37.5 mg, 75 mg, and 150 mg prolonged-release hard capsules
venlafaxine
What Venlafaxine Krka is and what it is used for
Venlafaxine Krka contains the active substance venlafaxine.
Venlafaxine Krka is an antidepressant that belongs to a group of drugs called serotonin and norepinephrine reuptake inhibitors ( SNRIs ). This group of drugs is used to treat depression and other conditions such as anxiety disorders. It is believed that people who are depressed and or have anxiety have lower levels of serotonin and norepinephrine in the brain. It is not fully understood how antidepressants work, but they may help by increasing levels of serotonin and norepinephrine in the brain.
Venlafaxine Krka is a treatment for adults with depression. Venlafaxine Krka is also a treatment for adults with the following anxiety disorders: generalized anxiety, social phobia (fear of or avoidance of social situations), and panic disorder (panic attacks). It is important to treat depression or anxiety disorders properly to help you feel better. If the condition is not treated, it may not go away but become more serious and difficult to treat.
Venlafaxine contained in Venlafaxine Krka may also be approved to treat other diseases not mentioned in this leaflet. Ask your doctor, pharmacist, or another healthcare professional if you have any further questions, and always follow their instructions.
What you need to know before using Venlafaxine Krka
Do not use Venlafaxine Krka
- if you are allergic to venlafaxine or any of the other ingredients of this medicine (listed in section 6).
- if you are also taking or at any time in the last 14 days have taken any medicine called an irreversible monoamine oxidase inhibitor ( MAO inhibitor ) used to treat depression or Parkinson’s disease. Taking an irreversible MAOI together with Venlafaxine Krka can cause serious or even life-threatening side effects. In addition, you must wait at least 7 days after you stop taking Venlafaxine Krka before taking an MAO inhibitor (see also the section “Other medicines and Venlafaxine Krka” and the information in this section about serotonin syndrome).
Warnings and precautions
Talk to your doctor or pharmacist before taking Venlafaxine Krka:
- if you use other medicines which, if taken together with Venlafaxine Krka, can increase the risk of developing serotonin syndrome (see section “Other medicines and Venlafaxine Krka”)
- if you have eye problems, for example, certain types of glaucoma (increased pressure in the eye)
- if you previously had high blood pressure
- if you previously had heart problems
- if you have been told that you have an abnormal heart rhythm
- if you have previously had seizures (epileptic seizures)
- if you previously had low sodium levels in the blood ( hyponatremia )
- if you bruise easily or if you bleed easily (if you have had bleeding disorders), or if you are pregnant (see Pregnancy, breast-feeding and fertility ), or if you are taking other medicines that can increase the risk of bleeding, for example, warfarin (used to prevent blood clots)
- if your cholesterol levels rise
- if you or someone in your family has had mania or bipolar disorder (feelings of excessive excitement or euphoria )
- if you have previously had aggressive behavior
Venlafaxine Krka may cause a feeling of restlessness or inability to stand or sit still during the first weeks of treatment. Tell your doctor if this happens to you.
If you start to feel worse and have thoughts of harming yourself
You who are depressed and/or suffer from worry/anxiety may sometimes have thoughts of harming yourself or committing suicide. These thoughts can be exacerbated when you start using anti-depressant drugs, as it takes time for these types of drugs to work, usually about 2 weeks, sometimes longer. These thoughts may also occur when the dose is reduced or when treatment with Venlafaxine Krka is terminated.
These thoughts may be common:
- if you have previously had thoughts of harming yourself or committing suicide,
- if you are younger than 25 years. Studies have shown that young adults (younger than 25 years) with mental illness who are treated with antidepressants have an increased risk of suicidal thoughts and thoughts of harming themselves.
Contact a doctor or the nearest hospital immediately if you have thoughts of harming yourself or committing suicide.
It may help to tell a relative or close friend that you are depressed and/or suffering from worry/anxiety. Please ask them to read this leaflet. You can also ask them to tell you if they think you seem to be feeling worse or if they think your behavior is changing.
