Axert Warnings and Precautions (Cont.)

• Axert has been reported to increase the risk of a heart attack or a life-threatening change in a person's heart rhythm (arrhythmia). You should not take Axert if you have heart disease or a history of a heart attack or chest pain (see Axert and Heart Problems for more information). 

If you have risk factors for heart disease (see Heart Disease Risk Factors), it is also strongly recommended that you take your first dose of Axert in your healthcare provider's office. This is so your healthcare provider can monitor your heart. You should also have your heart checked periodically while taking Axert.

• In some cases, a stroke or transient ischemic attack ("mini stroke" or TIA) can be misdiagnosed as a migraine. Your healthcare provider should make sure you are not having a stroke, especially if you have never had migraines in the past (see Stroke Symptoms for more information on the symptoms of a stroke).
   
• If you have chest pain or tightness in the jaw or neck after taking Axert, contact your healthcare provider immediately. These side effects are fairly common with Axert and are not usually serious. However, your healthcare provider may need to make sure you are not having heart problems.
   
• Medications like Axert can cause blood vessels in the arms, legs, colon (large intestine), and other locations to spasm. This can cause a decrease in blood flow to these areas. Symptoms will vary based on the location. For example, a spasm in the colon can lead to severe abdominal pain (or stomach pain) or bloody diarrhea.

• Taking Axert with certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), can increase your risk of a dangerous group of symptoms called serotonin syndrome. Do not use Axert with depression medications without first discussing it with your healthcare provider. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

• Confusion
• Seeing or hearing things that are not really there (hallucinations)
• A fast heartbeat (tachycardia)
• Feeling faint
• A fever
• Sweating
• Muscle spasms
• Difficulty walking
• Diarrhea.

• Axert can cause an increase in blood pressure. You should not take Axert if you have untreated high blood pressure (hypertension).
   
• Axert may make some people drowsy or dizzy. You should not drive or operate heavy machinery until you know how Axert will affect you.
   
• Axert is considered a pregnancy Category C medication. This means that Axert may not be safe for use during pregnancy. Talk with your healthcare provider before using Axert if you are pregnant (see Axert and Pregnancy for more information).
   
• It is not known if Axert passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this.
   
• Tell your healthcare provider if you have liver problems (including liver failure or cirrhosis) or kidney problems (including kidney failure) before taking Axert. This is important because Axert is removed from the body through the liver and kidneys.
   
• Axert can interact with certain other medications (see Axert Drug Interactions).