Applies to the following strength(s): 15 mg
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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Depression
Initial dose: 15 mg, orally, 3 times a day
Early phase treatment: Increase to at least 60 mg per day fairly rapidly, as tolerated
-90 mg per day may be needed for sufficient MAO inhibition
-Clinical response may not be seen until at least 4 weeks at 60 mg per day dosing
Maintenance dose: After maximal benefit is achieved, reduce dose slowly over several weeks.
-Maintenance dose may be as low as 15 mg once a day or 15 mg every other day
Duration of therapy: As long as required
-This drug should rarely be the first antidepressant used; it is more suitable for patients unresponsive to more commonly used medications.
-This drug is effective in depressed patients characterized as atypical, nonendogenous, or neurotic, who often have mixed anxiety and depression and phobic or hypochondriacal features.
-Evidence of usefulness in severely depressed patients with endogenous features is less conclusive.
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
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.
-Balance this risk with the clinical need for treatment.
-Short term studies did not show increased suicidality in adults beyond the age of 24; there was a reduction of risk in patients 65 years and older.
-Depression and certain other psychiatric disorders are themselves associated with increased risk of suicidality.
-Monitor all patients starting antidepressants closely for clinical worsening, suicidality, or unusual behavior changes.
-Advise families and caregivers of the need for close observation and communication with the prescriber.
-This drug is not approved for use in pediatric patients.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Data not available
-Monitor for clinical worsening, suicidality, or unusual changes in behavior, especially during the first few months of therapy and during dose changes.
-Hypertensive crisis is the most important adverse reaction with this drug, watch for some or all of the following symptoms: occipital headache with may radiate frontally, palpitation, neck stiffness or soreness, nausea, vomiting, sweating (sometimes with fever and sometimes with cold, clammy skin), dilated pupils, and photophobia. Either tachycardia or bradycardia may be present, and can be associated with constricting chest pain.
-Observe blood pressure frequently.
-Discontinue therapy immediately for palpitation or frequent headaches.
-Patients should not take sympathomimetic drugs (including amphetamines, cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and phenylalanine).
-Patients should avoid high protein foods that have undergone protein breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
-Patients should avoid cheeses (especially aged varieties), pickled herring, beer, wine, alcohol-free or reduced-alcohol beer or wine, liver, yeast extract (including large quantities of brewer's yeast), dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava beans), sauerkraut, meat extract, and yogurt.
-Excessive amounts of caffeine and chocolate may cause hypertensive reactions.
-Patients should avoid the following over-the-counter medications: cold and cough preparations (including those with dextromethorphan), nasal decongestants (tablets, drops, or spray), hay fever medications, sinus medications, anti-appetite medicines, weight reducing preparations, "pep" pills, L-tryptophan containing preparations.
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