Sexual dysfunction
Medicines such as Venlafaxine Krka (so-called SSRI -/SNRI preparations) can cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms have persisted after discontinuation of treatment.
Dry mouth
Dry mouth has been reported in 10% of patients treated with venlafaxine. This can increase the risk of cavities in the teeth ( caries ). You should therefore be extra careful with dental hygiene.
Diabetes
Venlafaxine Krka can change your blood sugar levels. The dose of your diabetes medication may therefore need to be adjusted.
Children and young people
Venlafaxin Krka should not normally be used for the treatment of children and adolescents under the age of 18. The risk of side effects such as suicide attempts, suicidal thoughts, and hostility (mainly aggression, defiance, and anger) is greater in patients under the age of 18 when they take medicines of this type. Despite this, this medicine can be prescribed by a doctor for patients under 18 years of age, if the doctor considers it appropriate. If you are under 18 and want to discuss why you have been given this medicine, you should contact your doctor again. You should also inform your doctor if you notice any of the above symptoms or if they worsen.
The long-term effects on growth, maturation and cognitive and behavioral development have not yet been established for this drug in this age group.
Other medicines and Venlafaxine Krka
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. Your doctor will decide whether you can take Venlafaxine Krka together with other medicines.
You should not start or stop taking any medicines, including those bought without a prescription, natural and herbal medicines, before you have asked your doctor or pharmacist.
- Monoamine oxidase inhibitors, which are used to treat depression or Parkinson’s disease, must not be used together with Venlafaxine Krka. Tell your doctor if you have taken any such medicine in the last 14 days. (MAO inhibitors: see the section “What you need to know before you take Venlafaxine Krka”).
- Serotonergic syndrome: A potentially life-threatening condition or reaction similar to neuroleptic malignant syndrome (NMS), (see section “Possible side effects”) may occur during treatment with venlafaxine, especially when taken together with other drugs. Examples of such drugs include:
- triptans (used for migraines )
- other medicines to treat depression, such as SNRIs, SSRIs, tricyclic antidepressants, or medicines containing lithium
- drugs containing amphetamines (used to treat ADHD, narcolepsy, and obesity)
- 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, fentanyl, buprenorphine, tapentadol, pethidine, and pentazocine (used to treat severe pain)
- medicines containing dextromethorphan (used to treat cough)
- medicines containing methadone (used to treat opioid addiction or severe pain)
- medicines containing methylene blue (used to treat high levels of methemoglobin in the blood)
- products containing St. John’s wort (also called Hypericum perforatum, a (traditional) herbal medicine used to treat depression)
- products containing tryptophan (used for sleep problems and depression)
- antipsychotic medicines (used to treat symptoms of hearing, seeing, or feeling things that are not there, delusions, abnormal suspiciousness, confusion, and withdrawal).
Signs and symptoms of serotonin syndrome may include a combination of the following:
restlessness, hallucinations, loss of coordination, rapid heartbeat, elevated body temperature, rapid changes in blood pressure, overactive reflexes, diarrhea, coma, nausea, and 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 rate, sweating, severe muscle stiffness, confusion, and elevated muscle enzymes (determined by blood tests).
Tell your doctor immediately, or go to the nearest emergency room, if you think you have serotonin syndrome.
You must tell your doctor if you are taking medicines that can affect your heart rhythm.
Examples of these medicines are:
- antiarrhythmics eg quinidine, amiodarone, sotalol, or dofetilide (used to treat abnormal heart rhythm)
- antipsychotic drugs e.g. thioridazine (see also Serotonergic syndrome above)
- antibiotics such as erythromycin and moxifloxacin (used to treat infections caused by bacteria)
- antihistamines (used to treat allergies ).
The following medicines can also affect or be affected by ( interact ) Venlafaxine Krka and should be used with caution. You must tell your doctor or pharmacist if you are taking medicines that contain:
- ketoconazole (an antifungal medicine)
- haloperidol or risperidone (to treat psychiatric conditions)
- metoprolol (a beta blocker to treat high blood pressure and heart problems)
Venlafaxine Krka with food, drink, and alcohol
Venlafaxine Krka should be taken with a meal (see section 3 “How to take Venlafaxine Krka”).
