HALF-LIFE: 20-40 hours STARTING DOSE: 7.5mg-15mg per day TARGET DOSING RANGE: 30mg-45mg per day BEST TIME TO DOSE: Bedtime HOW TO DOSE: > Initial 7.5mg-15mg PO QHS for 2 weeks > Increase dose by 7.5mg-15mg per day every 1-2 weeks > Max dose 45mg/day PREGNANCY: Minimal data on safety. Not a contraindication. BREASTFEEDING: Minimal date on safety. Not a contraindication. FDA INDICATIONS: 1) Major Depressive Disorder
Available in orally disintegrating tablets
Metabolized primarily through CYP1A2, CYP2D6, and CYP3A4
Caution with MAOIs or other serotonin agents (Serotonin syndrome, Hypertensive crisis?)
Good agent for patients with depression, anxiety, and insomnia
Good choice for depressed patients with cancer or depressed elderly frail patients
Minimal sexual dysfunction. Best used for patients who have had sexual side effects with other agents.
Weight gain, increased appetite, and sedation are common side effects
Different doses have different effects.
Low doses more sedating.
Higher doses less sedating/more activating due to increase in noradrenergic effects relative to antihistaminergic effects at high doses.