Give in divided doses. May give maintenance dose once at bedtime. Outpatients: initially 75mg/day, may increase to 150mg/day, max 200mg/day; maintenance: 50–150mg/day. Hospitalized: initially 100mg/day, may increase gradually to 200mg/day; if no improvement in 2–3 weeks, may increase to max 250–300mg/day. Adolescents and elderly: initially 50mg/day, may increase gradually to 100mg/day.
During or within 14 days of MAOIs. Concomitant linezolid, IV methylene blue. Acute post-MI.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or changes. Monitor for signs/symptoms of serotonin syndrome; discontinue if occurs. Seizure disorders. ECT. Mania/hypomania. Psychosis. Urinary retention. Glaucoma. Cardiovascular disease. Diabetes. Hyperthyroidism. Hepatic impairment. Elderly. Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Hyperpyretic crisis, convulsions, death with MAOIs. Increased risk of serotonin syndrome with other serotonergic drugs (eg, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort) or with drugs that impair serotonin metabolism (eg, MAOIs, linezolid, IV methylene blue). Potentiates alcohol, sympathomimetics, benzodiazepines, other CNS depressants. Potentiated by CYP2D6 inhibitors; monitor plasma levels with cimetidine, SSRIs, phenothiazines, type 1C antiarrhythmics (eg, quinidine). Antagonized by barbiturates, carbamazepine, phenytoin. Paralytic ileus, hyperpyrexia with anticholinergics. Blocks guanethidine.
Drowsiness, anticholinergic effects, CNS overstimulation, arrhythmias, extrapyramidal symptoms, cardiovascular effects, GI upset, fatigue, rash, hyperhidrosis, headache, changes in blood sugar, photosensitivity, edema, blood dyscrasias, jaundice.