Avoid alcohol while taking Venlafaxine Krka.
Pregnancy, breastfeeding, and fertility
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before using this medicine. Do not use Venlafaxine Krka until you have discussed the potential benefits and potential risks to your unborn baby with the doctor.
If you take Venlafaxine Krka at the end of pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have previously had bleeding disorders. The doctor or midwife should be informed that you are taking Venlafaxine Krka so that they can advise you about this.
Tell your midwife or doctor that you are using Venlafaxine Krka. When similar drugs ( SSRIs ) are used during pregnancy, the risk of a serious condition called persistent pulmonary hypertension of the newborn (PPHN) may increase. This condition causes the child to breathe faster and appear bluish. The symptoms usually appear within 24 hours of the baby being born. If this affects your child, contact your midwife or doctor immediately.
Other symptoms that your baby may have when it is born if you take this medicine during pregnancy are that the baby has breathing difficulties and does not eat properly. If your baby has these symptoms at birth and you are worried, contact the doctor and/or midwife who can give you advice.
Venlafaxine Krka passes into breast milk. There is a risk that the child will be affected. You should therefore talk to your doctor who will decide whether you should stop breastfeeding or discontinue treatment with this medicine.
Driving ability and use of machinery
Do not drive or operate machinery until you know how this medicine affects you.
You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires increased vigilance. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. A description of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. Discuss with a doctor or pharmacist if you are unsure.
Venlafaxine Krka contains sucrose
If you have an intolerance to some sugars, you should consult your doctor before taking this medicine.
How to use Venlafaxine Krka
Always take this medicine as directed by your doctor. Ask your doctor or pharmacist if you are unsure.
The usual recommended starting dose for the treatment of depression, generalized anxiety, and social phobia is 75 mg per day. The dose can be increased gradually by the doctor and if necessary up to a maximum of 375 mg per day for depression. If you are being treated for panic disorder, the doctor will start with a lower dose (37.5 mg) and then increase the dose step by step. The highest dose for generalized anxiety disorder, social phobia, and panic disorder is 225 mg daily.
Take Venlafaxine Krka at about the same time each day, either in the morning or in the evening. The capsules must be swallowed whole with liquid and must not be opened, crushed, chewed, or dissolved.
Venlafaxine Krka should be taken with a meal.
If you have liver or kidney problems, talk to your doctor as your dose of this medicine may need to be changed.
Do not stop taking this medicine without first talking to your doctor (see section “If you stop taking Venlafaxine Krka”).
If you have used too much Venlafaxine Krka
If you have ingested too much medicine, or if, for example, a child has ingested the medicine by mistake, immediately contact a doctor or hospital for an assessment of the risk and advice.
The symptoms of a possible overdose can be a rapid heartbeat, changes in the level of alertness (from drowsiness to coma ), blurred vision, convulsions, and vomiting.
If you forget to use Venlafaxine Krka
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 just take one dose as usual. Do not take a double dose to make up for a missed dose. Do not take more than the amount of Venlafaxine Krka that you have been prescribed per day.
If you stop using Venlafaxine Krka
You should not stop taking the treatment or reduce the dose without first consulting the doctor, even if you feel better. If the doctor thinks that you no longer need Venlafaxine Krka, he/she may ask you to reduce the dose slowly before stopping the treatment completely. It is known that side effects can occur when stopping this medicine, especially if you stop suddenly or if the dose is reduced too quickly. Some patients may experience symptoms such as suicidal thoughts, aggressiveness, fatigue, dizziness, intoxication, headache, insomnia, nightmares, dry mouth, loss of appetite, nausea, diarrhea, nervousness, restlessness, confusion, ringing in the ears, goosebumps or, rarely, a feeling of electric shock, weakness, sweating, seizures or flu-like symptoms, vision problems and increased blood pressure (which can cause headaches, dizziness, ringing in the ears, sweating, etc.).
