Usual Adult Dose for Depression

25 mg orally 3 to 4 times per day

• Maximum dose: 150 mg/day

• The total daily dosage may be given once a day.
• Patients should be started at lower doses, and the doses should be gradually increased.
• When doses above 100 mg per day are given, plasma levels should be monitored and maintained in the optimum range of 50 to 150 ng/mL.

Usual Geriatric Dose for Depression

30 to 50 mg orally per day, in divided doses

Comments:

• The total daily dosage may be given once a day.
• Patients should be started at lower doses, and the doses should be gradually increased.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Therapeutic drug monitoring/range: 50 to 150 ng/mL

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.

• The dosage should be reduced if the patient develops minor side effects.
• The drug should be discontinued if adverse effects of a serious nature or allergic manifestations develop.

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 changed 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:

• Treatment may be taken in divided doses or as a once a day dose.

• Oral solution: Protect from light.

• 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.

• Cardiovascular: Blood pressure, cardiac function, especially in elderly patients.
• Other: Drug levels, especially in those receiving doses over 100 mg/day.
• Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.

• 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?