RX Medications

Provider check-ins, prescription medication for anxiety and depression (if appropriate), and pre-filmed Virtual Sessions.

Prescription medication

Ro Mind features provider check-ins, prescription medication for anxiety and depression (if appropriate), and pre-filmed Virtual Sessions. Your healthcare provider will work with you to determine the most effective treatment plan. Prescription medication for anxiety and depression can take 4–6 weeks to begin working, and it is not uncommon to try multiple different medications and have dosage adjustments before finding the one that's best for you.

Fluoxetine

Generic for Prozac

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) medication that is used in the treatment of depression.

Sertraline

Generic for Zoloft

Sertraline is a selective serotonin reuptake inhibitor (SSRI) medication that is used in the treatment of depression.

Escitalopram

Generic for Lexapro

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) medication that is used in the treatment of anxiety and depression.

Duloxetine

Generic for Cymbalta

Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) medication that is used in the treatment of anxiety and depression.

Venlafaxine ER

Generic for Effexor XR

Venlafaxine ER is a serotonin-norepinephrine reuptake inhibitor (SNRI) medication that is used in the treatment of anxiety and depression.

Mirtazapine

Generic for Remeron

Mirtazapine is an atypical antidepressant medication that is used in the treatment of depression.

Bupropion SR

Generic for Wellbutrin SR (Sustained-Release)

Bupropion SR is an atypical antidepressant medication that is used in the treatment of depression.

Bupropion XL

Generic for Wellbutrin XL (Extended-Release)

Bupropion XL is an atypical antidepressant medication that is used in the treatment of depression.

Buspirone

Generic for BuSpar

Buspirone is an anxiolytic medication that is used in the treatment of anxiety.

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Important Safety Information for Bupropion Sustained-Release (SR)

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of bupropion SR?

Bupropion SR is an aminoketone antidepressant used to treat Major Depressive Disorder (MDD). It is also categorized as a norepinephrine-dopamine reuptake inhibitor (NDRI).

Who should not use bupropion SR?

Do not use bupropion SR if:

  • You have had seizures in the past or have been diagnosed with a seizure disorder.
  • You have a current or prior diagnosis of bulimia or anorexia nervosa.
  • You have abruptly discontinued alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. When MAOIs are used at the same time as bupropion, there is an increased risk of very high blood pressure levels which can lead to a medical emergency.
  • You have a known allergic reaction to bupropion hydrochloride.
How should I take bupropion SR?

You can take bupropion SR with or without food. The tablet should be swallowed whole and not crushed, split, or chewed.

You should take bupropion SR exactly as prescribed, and continue to take bupropion SR as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking bupropion SR without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using bupropion SR?
  • Bupropion SR contains the active ingredient bupropion. It is the same active ingredient that is found in medications called Wellbutrin, Wellbutrin SR, Wellbutrin XL, Aplenzin, Zyban, or Forfivo XL. Tell your provider if you are taking one of these medications.
  • Bupropion SR has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.
  • Bupropion SR has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • Antipsychotics, such as risperidone (Risperdal) and haloperidol (Haldol)
  • Other antidepressants, including SSRIs and SNRIs
  • Theophylline (Elixophyllin)
  • Corticosteroids, such as prednisone
  • Drugs used to treat Parkinson’s Disease called levodopa and amantadine
  • Digoxin (Digox)
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • Liver problems
  • Kidney problems
  • If you are a smoker and/or you’re trying to quit smoking
  • Alcohol or opiate abuse
  • Diabetes
  • Eating disorders
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if bupropion SR should be used during pregnancy and while breastfeeding.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking bupropion SR?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with bupropion SR. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Smoking Cessation: Some people have had serious side effects while taking bupropion to help them quit smoking (known as the brand name drug Zyban). These side effects include new or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depression, or suicidal thoughts or actions. If you are thinking of quitting smoking, talk to your provider before you start taking bupropion.
  • Risk of seizure: Bupropion SR can cause seizure and the chance of seizure is related to too high of a dose of bupropion SR. Tell your provider about any past history of seizure, all medical history, and any other medications you are taking.
  • Increase in blood pressure: Bupropion SR can increase blood pressure. Your blood pressure should be well controlled prior to starting treatment. The chance of high blood pressure may be higher if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking. Your provider will monitor your blood pressure regularly. Consider monitoring your blood pressure at home.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Psychosis and other neuropsychiatric reactions: Depressed patients treated with bupropion SR have had a variety of neuropsychiatric signs and symptoms, including delusions, hallucinations, psychosis, concentration disturbance, paranoia, and confusion. Some of these patients had a diagnosis of bipolar disorder. Monitor for these signs and symptoms and tell your provider right away if these reactions occur.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Allergic Reactions, some severe: Discontinue bupropion SR if you develop an allergic or anaphylactic reaction including skin rash, itching, hives, chest pain, swelling, and shortness of breath.
  • Cognitive and Motor Impairment: Bupropion SR may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected.
  • Alcohol Use: Limit or avoid using alcohol while taking bupropion SR. If you usually drink a lot of alcohol, talk with your provider first before suddenly stopping. If you suddenly stop drinking alcohol, you may increase your chance of having seizures.
What are the most common side effects of bupropion SR?
  • Agitation
  • Headache
  • Dizziness
  • Nausea, vomiting
  • Constipation
  • Tremor
  • Sweating
  • Dry mouth
  • Sore throat
  • Insomnia, trouble sleeping
  • A rapid or irregular heartbeat
  • Loss of appetite, weight loss

