucoma (increased pressure in the eye)
if you have a history of high blood pressure
if you have a history of heart problems
if you have a history of fits (seizures)
if you have a history of low sodium levels in your blood (hyponatraemia)
if you have a tendency to develop bruises or a tendency to bleed easily (history of bleeding
disorders), or if you are taking other medicines that may increase the risk of bleeding
if your cholesterol levels get higher during treatment.
if you have a history of, or if someone in your family has had, mania or bipolar disorder
(feeling over-excited or euphoric)
if you have a history of aggressive behaviour.
Apclaven XL may cause a sensation of restlessness or an inability to sit or stand still. You should tell
your doctor if this happens to you.
If any of these conditions apply to you, please talk with your doctor before taking Apclaven XL
Thoughts of suicide and worsening of your depression or anxiety disorder
If you are depressed and/or have anxiety disorders, you can sometimes have thoughts of harming or
killing yourself. These may be increased when first starting antidepressants, since these medicines all
take time to work, usually about two weeks but sometimes longer.
You may be more likely to think like this:
if you have previously had thoughts about killing or harming yourself
if you are a young adult. Information from clinical trials has shown an increased risk of suicidal
behaviour in adults (aged less than 25 years) with psychiatric conditions who were treated with
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a
hospital straight away.
You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety
disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression
or anxiety is getting worse, or if they are worried about changes in your behaviour.
Dry mouth is reported in 10% of patients treated with Apclaven XL. This may increase the risk of
caries. Therefore, you should take special care in your dental hygiene
Your blood glucose levels may be altered due to Apclaven XL. Therefore, the dosage of your diabetes
medicines may need to be adjusted.
Use in children and adolescents under 18 years of age
Apclaven XL should normally not be used for children and adolescents under 18 years. Also, you
should know that patients under 18 have an increased risk of side effects, such as suicide attempt,
suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when
they take this class of medicines. Despite this, your doctor may prescribe Apclaven XL for patients
under 18 because he/she decides that this is in their best interests. If your doctor has prescribed
Apclaven XL for a patient under 18, and you want to discuss this, please go back to your doctor. You
should inform your doctor if any of the symptoms listed above develop or worsen when patients under
18 are taking Apclaven XL. Also, the long-term safety effects concerning growth, maturation and
cognitive and behavioural development of Apclaven XL in this age group has not yet been
Taking Apclaven XL with other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines,
including medicines obtained without a prescription.
Your doctor should decide whether you can take Apclaven XL with other medicines.
Do not start or stop taking any medicines, including those bought without a prescription, natural and
herbal remedies, before checking with your doctor or pharmacist.
monoamine oxidase inhibitors (MAOIs: see the section “Before you take Apclaven XL
serotonin syndrome: serotonin syndrome, a potentially life-threatening condition (see the
section “Possible Side Effects”), may occur with Apclaven XL treatment, particularly when
taken with other medicines. Examples of these medicines include:
triptans (used for migraine)
medicines to treat depression, for instance SNRI, SSRIs, tricyclics, or medicines containing
medicines containing linezolid, an antibiotic (used to treat infections)
medicines containing moclobemide, a reversible MAOI (used to treat depression)
medicines containing sibutramine (used for weight loss)
medicines containing tramadol (a pain-killer)
products containing St. John‟s Wort (also called Hypericum perforatum, a natural or herbal
remedy used to treat mild depression)
products containing tryptophan (used for problems such as sleep and depression)
Signs and symptoms of serotonin syndrome may include a combination of the following: restlessness,
hallucinations, loss of coordination, fast heart beat, increased body temperature, fast changes in blood
pressure, overactive reflexes, diarrhoea, coma, nausea, vomiting. Get medical care right away if you
think serotonin syndrome is happening to you.
