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VIEPAX XL 150 MG PROLONGED RELEASE TABLETS
Active substance(s): VENLAFAXINE HYDROCHLORIDE
ViePax® XL 75 mg PROLONGED-RELEASE TABLETS
ViePax® XL 150 mg PROLONGED-RELEASE TABLETS
IMPORTANT THINGS YOU SHOULD KNOW
ABOUT ViePax XL
Please read all of this leaflet before you start to take
your medicine as it contains important information
about ViePax XL.
ViePax XL is used to treat depression, severe
and persistent anxiety known as generalised
anxiety disorder (GAD), social anxiety disorder
(also known as social phobia) and panic
disorder (panic attacks).
ViePax XL is not for use in children and
adolescents – see in section 2 'Children and
ViePax XL may not start to work immediately.
Some people taking antidepressants may feel
worse before feeling better. Your doctor may ask to
see you again in a couple of weeks after you start
treatment and then regularly until you start to feel
well again. Tell your doctor if you do not start to
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
you first start taking 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
yourself or harming yourself.
• If you are a young adult. Information from clinical
trials has shown an increased risk of suicidal
behaviour in young adults (less than 25 years
old) with psychiatric conditions who were treated
with an antidepressant.
If you have thoughts of harming or killing yourself
at any time, contact your doctor or go to a hospital
Some people who are depressed may think of
harming or killing themselves. If this happens
you should see your doctor or go to a hospital
straight away – see in section 2 'Thoughts of
suicide and worsening of your depression or
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.
If you take too many tablets it is important to
seek immediate medical attention, even if you
feel well, because of the risk of serious side
Dry mouth is reported in 10% of patients treated
with venlafaxine. This may increase the risk of
tooth decay (caries). Therefore, you should take
special care in your dental hygiene.
If you have any concerns about how you feel, or
about this medication, it is important that you
talk to your doctor – even if you feel anxious or
worried about doing so. You may find it helpful
to tell a friend or relative that you are depressed
or suffering from an anxiety disorder, and that you
have been prescribed this medication; it might be
useful to show them this leaflet.
Do not stop taking ViePax XL or change your
dose without the advice of your doctor even
if you feel better. If you stop taking ViePax XL
abruptly you may get withdrawal reactions – see in
section 3 'If you stop taking ViePax XL'.
If you have heart problems such as fast or
irregular heart rate or high blood pressure you
should talk to your doctor before taking Viepax
XL – see in section 2 'Before you take ViePax XL'.
Taking certain other medicines with ViePax
XL may cause problems. You should tell your
doctor if you are taking any other medicines –
see in section 2 'What you need to know before you
take ViePax XL'.
See your doctor without delay if you feel restless
and feel like you can't keep still, feel 'high' or very
over-excited, have jerky muscle movements which
you can't control. See section 4 'Possible side
effects' for other important information.
If you are pregnant, or intend to become
pregnant, or breast-feeding, you should talk
to your doctor – see in section 2 'Pregnancy and
More information on all of these points is provided
in the rest of this leaflet. Read all of this leaflet
carefully before you start taking this medicine
because it contains important information for
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor
• This medicine has been prescribed for you only.
Do not pass it on to others. It may harm them,
even if their signs of illness are the same as
• If you get any side effects, talk to your doctor
or pharmacist. This includes any possible side
effects not listed in this leaflet. See section 4.
What is in this leaflet:
1. What ViePax XL is and what it is used for
2. What you need to know before you take ViePax
3. How to take ViePax XL
4. Possible side effects
5. How to store ViePax XL
6. Contents of the pack and other information
1. WHAT ViePax XL IS AND WHAT IT IS USED FOR
that may increase the risk of bleeding e.g.,
warfarin (use to prevent blood clots).
• If your cholesterol levels get higher.
• 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.
ViePax XL may cause a sensation of restlessness
or an inability to sit or stand still during the first few
weeks of treatment. You should tell your doctor if
this happens to you.
The name of your medicine is ViePax XL 75 mg
or ViePax XL 150 mg Prolonged-release Tablets
(referred to as ViePax XL throughout this leaflet).
ViePax XL contains the active substance
ViePax XL is an antidepressant that belongs
to a group of medicines called serotonin and
norepinephrine reuptake inhibitors (SNRIs). This
group of medicines is used to treat depression
and other conditions such as anxiety disorders.
