Usual Adult Dose for Depression

100 to 200 mg orally per day

• Maximum dose: 300 mg/day

• Doses should be initiated at a lower level and increased according to tolerance and clinical response.
• In severely ill patients, doses may be further increased to 300 mg per day if needed.
• Treatment of patients requiring as much as 300 mg should generally be initiated in a hospital setting.

Usual Geriatric Dose for Depression

25 to 100 mg orally per day

• Maximum dose: 150 mg/day

• Doses should be initiated at a lower level and increased according to tolerance and clinical response.
• Initial treatment may be given once a day or in divided doses.
• In severely ill patients, doses may be further increased to 150 mg/day if needed.
• Most patients should not exceed doses of 100 mg/day.

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.

• Starting this drug: Use should be avoided; healthcare providers should consider other interventions (e.g., hospitalization) in patients who require urgent treatment.
• Patients already receiving this drug: If alternative treatments are not available AND the potential benefits of treatment outweigh the risks of serotonin syndrome, this drug should be promptly stopped and linezolid or IV methylene blue should be administered.
• Patients should be monitored for serotonin syndrome for 2 weeks OR until 24 hours after the last dose of the MAOI, whichever comes first.
• This drug may be resumed 24 hours after the last dose of the MAOI.

• Providers should consider reducing the dose.

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

Administration advice:

• Initial therapy can be administered in divided doses or as a single daily dose.
• Maintenance treatment may be given as a once a day dose.

• Protect from moisture and excessive heat.

• The best evidence of impending toxicity from very high doses is prolongation of the QRS or QT intervals.
• Symptoms of intolerance, especially drowsiness, dizziness, and postural hypotension, should alert the healthcare provider to the need for reduction in dosage.

• Cardiovascular: Blood pressure, cardiac function, especially in elderly patients
• Hematologic: Periodic blood cell counts, signs/symptoms of infection
• Metabolic: Blood glucose levels
• 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 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 advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.