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Fluoxetine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What is the FDA-approved use of fluoxetine?

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for acute and maintenance treatment of Major Depressive Disorder (MDD).

Who should not use fluoxetine?

Do not use fluoxetine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide or thioridazine. Taking these medications with fluoxetine can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
How should I take fluoxetine?

You can take fluoxetine with or without food.

You should take fluoxetine exactly as prescribed, and continue to take fluoxetine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking fluoxetine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using fluoxetine?
  • Fluoxetine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.
    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • NSAIDs, such as ibuprofen or naproxen
  • Aspirin
  • Blood thinners, such as warfarin (Coumadin)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • Benzodiazepines, such as diazepam and alprazolam
  • Other or SSRIs or SNRIs, such as sertraline (Zoloft)
  • Tamoxifen
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • Irregular heartbeat or heart issues
  • Bipolar Disorder
  • Glaucoma or eye problems
  • Diabetes
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if fluoxetine should be used during pregnancy. There have been reports of fluoxetine passing into breast milk. Talk to your provider about the best way to feed your baby while taking fluoxetine.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking fluoxetine?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with fluoxetine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when fluoxetine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Allergic Reactions and Rash: Tell your provider if you develop a rash or hives. Discontinue use of fluoxetine and seek emergency care immediately if you have a severe allergic reaction. Signs and symptoms of a severe allergic reaction include swelling of the face, eyes, or mouth, or having trouble breathing.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Fluoxetine may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Cognitive and Motor Impairment: Fluoxetine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take fluoxetine.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
What are the most common side effects of fluoxetine?
  • Sweating
  • Headache
  • Tremor
  • Nausea, diarrhea
  • Dry mouth
  • Nervousness, anxiety
  • Lack of appetite, weight loss
  • Lack of energy, or feeling generally weak
  • Change in sleep habits, including insomnia or increased sleepiness
  • Sexual problems, including decreased sex drive, erectile dysfunction, or trouble ejaculating

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Sertraline

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What is the FDA-approved use of sertraline?

Sertraline is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of Major Depressive Disorder (MDD).

Who should not use sertraline?

Do not use sertraline if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide. Taking this medication with sertraline can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
  • You have a known allergic reaction to sertraline.
How should I take sertraline?

You can take sertraline with or without food.

You should take sertraline exactly as prescribed, and continue to take sertraline as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking sertraline without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using sertraline?
  • Sertraline has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • NSAIDs, such as ibuprofen or naproxen
  • Aspirin
  • Blood thinners, such as warfarin (Coumadin)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • Other SSRIs or SNRIs, such as fluoxetine (Prozac)
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Liver problems
  • Irregular heartbeat or heart problems
  • Stroke
  • High blood pressure
  • Seizures
  • Glaucoma or eye problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if sertraline should be used during pregnancy or while breastfeeding.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking sertraline?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with sertraline. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when sertraline is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Increased risk of bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Sertraline may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Cognitive and Motor Impairment: Fluoxetine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take sertraline.
What are the most common side effects of sertraline?
  • Agitation
  • Anxiety
  • Increased sweating
  • Tremor or shaking
  • Feeling tired or fatigued
  • Nausea, loss of appetite, diarrhea, or indigestion
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Escitalopram

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of escitalopram?