It is thought that people who are depressed and/
or anxious have lower levels of serotonin and
noradrenaline in the brain. It is not fully understood
how antidepressants work, but they may help by
increasing the levels of serotonin and noradrenaline
in the brain.
ViePax XL is a treatment for adults with depression.
ViePax XL 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
2. WHAT YOU NEED TO KNOW BEFORE YOU
TAKE ViePax XL
Do not take ViePax XL
• If you are allergic to venlafaxine or any of the
other ingredients of ViePax XL (section 6 contains
a full list).
• If you are also taking, or have taken 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 ViePax XL,
can cause serious or even life-threatening side
effects. Also, you must wait at least 7 days after
you stop taking ViePax XL before you take
any MAOI (see also the section entitled “Other
medicines and ViePax XL” and the information in
that section about “Serotonin syndrome”).
Warnings and precautions
If any of the following apply to you, please tell your
doctor before taking ViePax XL:
• If you use other medicines that, if taken
concomitantly with ViePax XL, could increase the
risk of developing serotonin syndrome (see the
section “Other medicines and ViePax XL”).
• 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 been told you have an abnormal heart
• If you have a history of fits (seizures).
• If you have a history of low sodium levels in your
• 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
Your blood glucose levels may be altered due to
ViePax XL. Therefore, the dosage of your diabetes
medicines may need to be adjusted.
Children and adolescents
ViePax 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 ViePax XL for patients under 18
because he/she decides that this is in their best
interests. If your doctor has prescribed ViePax 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 ViePax XL. Also, the long-term safety effects
concerning growth, maturation and cognitive and
behavioural development of ViePax XL in this age
group has not yet been demonstrated.
Other medicines and ViePax XL
Please tell your doctor or pharmacist if you
are taking or have recently taken any other
medicines, including medicines obtained without a
Do not start or stop taking any medicines,including
those bought without a prescription, natural and
herbal remedies, before checking with your doctor
Your doctor should decide whether you can take
ViePax XL with other medicines, such as:
• Monoamine oxidase inhibitors which are used
to treat depression or Parkinson’s disease must
not be taken with ViePax XL. Tell your doctor if
you have taken these medicines within the last 14
days. (MAOIs: see the section “What you need to
know before you take ViePax XL”).
• Products associated with serotonin syndrome:
A potentially life‑threatening condition or
Neuroleptic Malignant Syndrome (NMS)like reactions (see the section “Possible Side
Effects”), may occur with venlafaxine treatment,
particularly when taken with other medicines.
Examples of these medicines include:
• Triptans (used for migraine)
• Other 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
• Medicines containing tramadol (a pain‑killer),
fentanyl, tapentadol, pethidine, or pentazocine
(used to treat severe pain)
• Medicines containing dextromethorphan (used to
• Medicines containing methadone (used to treat
opioid drug addiction or severe pain)
• Medicines containing methylene blue (used to
treat high levels of methaemoglobin in the blood)
• 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)
• Antipsychotics (used to treat a disease with
symptoms such as hearing, seeing or sensing
things which are not there, mistaken beliefs,
unusual suspiciousness, unclear reasoning and
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.
In its most severe form, serotonin syndrome
can resemble Neuroleptic Malignant Syndrome
(NMS). Signs and symptoms of NMS may include
a combination of fever, fast heart beat, sweating,
severe muscle stiffness, confusion, increased
muscle enzymes (determined by a blood test).
Tell your doctor immediately, or go to the
casualty department at your nearest hospital
if you think serotonin syndrome is happening
You must tell your doctor if you are taking medicines
that can affect your heart rhythm.
Examples of these medicines include:
• Antiarrhythmics such as quinidine, amiodarone,
sotalol or dofetilide (used to treat abnormal heart
• Antipsychotics such as thioridazine (See also
Serotonin syndrome above)
• Antibiotics such as erythromycin or moxifloxacin
(used to treat bacterial infections)
• Antihistamines (used to treat allergy)
The following medicines may also interact with
ViePax 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
• Metoprolol (a beta blocker to treat high blood
pressure and heart problems)
• Oral contraceptives
Taking ViePax XL with food and drink
ViePax XL should be taken with food (see section
3 “How to take ViePax XL”).