The doctor will tell you how to gradually stop treatment with Venlafaxine Krka. This may take a few weeks or months. In some patients, it may need to be done gradually over several months or longer. If you experience any of these or other symptoms that bother you, consult your doctor.
If you have further questions about this medicine, contact your doctor or pharmacist.
Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
If any of the following occur, do not take more Venlafaxine Krka. Tell the doctor immediately, or go to the nearest emergency room.
Uncommon (may affect up to 1 in 100 users)
- Swelling of the face, mouth, tongue, throat, hands, or feet and/or a raised itchy rash ( hives ), difficulty swallowing or breathing.
Rare (may affect up to 1 in 1,000 users)
- Chest tightness, wheezing, difficulty swallowing, or breathing.
- Severe skin rash, itching, or hives (raised patches of red or pale skin that often itch).
- Signs and symptoms of serotonin syndrome such as restlessness, hallucinations, loss of coordination, rapid heartbeat, elevated body temperature, rapid changes in blood pressure, overactive reflexes, diarrhea, coma, nausea, and 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 rate, sweating, severe muscle stiffness, confusion, and elevated muscle enzymes (determined by blood tests).
- Signs of infection, such as fever, chills, shaking, headache, sweating, and flu-like symptoms. This may be due to a blood disorder that leads to an increased risk of infection.
- Severe rashesh can lead to severe blistering and peeling of the skin.
- Unexplained muscle pain, soreness, or weakness. This may be a sign of rhabdomyolysis.
Has been reported (occurring in an unknown number of users)
- Signs and symptoms of a condition called “stress cardiomyopathy” which may include chest pain, shortness of breath, dizziness, fainting, and irregular heartbeat.
Other side effects that you should tell your doctor are (the frequency of these side effects is included in the “Other side effects that may occur” list below):
- Coughing, wheezing and shortness of breath, may occur along with fever.
- Black (tarry) stool or blood in the stool.
- Itching, yellowish skin or yellow eyes, or dark urine, can be symptoms of an inflammation of the liver ( hepatitis ).
- Heart problems, for example, fast or irregular heart rate, and high blood pressure.
- Eye problems, such as blurred vision, and dilated pupils.
- Nerve problems, such as dizziness, tingling, and numbness, movement disorder (muscle spasms or stiffness), and seizures.
- Mental problems, such as hyperactivity and feeling unusually excited.
- Withdrawal symptoms (see section 3 “How to take Venlafaxine Krka, If you stop taking Venlafaxine Krka”).
- Prolonged bleeding – if you cut or injure yourself, it may take a little longer than usual for the bleeding to stop.
Other side effects that may occur
Very common (may affect more than 1 in 10 users)
- Dizziness, headache, drowsiness
- Insomnia
- Nausea, dry mouth, constipation
- Sweats (even at night)
Common (may affect up to 1 in 10 users)
- Loss of appetite
- Confusion, feeling detached from oneself, failure to orgasm, decreased libido, agitation, nervousness, abnormal dreams
- Tremors, a feeling of restlessness or an inability to sit or stand still, numbness and tingling, altered sense of taste, increased muscle tension
- Visual disturbances including blurred vision, dilated pupils, and inability of the eye to automatically change focus from distant to near objects
- Ringing in the ears ( tinnitus )
- Rapid heartbeat, palpitations
- Increased blood pressure, flushing
- Shortness of breath, yawning
- Vomiting, diarrhea
- Mild skin rash, itching
- Need to urinate more often than usual, inability to urinate, difficulty urinating
- Irregular periods such as increased bleeding or more irregular bleeding, abnormal ejaculation/orgasm (in men), erectile dysfunction ( impotence )
- Weakness ( asthenia ), fatigue, chills
- Weight gain, weight loss
- Elevated cholesterol level
Uncommon (may affect up to 1 in 100 users)
- Overactivity, flight of mind, and reduced need for sleep (mania)
- Hallucinations, feeling detached from reality, abnormal orgasm, lack of emotion, feeling overly excited, teeth grinding.