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for:

  • Acute and Maintenance Treatment of Major Depressive Disorder (MDD)
  • Acute Treatment of Generalized Anxiety Disorder (GAD)
Who should not use escitalopram?

Do not use escitalopram if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You are taking a medication called pimozide. Taking this medication with escitalopram can increase the risk of prolonged QT interval, which is a potentially dangerous change to the electrical signals that make your heart beat.
  • You have a known allergic reaction to escitalopram.
How should I take escitalopram?

You can take escitalopram with or without food.

You should take escitalopram exactly as prescribed, and continue to take escitalopram as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking escitalopram without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using escitalopram?
  • Escitalopram has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • NSAIDs, such as ibuprofen or naproxen
  • Aspirin
  • Blood thinners, such as warfarin (Coumadin)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft) or citalopram (Celexa)
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • Heart problems
  • Glaucoma or eye problems
  • Liver problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if escitalopram should be used during pregnancy. There have been reports of escitalopram passing into breast milk. Talk to your provider about the best way to feed your baby while taking escitalopram.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking escitalopram?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with escitalopram. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when escitalopram is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Escitalopram may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, or blood thinners such as warfarin (Coumadin).
  • Cognitive and Motor Impairment: escitalopram may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while taking escitalopram.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
What are the most common side effects of escitalopram?
  • Insomnia
  • Headache
  • Decreased libido
  • Nausea, diarrhea
  • Increased sweating
  • Fatigue and drowsiness
  • Difficulty sleeping, insomnia
  • Difficulty reaching orgasm, or abnormal ejaculation

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Duloxetine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of duloxetine?

Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SSRI) used for:

  • Acute and Maintenance Treatment of Major Depressive Disorder (MDD)
  • Generalized Anxiety Disorder (GAD)
Who should not use duloxetine?

Do not use duloxetine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. Taking an MAOI at the same time as duloxetine may increase the risk of serotonin syndrome.
How should I take duloxetine?

You can take duloxetine with or without food.

You should take duloxetine exactly as prescribed, and continue to take duloxetine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking duloxetine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using duloxetine?
  • Duloxetine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include
  • Monoamine oxidase inhibitors (MAOIs)
  • NSAIDs, such as ibuprofen or naproxe
  • Aspirin
  • Blood thinners, such as warfarin (Coumadin)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft) or citalopram (Celexa)
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Liver problems
  • Heavy alcohol use
  • Kidney problems
  • Seizures
  • Heart problems
  • Glaucoma or eye problems
  • Diabetes
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI use, particularly later in pregnancy, may increase risk of complications in the newborn. Use of duloxetine during the month before delivery may lead to an increased risk for postpartum hemorrhage. You should discuss with your provider if duloxetine should be used during pregnancy. There have been reports of duloxetine passing into breast milk. Talk to your provider about the best way to feed your baby while taking duloxetine.

    There is a pregnancy exposure registry that monitors the pregnancy outcomes in women exposed to duloxetine during pregnancy. To enroll, contact the Cymbalta (duloxetine) Pregnancy Registry at 1-866-814-6975 or https://lillypregnancyregistry.com/

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking duloxetine?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with duloxetine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Liver Failure: Severe liver problems, sometimes fatal, have been reported with duloxetine. Talk to your provider if you develop itching, right upper belly pain, dark urine, or yellow skin/eyes, which may be signs of liver problems. Heavy alcohol consumption may be associated with severe liver injury.
  • Decrease in blood pressure when standing up, falls, and fainting: Monitor especially during the beginning of treatment and with any dose increases. Your provider may consider lowering your dosage.
  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when duloxetine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Duloxetine may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, and warfarin. A post-marketing study showed a higher incidence of postpartum hemorrhage in mothers taking duloxetine.
  • Severe Skin Reactions: These skin reactions may need to be treated in a hospital and may be life-threatening. Call your provider right away or get emergency help if you have skin blisters, peeling rash, sores in your mouth, hives, or any other allergic reactions.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
What are the most common side effects of duloxetine?
  • Agitation
  • Headache
  • Dry mouth
  • Fast heartbeat
  • Nausea, vomiting
  • Increased sweating
  • Constipation, diarrhea
  • Decreased appetite, weight loss
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Venlafaxine Extended-Release

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of venlafaxine extended-release?