You should avoid alcohol while you are taking
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you
may be pregnant or are planning to have a baby,
ask your doctor or pharmacist for advice before
taking this medicine. You should use ViePax XL
only after discussing the potential benefits and
the potential risks to your unborn child with your
Make sure your midwife and/or doctor know you
are on ViePax XL. When taken during pregnancy,
similar drugs (SSRIs) may increase the risk of
a serious condition in babies, called persistent
pulmonary hypertension of the newborn (PPHN),
making the baby breathe faster and appear bluish.
These symptoms usually begin during the first 24
hours after the baby is born. If this happens to
your baby you should contact your midwife and/or
If you are taking ViePax XL during pregnancy,other
symptoms your baby might have when it is born is
not feeding properly, in addition to having trouble
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
ViePax 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 ViePax XL.
Driving and operating machinery
Venlafaxine can cause impaired judgement,
thinking, and movement and coordination as well
as problems with vision. If you are affected by any
of these you should not drive, operate machinery
or take part in any activities where such effects
could put you or others at risk.
3. HOW TO TAKE ViePax XL
Always take ViePax 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 225 mg/day.
Take ViePax XL at approximately the same time
each day, either in the morning or in the evening.
The tablets must be swallowed whole with fluid and
not crushed, divided, chewed or dissolved.
ViePax XL should be taken with food.
If you have liver or kidney problems, talk to your
doctor, since your dose of ViePax XL may need to
Do not stop taking ViePax XL without talking to
your doctor (see the section “If you stop taking
If you take more ViePax XL than you should
Call your doctor or pharmacist immediately if you
take more than the amount of ViePax XL prescribed
by your doctor.
The symptoms of a possible overdose may include
a rapid heart beat, changes in level of alertness
(ranging from sleepiness to coma), blurred vision,
seizures or fits, and vomiting.
If you forget to take ViePax 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 ViePax
XL that has been prescribed for you in one day.
If you stop taking ViePax 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 ViePax 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 ViePax XL, especially when ViePax 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 ViePax 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.
4. POSSIBLE SIDE EFFECTS
Like all medicines, ViePax XL can cause side
effects, although not everybody gets them.
If any of the following happen, do not take more
ViePax XL. Tell your doctor immediately, or go
to the casualty department at your nearest
Uncommon (may affect up to 1 in 100 people)
• Swelling of the face, mouth, tongue, throat,
hands, or feet and/or a raised itchy rash (hives),
trouble swallowing or breathing
Rare (may affect up to 1 in 1,000 people)
• Chest tightness, wheezing, trouble swallowing or
• Severe skin rash, itching, or hives (elevated
patches of red or pale skin that often itch)
• Chest tightness, wheezing, trouble swallowing or
• Severe rash, itching, or hives (elevated patches
of red or pale skin that often itch)
• Signs and symptoms of serotonin syndrome
which may include restlessness, hallucinations,
loss of coordination, fast heart beat, increased
body temperature, fast changes in blood
pressure, overactive reflexes, diarrhoea, coma,
nausea, vomiting. In its most severe form,
serotonin syndrome can resemble Neuroleptic
Malignant Syndrome (NMS). Signs and
symptoms of NMS may include a combination of
fever, fast heart beat, sweating, severe muscle
stiffness, confusion, increased muscle enzymes
(determined by a blood test).
• Signs of infection, such as high temperature,
chills, shivering, headaches, sweating, flu-like
symptoms. This may be the result of a blood
disorder which leads to an increased risk of
• Severe rash, which may lead to severe blistering
and peeling of the skin.
• Unexplained muscle pain, tenderness or
weakness. This may be a sign of rhabdomyolysis.
Other side effects that you should tell your doctor
about include (The frequency of these side effects
are included in the list “Other side effects that may
• Coughing, wheezing, shortness of breath which
may be accompanied by a high temperature
• Black (tarry) stools or blood in stools
• Itchiness, yellow skin or eyes, or dark urine,
which may be symptoms of inflammation of the
• Heart problems, such as fast or irregular heart
rate, increased blood pressure
• Eye problems, such as blurred vision, dilated
• Nerve problems, such as dizziness, pins and
needles, movement disorder (muscle spasms or
stiffness), seizures or fits
• Psychiatric problems, such as hyperactivity and
euphoria (feeling unusually overexcited)
• Withdrawal effects (see the section “How to take
ViePax XL, if you stop taking ViePax XL”).
• Prolonged bleeding – if you cut or injure yourself,
it may take slightly longer than usual for bleeding
Other side effects that may occur
Very common: may affect more than 1 in 10
• dizziness; headache, drowsiness
• nausea; dry mouth, constipation
• sweating (including night sweats)
Common: may affect up to 1 in 10 people
• appetite decreased
• confusion; feeling separated (or detached)
from yourself; lack of orgasm; decreased libido;
nervousness; abnormal dreams
• tremor; a sensation of restlessness or an inability
to sit or stand still; pins and needles; altered taste
sensation; increased muscle tonus
• visual disturbance including blurred vision;
dilated pupils; inability of the eye to automatically
change focus from distant to near objects
• ringing in the ears (tinnitus)
• fast heartbeat; palpitations
• increase in blood pressure; flushing
• shortness of breath; yawning
• vomiting; diarrhoea
• increased frequency in urination; inability to pass
urine; difficulties passing urine
• menstrual irregularities such as increased
bleeding or increased irregular bleeding;
abnormal ejaculation/orgasm (males); erectile
• weakness (asthenia); fatigue; chills
• weight gain; weight loss
• increased cholesterol
Uncommon: may affect up to 1 in 100 people
• over activity, racing thoughts and decreased
need for sleep (mania)
• hallucinations; feeling separated (or detached)
from reality; abnormal orgasm ; lack of feeling
or emotion; feeling over-excited; grinding of the
• fainting; involuntary movements of the muscles;
impaired coordination and balance
• feeling dizzy (particularly when standing up too
quickly); decrease in blood pressure
• vomiting blood, black tarry stools (faeces) or
blood in stools; which can be a sign of internal
• sensitivity to sunlight; bruising; abnormal hair
• inability to control urination
• stiffness, spasms and involuntary movements of
• slight changes in blood levels of liver enzymes
Rare: may affect up to 1 in 1,000 people
• seizures or fits
• coughing, wheezing and shortness of breath
which may be accompanied by a high temperature
• disorientation and confusion often accompanied
by hallucination (delirium)
• excessive water intake (known as SIADH)
• decrease in blood sodium levels
• severe eye pain and decreased or blurred vision
• abnormal, rapid or irregular heartbeat, which
could lead to fainting
• severe abdominal or back pains (which could
indicate a serious problem in the gut, liver or
• itchiness, yellow skin or eyes, dark urine, or
flu-like symptoms, which are symptoms of
inflammation of the liver (hepatitis)
Very rare (may affect up to 1 in 10,000 people)
• prolonged bleeding, which may be a sign of
reduced number of platelets in your blood, leading
to an increased risk of bruising or bleeding
• abnormal breast milk production
• unexpected bleeding, e.g. bleeding gums, blood
in the urine or in vomit, or the appearance of
unexpected bruises or broken blood vessels
Frequency not known (cannot be estimated
from the available data)
• suicidal ideation and suicidal behaviours; cases
of suicidal ideation and suicidal behaviours have
been reported during venlafaxine therapy or early
after treatment discontinuation (see section 2,
What you need to know before you take ViePax
ViePax 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, ViePax 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 ViePax 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.
Reporting of side effects
If you get any side effects, talk to your doctor or
pharmacist. This includes any possible side effects
not listed in this leaflet. You can also report side
effects directly via the Yellow Card Scheme at
www.mhra.gov.uk/yellowcard. By reporting side
effects you can help provide more information on
the safety of this medicine.
5. HOW TO STORE ViePax XL
Keep out of the reach and sight of children.
Do not use ViePax XL after the expiry date, which
is stated on the packaging.
This medicinal product does not require any
special storage conditions.
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 to protect the environment.
6. CONTENTS OF THE PACK AND OTHER
What ViePax XL contains
The active substance is venlafaxine.
Each tablet contains 75 mg or 150 mg venlafaxine
as venlafaxine hydrochloride.
Other ingredients in these tablets are: microcrystalline
cellulose, hypromellose, ethylcellulose, magnesium
stearate, silica colloidal anhydrous, dibutyl sebacate
and macrogol 400. ViePax XL 150 mg Tablets also
contain carnauba wax.
What ViePax XL looks like and contents of the
ViePax XL 75 mg and ViePax XL 150 mg are white,
convex, capsule-shaped coated tablets.
ViePax XL 75 mg and ViePax XL 150 mg come in
calendar packs of 28 tablets.
Marketing Authorisation Holder and
DEXCEL® - PHARMA LTD., 7 Sopwith Way,
Drayton Fields, Daventry, Northamptonshire,
NN11 8PB, UK.
This leaflet was last revised in August 2016
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.