The following medicines may also interact with Apclaven XL and should be used with caution. It is
especially important to mention to your doctor or pharmacist if you are taking medicines containing:
ketoconazole (an antifungal medicine)
haloperidol or risperidone (to treat psychiatric conditions)
metoprolol (a beta blocker to treat high blood pressure and heart problems)
Taking Apclaven XL with food and drink
Apclaven XL should be taken with food (see section “How to take Apclaven XL Capsules”).
You should avoid alcohol while you are taking Apclaven XL.
Pregnancy and breast-feeding
Tell your doctor if you become pregnant, or you are trying to become pregnant. You should use
Apclaven XL only after discussing the potential benefits and the potential risks to your unborn child
with your doctor.
If you are taking Apclaven XL during pregnancy, let your midwife and/or doctor know, as your baby
might have some symptoms when it is born. These symptoms usually begin during the first 24 hours
after the baby is born. They include not feeding properly and trouble with breathing. If your baby has
these symptoms when it is born and you are concerned, contact your doctor and/or midwife who will
be able to advise you.
Apclaven XL passes into breast milk. There is a risk of an effect on the baby. Therefore, you should
discuss the matter with your doctor, and he/she will decide whether you should stop breast-feeding or
stop the therapy with Apclaven XL.
Driving and using machines
Do not drive or use any tools or machines until you know how Apclaven XL affects you.
Important information about some of the ingredients of Apclaven XL
sunset yellow as a colouring agent - is contained in the 75 mg and 150 mg strength capsules. It
may cause an allergic reaction.
ponceau 4R red as a colouring agent - is contained in the 37.5 mg capsules. It may cause an
sucrose – is contained in all strength capsules. If you have been told by your doctor that you
have intolerance to some sugars, contact your doctor before taking this medicinal product
HOW TO TAKE APCLAVEN XL CAPSULES
Always take Apclaven XL exactly as your doctor has told you. You should check with your doctor or
pharmacist if you are not sure.
The usual recommended starting dose for treatment of depression, generalised anxiety disorder and
social anxiety disorder is 75 mg per day. The dose can be raised by your doctor gradually, and if
needed, even up to a maximum dose of 375 mg daily for depression. If you are being treated for panic
disorder, your doctor will start with a lower dose (37.5 mg) and then increase the dose gradually. The
maximum dose for generalised anxiety disorder, social anxiety disorder and panic disorder is
Take Apclaven XL at approximately the same time each day, either in the morning or in the evening.
Capsules must be swallowed whole with fluid and not opened, crushed, chewed or dissolved.
Apclaven XL capsules should be taken with food.
If you have liver or kidney problems, talk to your doctor, since your dose of Apclaven XL may need
to be different.
Do not stop taking Apclaven XL without talking to your doctor (see the section “If you stop taking
If you take more Apclaven XL than you should
Call your doctor or pharmacist immediately if you take more than the amount of Apclaven XL
prescribed by your doctor.
The symptoms of a possible overdose may include a rapid heartbeat, changes in level of alertness
(ranging from sleepiness to coma), blurred vision, seizures or fits, and vomiting.
If you forget to take Apclaven XL
If you miss a dose, take it as soon as you remember. However, if it is time for your next dose, skip the
missed dose and take only a single dose as usual. Do not take more than the daily amount of Apclaven
XL that has been prescribed for you in one day.
If you stop taking Apclaven XL
Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel
better. If your doctor thinks that you no longer need Apclaven XL, he/she may ask you to reduce your
dose slowly before stopping treatment altogether. Side effects are known to occur when people stop
using Apclaven XL, especially when Apclaven XL is stopped suddenly or the dose is reduced too
quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness,
headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness,
agitation, confusion, ringing in the ears, tingling or rarely electric shock sensations, weakness,
sweating, seizures, or flu-like symptoms.
Your doctor will advise you on how you should gradually discontinue Apclaven XL treatment. If you
experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
POSSIBLE SIDE EFFECTS
Like all medicines, Apclaven XL can cause side effects, although not everybody gets them.
Do not be concerned if you see small white granules or balls in your stools after taking Apclaven XL.
Inside Apclaven XL capsules are spheroids or small white balls that contain the Apclaven XL active
ingredient. These spheroids are released from the capsule into your gastrointestinal tract. As the
spheroids travel the length of your gastrointestinal tract, Apclaven XL is slowly released. The spheroid
“shell” remains undissolved and is eliminated in your stools. Therefore, even though you may see
spheroids in your stools, your dose of Apclaven XL has been absorbed
If any of the following happen, do not take more Apclaven XL. Tell your doctor immediately, or go to
the casualty department at your nearest hospital:
chest tightness, wheezing, trouble swallowing or breathing
swelling of the face, throat, hands, or feet
feeling nervous or anxious, dizziness, throbbing sensations, sudden reddening of the skin and/or
a warm feeling
severe rash, itching, or hives (elevated patches of red or pale skin that often itch)
Serious side effects
If you notice any signs of the following, you may need urgent medical attention:
heart problems, such as fast or irregular heart rate, increased blood pressure
eye problems, such as blurred vision, dilated pupils
nerve problems, such as dizziness, pins and needles, movement disorder, seizures or fits
psychiatric problems, such as hyperactivity and euphoria
treatment withdrawal (see the section “How to take Apclaven XL Capsules, if you stop taking
Other reported side effects
Very common (affects more than 1 in 10 users)
Headache; dry mouth; sweating (including night sweats)
Common (affects 1 to 10 users in 100)
Weight loss; appetite decreased; constipation; vomiting; increased cholesterol
Feeling separated (or detached) from yourself and reality; nervousness; confusion; abnormal
Tremor; increased muscle tonus
Pins and needles
Increase in blood pressure; flushing, palpitations
Increased frequency in urination; difficulties passing urine
Decreased libido; abnormal ejaculation/orgasm (males); lack of orgasm; erectile dysfunction
Menstrual irregularities such as increased bleeding or increased irregular bleeding
Weakness (asthenia); dizziness; sedation, chills
Uncommon (affects 1 to 10 users in 1,000)
Bruising; black tarry stools (faeces) or blood in stools, which can be a sign of internal bleeding
Grinding of the teeth; involuntary movement of the muscles
General swelling of the skin especially the face, mouth, tongue, throat area or hands and feet
and/or a raised itchy rash (hives) may be present
Sensitivity to sunlight; abnormal hair loss; rash
Impaired coordination and balance; feeling dizzy (particularly when standing up too quickly),
fainting, fast heartbeat
Weight gain; diarrhoea
Altered taste sensation
Lack of feeling or emotion; agitation
Ringing in the ears (tinnitus)
Inability to pass urine;
Abnormal orgasm (females)
Rare (affects 1 to 10 users in 10,000)
A sensation of restlessness or an inability to sit or stand still; seizures or fits; feeling overexcited or euphoric.
