Usual Adult Dose for Depression

OUTPATIENTS:

• Initial dose: 75 mg orally per day in divided doses; this may be increased to 150 mg/day (if needed)
• Maintenance dose: 40 to 100 mg orally per day
• Maximum dose: 150 mg/day

Alternate outpatient treatment regimen: 50 to 100 mg orally as a single dose at bedtime; this may be increased by 25 or 50 mg as needed at bedtime to a total of 150 mg/day

INPATIENTS:

• Initial dose: 100 mg orally per day
• Maintenance dose: 40 to 100 mg orally as a single dose at bedtime
• Maximum dose: 300 mg/day

Comments:

• Dose increases should preferably be made in the late afternoon or at bedtime due to the sedative effect.
• The full therapeutic effect may take as long as 30 days to develop.
• Maintenance doses should be reduced to the lowest amount that will maintain relief of symptoms when satisfactory improvement has been obtained.
• Maintenance therapy should be continued for 3 months or longer to lessen the possibility of relapse.

Use: Relief of symptoms of depression

Usual Geriatric Dose for Depression

10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

Comments:

• The full therapeutic effect may take as long as 30 days to develop.
• Elderly patients should be monitored carefully and serum levels obtained as clinically appropriate.
• Dose adjustments should be made according to clinical response.

Use: Relief of symptoms of depression

Usual Pediatric Dose for Depression

12 years or older: 10 mg orally 3 times a day AND 20 mg orally once a day at bedtime

Comments:

• The full therapeutic effect may take as long as 30 days to develop.
• Dose adjustments should be made according to clinical response.

Use: Relief of symptoms of depression

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Use with caution

Dose Adjustments

Switching TO/FROM this drug FROM/TO a MAOI used to treat psychiatric disorders:

• Allow a medication-free interval of at least 14 days.
• Treatment should be started cautiously and the dose should be gradually increased until an optimal response is achieved.

Precautions

US BOXED WARNINGS:
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 this drug 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.
• This drug is not approved for use in pediatric patients.

Safety and efficacy have not been established in patients younger than 12 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Tablets should be taken with water.

Storage requirements:

• Tablets: Protect from light.

General:

• The risk of serotonin syndrome with the use of non-IV methylene blue formulations or IV doses much lower than 1 mg/kg is unknown.
• Treatment may be more effective in patients with endogenous depression compared to patients with other depressive states.

Monitoring:

• Cardiovascular: Blood pressure, ECG (especially in pediatric patients prior to starting treatment)
• Other: Drug levels, especially in those receiving doses over 100 mg/day.
• Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.

Patient advice:

• Patients should be advised to avoid abrupt discontinuation of this drug.
• Patients should tell their healthcare provider(s) about all the medicines that they take, including prescription and non-prescription medicines.
• This medicine may increase the risk of suicidal thoughts and behavior. Patients should be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Patients should report any behavior of concern to their healthcare provider(s) as soon as possible.
• Patients should be advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be cautioned accordingly since this drug may impair the mental and/or physical abilities required for the performance of operating an automobile or machinery.

Frequently asked questions

• Can antidepressants be used for arthritis pain?
• What are some common side effects of antidepressants?