Venlafaxine extended-release is a serotonin and norepinephrine reuptake inhibitor (SNRI) for the treatment of:

  • Major Depressive Disorder (MDD)
  • Generalized Anxiety Disorder (GAD)
Who should not use venlafaxine extended-release?

Do not use venlafaxine extended-release if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. MAOIs may increase the risk of serotonin syndrome.
  • You have a known allergic reaction to venlafaxine hydrochloride or desvenlafaxine succinate.
How should I take venlafaxine extended-release?

You should take venlafaxine extended-release with food.

You should take venlafaxine extended-release exactly as prescribed, and continue to take venlafaxine extended-release as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking venlafaxine extended-release without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using venlafaxine extended-release?
  • Venlafaxine extended-release has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic Antidepressants (TCAs)
  • NSAIDs, such as ibuprofen or naproxen
  • Aspirin
  • Blood thinners, such as warfarin (Coumadin)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • Other antidepressants, including SSRIs or SNRIs such as sertraline (Zoloft)
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • High blood pressure
  • High cholesterol
  • Heart problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. SSRI or SNRI use, particularly later in pregnancy, may increase risk of complications in the newborn. You should discuss with your provider if venlafaxine extended-release should be used during pregnancy. Some venlafaxine extended-release may pass into breast milk. Talk to your provider about the best way to feed your baby while taking venlafaxine extended-release.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking venlafaxine extended-release?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with venlafaxine extended-release. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when venlafaxine extended-release is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Increases in blood pressure: Your blood pressure should be well controlled prior to starting treatment. Your provider will monitor your blood pressure regularly. Consider monitoring your blood pressure at home.
  • Abnormal Bleeding: Tell your provider if you experience any increased or unusual bruising, bleeding, or nose bleed. Venlafaxine extended-release may increase the risk of bleeding when taken with NSAIDs (such as ibuprofen or naproxen), aspirin, warfarin, and other anticoagulants.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Cognitive and Motor Impairment: Venlafaxine extended-release may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. Do not drink alcohol while you take venlafaxine extended-release.
  • Lung Disease and Inflammation (Pneumonitis): Venlafaxine extended-release may cause rare lung problems. Monitor for symptoms such as worsening shortness of breath, cough, or chest discomfort.
What are the most common side effects of venlafaxine extended-release?
  • Tremor
  • Headache
  • Dizziness
  • Nervousness
  • Constipation
  • Dry mouth
  • Nausea, vomiting
  • Abnormal dreams
  • Decreased appetite, weight loss
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including abnormal ejaculation, erectile dysfunction, or decreased sex drive

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Mirtazapine

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What is the FDA-approved use of mirtazapine?

Mirtazapine is used to treat Major Depressive Disorder (MDD).

Who should not use mirtazapine?

Do not use mirtazapine if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. When MAOIs are used at the same time as mirtazapine, it may increase the risk of serotonin syndrome.
  • You have a known allergic reaction to mirtazapine.
How should I take mirtazapine?

You can take mirtazapine with or without food.

