PEXEVA® Samples

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Instructions:

Select desired product samples below.
Click 'Submit' and review order.
Print out Order form, sign it and fax it to 1-877-493-3645

This form must be filled out completely before your sample request can be processed. You should receive your samples within 7-10 business days. If you have any questions, please call us at 1-877-493-3619 (M-F 8am-5pm MST).

Please send me the following:

	PEXEVA® (paroxetine mesylate) 20 mg Tablets (8 physician sample bottles) Each sample unit contains 7 tablets.
	PEXEVA® Co-Pay Benefit Brochure/Cards (3 packs containing 10 cards each)
	Home Delivery Mail Order Prescription Forms (1 pack containing 5 forms)

Important Safety Information

Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of paroxetine mesylate or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. PEXEVA® (paroxetine mesylate) is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk, Precautions: Information for Patients, and Precautions: Pediatric Use)

All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

Concomitant use of PEXEVA® (paroxetine mesylate) in patients taking monoamine oxidase inhibitors (MAOIs), thioridazine, or pimozide is contraindicated. If concomitant use of paroxetine with a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases. PEXEVA® (paroxetine mesylate) tablets are contraindicated in patients with a hypersensitivity to paroxetine or any of the inactive ingredients in PEXEVA® (paroxetine mesylate) tablets.

Please see Important Safety Information, including Black Boxed Warning

Please see accompanying full Prescribing Information including use in Pregnancy

(See WARNINGS—Clinical Worsening and Suicide Risk and Usage in Pregnancy: Teratogenic and Nonteratogenic Effects).

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

Please see Full Prescribing Information


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