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