You should take mirtazapine exactly as prescribed, and continue to take mirtazapine as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking mirtazapine without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using mirtazapine?
  • Mirtazapine has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • Tricyclic Antidepressants (TCAs)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • SSRIs or SNRIs, such as fluoxetine (Prozac)
  • St. John’s Wort
  • Warfarin (Coumadin)
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • Irregular heartbeat or heart problems
  • High cholesterol or triglyceride levels
  • Liver problems
  • Kidney problems
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if mirtazapine should be used during pregnancy and while breastfeeding.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking mirtazapine?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with mirtazapine. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Decreased levels of a type of white blood cell (agranulocytosis): Mirtazapine may put you at risk for a condition that prevents your body from fighting off infections. If you experience fever, chills, sore throat, mouth sores, or flu-like symptoms, you should stop taking mirtazapine and contact your provider.
  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of an SSRI or SNRI at once or when mirtazapine is taken along with other drugs that increase the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • QT Prolongation: Tell your provider right away if you experience fast, slow, or irregular heart rate, shortness of breath, fainting, or dizziness, which may indicate serious cardiac arrhythmia.
  • Feeling sleepy or drowsy: Mirtazapine may make you drowsy or sleepy so taking it in the evening prior to sleep is recommended. Talk to your provider about the best time to take mirtazapine.
  • Cognitive and Motor Impairment: Mirtazapine may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. You should avoid alcohol while taking mirtazapine.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Low Sodium in the Blood (Hyponatremia): Elderly people may be at greater risk for this condition. Symptoms may include headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, and memory problems.
  • Increased Levels of Phenylalanine: For patients with phenylketonuria (PKU), it is important to note that mirtazapine contains phenylalanine. If you have PKU, review mirtazapine doses and effects on total phenylalanine ingestion levels with your healthcare provider.
What are the most common side effects of mirtazapine?
  • Sleepiness
  • Dizziness
  • Dry mouth
  • Weight gain
  • Increased appetite

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Bupropion Extended-Release (XL)

Warning: Suicidal Thoughts and Behaviors

Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk in patients 65 and older.

Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.

Call your healthcare provider right away or 911 in an an emergency if you observe any of the following behaviors, especially if they are new, worse, unusual, or worry you: emergence of suicidality, worsening of depression, emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, inability to sit still or restlessness, racing thoughts that you can’t fully control, or becoming easily distracted.

What are the FDA-approved uses of bupropion XL?

Bupropion XL is an aminoketone antidepressant used to treat Major Depressive Disorder (MDD) and seasonal affective disorder (SAD). It is also categorized as a norepinephrine-dopamine reuptake inhibitor (NDRI).

Who should not use bupropion XL?

Do not use bupropion XL if:

  • You have had seizures in the past or have been diagnosed with a seizure disorder.
  • You have a current or prior diagnosis of bulimia or anorexia nervosa.
  • You have abruptly discontinued alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), linezolid, or intravenous methylene blue. When MAOIs are used at the same time as bupropion, there is an increased risk of very high blood pressure levels which can lead to a medical emergency.
  • You have a known allergic reaction to bupropion hydrochloride.
How should I take bupropion XL?

You can take bupropion XL with or without food. The tablet should be swallowed whole and not crushed, split, or chewed.

You should take bupropion XL exactly as prescribed, and continue to take bupropion XL as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking bupropion XL without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using bupropion XL?
  • Bupropion SR contains the active ingredient bupropion. It is the same active ingredient that is found in medications called Wellbutrin, Wellbutrin SR, Wellbutrin XL, Aplenzin, Zyban, or Forfivo XL. Tell your provider if you are taking one of these medications.
  • Bupropion XL has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • Antipsychotics, such as risperidone (Risperdal) and haloperidol (Haldol)
  • Other antidepressants, including SSRIs and SNRIs
  • Theophylline (Elixophyllin)
  • Corticosteroids, such as prednisone
  • Drugs used to treat Parkinson’s Disease called levodopa and amantadine
  • Digoxin (Digox)
  • Tamoxifen
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Seizures
  • Liver problems
  • Kidney problems
  • If you are a smoker and/or you’re trying to quit smoking
  • Alcohol or opiate abuse
  • Diabetes
  • Eating disorders
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if bupropion XL should be used during pregnancy and while breastfeeding.

