My doctor wanted me to take Cymbalta, the insurance said no and wanted to substitute Effexor. Well, we picked it up got home and thank goodness my husband read the enclosure. The pharmacist even failed to tell us not to take Wffexor is you take Ultram (Tramadol). It said, could cause death if taken together. I called the pharmacy they were not going to take it back, I told them what the insert said and told them they could eat it since the pharmacist did not warm me, THEY TOOK IT BACK REAL FAST.