Usual Adult Dose for Depression

15 to 40 mg orally per day divided into three or four doses

• Maximum dose: 60 mg/day

• Dosage increments should be made in the morning dose.
• After a satisfactory improvement is reached, the dose should be reduced to the lowest effective amount to relieve symptoms.

Usual Geriatric Dose for Depression

5 mg orally 3 times a day, increasing gradually if necessary

Comments:

• Cardiovascular status should be monitored closely if daily dosage exceeds 20 mg.
• After a satisfactory improvement is reached, the dose should be reduced to the lowest effective amount to relieve symptoms.

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.
• Treatment should be started cautiously and the dose should be gradually increased until an optimal response is achieved.

• If minor adverse reactions develop: Dosage reductions may be required.
• If major adverse reactions or hypersensitivity reactions occur: Prompt discontinuation of the drug is necessary.

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

General:

• Activating properties of this drug may be more effective in the treatment of withdrawn and anergic patients with depression.

• Cardiovascular: Cardiovascular system monitoring in elderly patients receiving doses over 20 mg/day
• Psychiatric: Patients should be monitored for clinical 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.
• Somnolence has been reported. Caution in driving and operating machinery is recommended until the individual response to the drug has been determined.