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking bupropion XL?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with bupropion XL. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Smoking Cessation: Some people have had serious side effects while taking bupropion to help them quit smoking (known as the brand name drug Zyban). These side effects include new or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depression, or suicidal thoughts or actions. If you are thinking of quitting smoking, talk to your provider before you start taking bupropion.
  • Risk of seizure: Bupropion XL can cause seizure and the chance of seizure is related to too high of a dose of bupropion XL. Tell your provider about any past history of seizure, all medical history, and any other medications you are taking.
  • Increase in blood pressure: Bupropion XL can increase blood pressure. Your blood pressure should be well controlled prior to starting treatment. The chance of high blood pressure may be higher if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking. Your provider will monitor your blood pressure regularly. Consider monitoring your blood pressure at home.
  • Activation of Mania/Hypomania: Especially at the beginning of treatment, monitor for changes in behavior such as an unusually elevated mood, feeling unusually irritable, a big increase in energy, being more talkative than usual, racing thoughts, or engaging in risky behaviors. These changes in behavior could be signs of undiagnosed Bipolar Disorder.
  • Psychosis and other neuropsychiatric reactions: Depressed patients treated with bupropion XL have had a variety of neuropsychiatric signs and symptoms, including delusions, hallucinations, psychosis, concentration disturbance, paranoia, and confusion. Some of these patients had a diagnosis of bipolar disorder. Monitor for these signs and symptoms and tell your provider right away if these reactions occur.
  • Eye Effects: In rare instances, antidepressants may cause a certain type of eye problem called acute angle-closure glaucoma. Monitor for eye pain, changes in your vision, or swelling or redness in or around the eye.
  • Allergic Reactions, some severe: Discontinue bupropion XL if you develop an allergic or anaphylactic reaction including skin rash, itching, hives, chest pain, swelling, and shortness of breath.
  • Cognitive and Motor Impairment: Bupropion XL may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected.
  • Alcohol Use: Limit or avoid using alcohol while taking bupropion XL. If you usually drink a lot of alcohol, talk with your provider first before suddenly stopping. If you suddenly stop drinking alcohol, you may increase your chance of having seizures.
What are the most common side effects of bupropion XL?
  • Agitation
  • Sore throat
  • Dry mouth
  • Tremor
  • Sweating
  • Headache
  • Dizziness
  • Constipation
  • Nausea, vomiting
  • Insomnia, trouble sleeping
  • Loss of appetite, weight loss
  • A rapid or irregular heartbeat

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Important Safety Information for Buspirone

What is the FDA-approved use of buspirone?

Buspirone is used for the management of generalized anxiety disorder or the short-term relief of the symptoms of anxiety.

Who should not use buspirone?

Do not use buspirone if:

  • You are taking a class of medications called monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate), the antibiotic linezolid (Zyvox), or intravenous methylene blue. If you take buspirone at the same time as an MAOI, there is an increased risk of serotonin syndrome and high blood pressure.
  • You have a known allergic reaction to buspirone.
How should I take buspirone?

You can take buspirone with or without food.

You should take buspirone exactly as prescribed, and continue to take buspirone as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking buspirone without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.

If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.

What should I tell my Ro-affiliated provider before using buspirone?
  • Buspirone has many drug interactions. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

    Some medications to watch out for include:
  • Monoamine oxidase inhibitors (MAOIs), including the antibiotic linezolid (Zyvox) and intravenous methylene blue (rare)
  • Benzodiazepines, such as diazepam (Valium)
  • SSRIs or SNRIs, such as sertraline (Zoloft)
  • Migraine medications called triptans, such as sumatriptan (Imitrex)
  • St. John’s Wort
  • It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
  • Depression
  • Suicidal thoughts or attempted suicide
  • Bipolar Disorder
  • Family history of Bipolar Disorder or family history of suicide
  • Liver problems
  • Liver problems
  • Kidney problems
  • Parkinson’s Disease
  • High blood pressure
  • Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. You should discuss with your provider if buspirone should be used during pregnancy and while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking buspirone?
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with buspirone. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

  • Serotonin Syndrome: Serotonin syndrome is an uncommon, potentially life-threatening condition that occurs when taking too much of a drug that increases the activity of serotonin in the central nervous system. These medications may include MAOIs, triptans (a class of drugs used to treat migraines), tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, amphetamines, and St. John’s Wort. Monitor for symptoms of elevated body temperature, flushing, sweating, abdominal pain, diarrhea, agitation, and a racing heartbeat.
  • Cognitive and Motor Impairment: Buspirone may impair judgment, thinking, and motor skills. Avoid driving a car or operating hazardous machinery until you know that your performance is not affected. You should avoid alcohol while taking buspirone.
  • Neurologic effects: There have been rare reports of impaired neurologic function with use of buspirone. Symptoms may resemble symptoms of Parkinson’s Disease, such as restlessness, repetitive movements, inability to sit still, and involuntary movements (tardive dyskinesia). Tell your provider if you are experiencing these symptoms.
What are the most common side effects of buspirone?
  • Nausea
  • Headache
  • Dizziness
  • Nervousness
  • Lightheadedness
  • Excitement, jitteriness

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.