Adult Initially 5 mg/day which is stepwise increased over the 1st 4 wk: Wk 1 (day 1-7): 5 mg/day for 7 days; wk 2 (day 8-14): 10 mg/day for 7 days; wk 3 (day 15-21): 15 mg/day for 7 days; wk 4 (day 22-27): 20 mg/day for 7 days. Maintenance: 20 mg/day. Elderly >65 yr 20 mg/day. Moderate renal impairment (CrCl 30-49 mL/min) 10 mg/day. May be increased up to 20 mg/day if well tolerated after at least 7 days. Severe renal impairment (CrCl 5-29 mL/min) 10 mg/day.
Patients w/ epilepsy, former history of convulsions or w/ predisposing factors for epilepsy. Avoid concomitant use of NMDA-antagonists eg, amantadine, ketamine or dextromethorphan. Careful monitoring of patient to some factors that may raise urine pH including drastic changes in diet eg, from carnivore to vegetarian diet, or massive ingestion of alkalizing gastric buffers; states of renal tubular acidosis or severe UTI w/ Proteus bacteria. Not recommended in severe hepatic impairment. Not to be used during pregnancy. Lactation. Childn.
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