- Fainting, involuntary muscle movements, impaired coordination, and balance
- Dizziness (especially if you get up too quickly), decreased blood pressure
- Vomiting blood, black tarry stools, or blood in the stool, which may indicate internal bleeding
- Sensitivity to sunlight, bruising, abnormal hair loss
- Inability to control urine
- Stiffness, spasms, and involuntary muscle movements
- Some changes in the liver enzyme levels in the blood
Rare (may affect up to 1 in 1,000 users)
- Seizures
- Coughing, wheezing, and shortness of breath, which may occur along with fever
- Altered spatial perception and confusion, often combined with hallucinations ( delirium )
- Excessive fluid intake (so-called SIADH)
- Decreased sodium levels in the blood
- Severe pain in the eyes and impaired or blurred vision
- Abnormal, fa,st or irregular heartbeat, which can lead to fainting
- Severe pain in the stomach or back (which may indicate a serious disease in the abdomen, liver, or pancreas)
- Itching, yellow skin or eyes, dark urine, or flu-like symptoms, which are signs of liver inflammation ( hepatitis )
Very rare (may affect up to 1 in 10,000 users)
- Prolonged bleeding may be a sign of a reduced number of platelets in the blood, leading to an increased risk of bruising or bleeding
- Abnormal production of breast milk
- Unexpected bleeding, such as bleeding gums, blood in the urine or bloody vomit, or the appearance of unexpected bruises or burst blood vessels
Has been reported (occurring in an unknown number of users)
- Suicidal thoughts and suicidal tendencies, cases of suicidal thoughts and suicidal tendencies have been reported during treatment with venlafaxine or immediately after stopping treatment (see section 2, What you need to know before you take Venlafaxine Krka)
- Heavy vaginal bleeding soon after giving birth ( postpartum hemorrhage), see “Pregnancy, breast-feeding and fertility” in section 2 for more information
- Aggression
- Dizziness
Venlafaxine Krka sometimes causes side effects that you may not be aware of, such as increased blood pressure or abnormal heartbeats, small changes in blood levels of liver enzymes, sodium, or cholesterol. In rare cases, Venlafaxine Krka can affect the function of the platelets (thrombocytes) in the blood, leading to an increased risk of bruising or bleeding. Therefore, the doctor may want to take blood samples from time to time, especially if you have been taking Venlafaxine Krka for a long time.
How to store Venlafaxine Krka
Keep this medicine out of the sight and reach of children.
Use before the expiry date stated on the packaging after “EXP”.
The expiration date is the last day of the specified month.
No special storage instructions.
Medicines must not be thrown into the drain or among the household waste. Ask the pharmacist how to dispose of medicines that are no longer used. These measures will help to protect the environment.
Contents of the packaging and other information
Contents declaration
The active substance is venlafaxine. Each prolonged-release hard capsule contains 37.5 mg, 75 mg, or 150 mg of venlafaxine as venlafaxine hydrochloride.
Other ingredients in the capsule contents are sugar spheres (sucrose, corn starch), hydroxypropyl cellulose (E463), povidone K 30 (E1201), ethyl cellulose, dibutyl sebacate and talc (E553B).
Other ingredients in the capsule shell are gelatin, red iron oxide (E172), titanium dioxide (E171), and yellow iron oxide (E172) (only in 75 mg and 150 mg capsules). See section 2 ” Venlafaxine Krka contains sucrose”.
Appearance and package sizes of the medicine
37.5 mg prolonged-release hard capsules: brown-pink and white (bottom: white, top: brown-pink) capsules filled with whitish granules.
75 mg hard prolonged-release capsules: light pink capsules filled with whitish grains.
150 mg hard prolonged-release capsules: brick-red capsules filled with whitish grains.
Package sizes:
Cartons containing 7 (37.5 mg only), 10, 14, 20, 28, 30, 50, 60, 98, 100 or 112 hard prolonged-release capsules in blister cards.
Cartons containing 50, 100, or 250 hard depot capsules in HDPE child-resistant cans.
Not all pack sizes may be marketed.
KRKA, dd, Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia