Depression 10 mg once daily. Increased after at least a wk to max of 20 mg once daily if necessary. Panic disorder w/ or w/o agoraphobia Initially 5 mg once daily. Increased after a wk to 10 mg once daily; further increases up to max of 20 mg daily. Elderly Initially half the recommended dose.
Discontinue in any patient entering a manic phase; who develops seizures. Increased anxiety symptoms in patients w/ panic disorders. Avoid in patients w/ unstable epilepsy. Closely monitor patients w/ controlled epilepsy. May alter glycaemic control in patients w/ DM. Suicide; haemorrhage. Avoid abrupt w/drawal. Patients w/ hepatic impairment or those who are poor metabolisers of CYP2C19. Not to be used during pregnancy. Not recommended during lactation. Not recommended in childn & adolescents <18 yr.
May cause serotonin syndrome w/ MAOIs. May lead to enhancement of serotonin associated effects eg, serotonin syndrome w/ other serotogenic medicines (eg, tramadol, sumatriptan) as well as other antidepressants w/ serotonergic properties.