Do not use Emsam if:

• you are allergic to any ingredient in Emsam;
• you are taking fluoxetine or have taken it within the past 5 weeks;
• you are taking bupropion, buspirone, cyclobenzaprine, dextromethorphan, meperidine, methadone, a norepinephrine reuptake inhibitor (e.g., atomoxetine), propoxyphene, a selective serotonin reuptake inhibitor (SSRI) (e.g., paroxetine), a serotonin and norepinephrine reuptake inhibitor (e.g., duloxetine, venlafaxine), St. John's wort, a tetracyclic antidepressant (e.g., mirtazapine), tramadol, or a tricyclic antidepressant (e.g., amitriptyline), or if you have taken any of these medicines within the past 7 days;
• you are taking another MAOI (e.g., phenelzine), a sympathomimetic, including an amphetamine, a cold product, or certain diet pills or preparations (e.g., ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine), or sibutramine, or if you have taken any of these medicines within the past 7 days;
• you are taking a 5-HT agonist (e.g., sumatriptan), apraclonidine, carbamazepine, methylphenidate, oxcarbazepine, or nefazodone;
• you will be undergoing elective surgery with general anesthesia or will be receiving cocaine or local anesthesia containing sympathomimetic vasoconstrictors;
• you have certain adrenal gland problems (eg, pheochromocytoma).

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have a history of bipolar disorder, mania, mood or mental problems, suicidal thoughts or attempts, or uncontrolled muscle movements (eg, twitching of the face and tongue and involuntary movements of the arms and legs)
• if you have a history of ulcer, heart problems, recent heart attack, seizures, blood problems, or a metabolism disorder

• Bupropion, cyclobenzaprine, dextromethorphan, a MAOI (eg, phenelzine), meperidine, methadone, a norepinephrine reuptake inhibitor (eg, atomoxetine), oral selegiline, propoxyphene, a serotonin or norepinephrine reuptake inhibitor (eg, duloxetine, venlafaxine), sibutramine, a SSRI (eg, fluoxetine), St. John's wort, sympathomimetics (eg, amphetamine , ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine), a tetracyclic antidepressant (eg, mirtazapine), or a tricyclic antidepressant (eg, amitriptyline) because serotonin syndrome (eg, fever, muscle stiffness or rigidity, vital sign changes, mental or mood changes, coma) may occur
• Apraclonidine or buspirone because severe high blood pressure may occur
• Nefazodone or tryptophan because nausea, dizziness, mental or mood changes, seizures, fever, or breathing or heart problems may occur
• Tramadol because the risk of seizures may be increased
• Carbamazepine or oxcarbazepine because they may increase the risk of Emsam's side effects 5-HT1 agonists (eg, sumatriptan), insulin, a meglitinide antidiabetic (eg, nateglinide), methylphenidate, or a sulfonylurea (eg, glipizide) because the risk of their side effects may be increased by Emsam
  
  Possible Side Effects
  
  

  Check with your doctor if any of these most common side effects persist or become bothersome:

  • diarrhea; dizziness; dry mouth; sleeplessness.
  Seek medical attention right away if any of these severe side effects occur:
  
  
  • severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal thinking; changes in sexual ability or desire; chest pain; enlarged pupils; fast, slow, or irregular heartbeat; increased sweating; memory loss; nausea; neck stiffness or soreness; new or worsening agitation, aggressiveness, anxiety, exaggerated feeling of well-being, hostility, impulsiveness, inability to sit still, irritability, panic attacks, or sleeplessness; painful menstruation; sensitivity to light; severe headache; swelling of the arms or legs; vomiting.
  
  
  More Information
  
  

  Emsam is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  If your symptoms do not improve or if they become worse, check with your doctor.

  
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