Major depressive episodes 10-20 mg once daily, initially for 2-4 wk for symptomatic treatment, then at least 6 mth further for consolidation of response. Panic disorder w/ or w/o agoraphobia Initially 5 mg daily for the 1st wk, then increase to 10 mg/day. Max: 20 mg/day. Social anxiety disorder, generalized anxiety disorder 10 mg once daily. Max: 20 mg/day. Reduced hepatic function 5 mg daily for the 1st 2 wk, may be increased to 10 mg. Obsessive-compulsive disorder 10 mg once daily. Max: 20 mg/day.
Avoid combination w/ moclobemide or serotonergic compd. Diabetics, history of mania/hypomania & co-administration of ECT in patients on SSRIs. Monitor patients w/ epilepsy especially unstable epilepsy. Discontinue if patient develops serotonin syndrome. Concomitant medicines that affect blood clotting, platelet function or patients w/ coagulopathy. Avoid abrupt w/drawal. Monitor patients for suicide risk in 1st few wk of treatment. Severe renal dysfunction (CrCl <30 mL/min).
MAOI, selegiline, lithium, tryptophan, agents that may lower seizure threshold, St. John's wort, omeprazole, high doses of cimetidine, drugs metabolised by CYP2D6, CYP2C19 enzymes.
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