Adult Initially 5 mg/day, taken at the same time daily, stepwise increased over 1st 4 wk of treatment. Wk 1 (day 1-7): 5 mg/day. Wk 2 (day 8-14): 10 mg/day. Wk 3 (day 15-21): 15 mg/day. Wk 4 (day 22-28): 20 mg/day. Max: 20 mg/day. Maintenance: 20 mg/day. Moderate renal impairment (CrCl 30-49 mL/min) 10 mg/day, increase up to 20 mg/day if tolerated well after at least 7 days. Severe renal impairment (CrCl 5-29 mL/min) 10 mg/day. Elderly >65 yr 20 mg once daily.
Patients w/ epilepsy, former convulsion history, or w/ epilepsy predisposing factors. Avoid concomitant use of N-methyl-D-aspartate antagonists eg, amantadine, ketamine or dextromethorphan. Carefully monitor patients w/ factors that may raise urinary pH. Patients w/ recent MI, uncompensated CHF (NYHA III-IV), or uncontrolled HTN. Minor or moderate influence on the ability to drive & use machines. Not recommended in patients w/ severe hepatic impairment. Pregnancy. Not to be used during breast-feeding. Not recommended for use in childn <18 yr.
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