Treatment of depression Initially 50 mg daily, may be increased if necessary in increments of 50 mg at intervals of at least 1 wk. Max: 200 mg daily. Obsessive-compulsive disorder Adult & adolescentInitially 50 mg daily. Childn 6-12 yr Initially 25 mg once daily. Panic disorder w/ or w/o agoraphobia, social anxiety & post-traumatic stress disorder Initially 25 mg daily. Thereafter, doses in all disorders may be increased if necessary in increments of 50 mg at intervals of at least 1 wk. Max: 200 mg daily. Premenstrual dysphoric disorder Initially 50 mg daily either throughout the menstrual cycle or during the luteal phase. Doses may be increased by 50 mg each menstrual cycle up to a max of 150 mg daily for continuous dosing or 100 mg daily when dosing during the luteal phase only. Patient who require 100 mg daily during luteal phase only dosing should initially be given 50 mg daily for the 1st 3 days of each luteal phase dosing period.
Monitor for menstrual irregularities, erythema multiforme & pancreatitis. Patients w/ hepatic or renal impairment. Pregnancy & lactation. Not for childn & adolescent <18 yr w/ major depressive disorder.
Risk of hyperthermia, rigidity, myoclonus, automatic instability w/ possible rapid fluctuations of vital signs, mental status changes that include confusion, irritability & extreme agitation progressing to delirium & coma w/ MAOIs. Increased plasma levels of TCAs & pimozide. Possible pharmacodynamic interaction w/ lithium & tryptophan. Enhancement of 5-HT-associated effects w/ serotonergic drugs (eg, tramadol, sumatriptan or fenfluramine). Potential increase in prothrombin time w/ warfarin. Possible serotonergic potentiation w/ St. John's wort. Decreased clearance w/ cimetidine.
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