Inability to control urination
Frequency not known
Reduced number of platelets in your blood, leading to an increased risk of bruising or bleeding;
blood disorders which may lead to an increased risk of infection; slight changes in blood levels
of liver enzymes; decrease in blood sodium levels;
Itchiness, yellow skin or eyes, dark urine, or flu-like symptoms, which are symptoms of
inflammation of the liver (hepatitis)
Excessive water intake (known as SIADH)
Abnormal breast milk production
A high temperature with rigid muscles, confusion or agitation, and sweating, or if you
experience jerky muscle movements which you can't control, these may be symptoms of serious
conditions known as neuroleptic malignant syndrome
Euphoric feelings, drowsiness, sustained rapid eye movement, clumsiness, restlessness, feeling
of being drunk, sweating or rigid muscles, which are symptoms of serotonergic syndrome
Disorientation and confusion often accompanied by hallucination (delirium)
Stiffness, spasms and involuntary movements of the muscles
Thoughts of harming or killing yourself
Severe eye pain and decreased or blurred vision
Decrease in blood pressure; abnormal, rapid or irregular heartbeat, which could lead to fainting
Coughing, wheezing, shortness of breath and a high temperature, which are symptoms of
inflammation of the lungs associated with an increase in white blood cells (pulmonary
Severe abdominal or back pains (which could indicate a serious problem in the gut, liver or
Skin rash, which may lead to severe blistering and peeling of the skin; itching; mild rash
Unexplained muscle pain, tenderness or weakness (rhabdomyolysis)
Swollen face or tongue, shortness of breath or difficulty breathing, often with skin rashes (this
may be a serious allergic reaction)
Apclaven XL sometimes causes unwanted effects that you may not be aware of, such as increases in
blood pressure or abnormal heart beat; slight changes in blood levels or liver enzymes, sodium or
cholesterol. More rarely, Apclaven XL may reduce the function of platelets in your blood, leading to
an increased risk of bruising or bleeding. Therefore, your doctor may wish to do blood tests
occasionally, particularly if you have been taking Apclaven XL for a long time.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please
tell your doctor or pharmacist.
HOW TO STORE APCLAVEN XL CAPSULES
Keep out of the sight and reach of children.
Do not use Apclaven XL after the expiry date which is stated on the carton after “EXP”. The expiry
date refers to the last day of that month.
Store below 30°C and store in the original container to protect from moisture.
Do not use Apclaven XL after 100 days of opening the bottle.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to
dispose of medicines no longer required. These measures will help protect the environment.
What Apclaven XL contains
The name of your medicine is Apclaven XL 37.5 mg or 75 mg or 150 mg Prolonged release capsule. It
will be referred to as Apclaven XL capsules throughout this leaflet. Each prolonged release capsule
contains either 37.5 mg or 75 mg or 150 mg venlafaxine hydrochloride as an active substance.
The other contents of the capsules are Sugar Spheres (contains sucrose), Ethyl cellulose (E462),
hydroxypropylcellulose Hypromellose (E464), Talc (E553b) Dibutyl sebacate, Oleic acid, and
Colloidal anhydrous silica.
The capsule shell contains: Gelatin, Sodium lauryl sulphate, Ponceau 4R red (E124), Quinoline yellow
(E104) and Titanium dioxide (E171) for 37.5 mg, Sunset yellow (E110), Quinoline yellow (E104) and
Titanium dioxide (E171) for 75 mg, Sunset yellow (E110), Quinoline yellow (E104), Patent blue
(E131) and Titanium dioxide (E171) for 150 mg.
Remember: This medicine is for you. Only a doctor can prescribe it for you. Never give it to someone
else. It may harm them even if their symptoms are the same as yours.
What Apclaven XL looks like and contents of the pack
Apclaven XL Prolonged release capsule is available in three strengths
37.5 mg: White to off-white pellets filled in hard gelatin capsule shells „size 3‟ with orange cap
and clear transparent body
75 mg: White to off-white pellets filled in hard gelatin capsule shells „size 1‟ with yellow cap
and clear transparent body
150 mg: White to off-white pellets filled in hard gelatin capsule shells „size 0‟ with buff cap
and clear transparent body.
Apclaven XL is available in a PVC/aluminium foil blister packs of 14, 28 or 30 capsules and in HDPE
bottles of 100 capsules.
Not all pack sizes may be marketed.
Marketing Authorisation Holder:
Aptil Pharma Limited, 9th Floor, CP House, 97-107 Uxbridge Road, Ealing, London W5 5TL
APC Pharmaceuticals & Chemicals (Europe) Limited, 9th Floor, CP House, 97-107 Uxbridge Road,
Ealing, London W5 5TL
APC Pharmaceuticals & Chemicals (Europe) Limited, 9th Floor, CP House, 97-107 Uxbridge Road,
Ealing, London W5 5TL
This leaflet was last revised in 03/2013.
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.