SYMBYAX Rx

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Elderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Monitor for serotonin syndrome or neuroleptic malignant syndrome-like signs/symptoms; discontinue if occurs. Discontinue if Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is suspected. Congenital or history of long QT syndrome and other conditions (eg, hypokalemia, hypomagnesemia, recent MI, uncompensated heart failure, bradyarrhythmias, other significant arrhythmias); monitor ECG periodically. Hepatic impairment. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1^st few months of treatment; discontinue if WBCs decline. Cardio- or cerebrovascular disease. Hypovolemia. Dehydration. History of seizures or mania/hypomania. Tardive dyskinesia. Conditions that affect metabolism or hemodynamic response. Diabetes. Monitor for hyperglycemia, hyperlipidemia; do fasting blood glucose and lipids testing at beginning, and during therapy. Monitor for weight gain. Angle-closure glaucoma. Urinary retention. Significant prostatic hypertrophy. Constipation. History of paralytic ileus or related conditions. Breast cancer. Perform fall risk assessments when initiating and recurrently on long-term therapy. Hyponatremia (esp. in elderly). Hyperprolactinemia. Exposure to extreme heat. Dysphagia. Sexual dysfunction. Reevaluate periodically. Write ℞ for smallest practical amount. Avoid abrupt cessation. Hepatic impairment. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to SSRIs or SNRIs exposure during 3^rd-trimester pregnancy). Labor & delivery. Pregnancy. Nursing mothers: not recommended.