Usual Adult Dose for Depression

Initial dose: 50 mg orally 2 to 3 times a day
Maintenance dose: 100 mg orally 2 to 3 times a day
Maximum dose: 600 mg/day

Comments:

• Increases above 300 mg/day should be made only if 300 mg/day has been ineffective during at least two weeks.
• Hospitalized patients who have been refractory to antidepressant treatment and who have no history of convulsive seizures may have dosage increased cautiously up to 600 mg/day in divided doses.
• This drug may be given in a single daily dose, not to exceed 300 mg, preferably at bedtime.
• Doses above 300 mg should be given in divided doses.

• Relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depression
• Depression accompanied by agitation or anxiety

Usual Geriatric Dose for Depression

Initial dose: 25 mg orally 2 to 3 times a day
Maintenance dose: 50 mg orally 2 to 3 times a day
Maximum dose: 300 mg/day

Comments:

• Once an effective dosage is established, this drug may be administered in a single bedtime dose, not to exceed 300 mg.
• Recommended maintenance dosage is the lowest dose that will maintain remission.
• If symptoms reappear, the dosage should be increased to previous level until symptoms are under control.

• Relief of symptoms of depression in patients with neurotic or reactive depressive disorders as well as endogenous and psychotic depression
• Depression accompanied by agitation or anxiety

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

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.
• After the medication-free interval, this drug may be started cautiously, with a gradual increase in dose until an optimal response is achieved.

• Providers should consider reducing the dose.

• Discontinue use.

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.

Dialysis

Data not available

Other Comments

Monitoring:

• Cardiovascular: Blood pressure, cardiac function, especially in elderly patients
• Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.

• Patients should be instructed to inform their other physician(s) and their dentist that they are using 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 told to 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 as soon as possible.
• Patients should be told to immediately report signs/symptoms of hypersensitivity, tardive dyskinesia, and/or neuroleptic malignant syndrome.
• Patients should be advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.
• This medicine may cause impaired judgment, thinking, or motor skills; patients should be advised to not drive a car or operate dangerous machinery until they know how this drug affects them.