Therapeutic class: ANTIDEPRESSANTS  

Adult Min/Max Dose: 100.0mg/250.0mg

Common Dosages by Indication:

Cataplexy Syndrome	take 1 capsule (25 mg) by oral route once daily at bedtime take 2 capsules (50 mg) by oral route once daily at bedtime take 1 capsule (25 mg) by oral route 2 times per day with meals take 1 capsule (25 mg) by oral route 3 times per day with meals take 2 capsules (50 mg) by oral route 2 times per day with meals take 2 capsules (50 mg) by oral route 3 times per day with meals take 1 capsule (50 mg) by oral route once daily at bedtime take 2 capsules (100 mg) by oral route once daily at bedtime take 1 capsule (50 mg) by oral route 2 times per day with meals take 1 capsule (50 mg) by oral route 3 times per day with meals take 2 capsules (100 mg) by oral route 2 times per day with meals take 4 capsules (200 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route 2 times per day with meals take 2 capsules (150 mg) by oral route once daily at bedtime
Depression	take 2 capsules (50 mg) by oral route 2 times per day with meals take 2 capsules (50 mg) by oral route 3 times per day with meals take 2 capsules (100 mg) by oral route once daily at bedtime take 1 capsule (50 mg) by oral route 2 times per day with meals take 1 capsule (50 mg) by oral route 3 times per day with meals take 2 capsules (100 mg) by oral route 2 times per day with meals take 5 capsules (250 mg) by oral route once daily at bedtime take 2 capsules (150 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route 2 times per day with meals take 1 capsule (75 mg) by oral route 3 times per day with meals
Obsessive-Compulsive Disorder	take 2 capsules (100 mg) by oral route once daily at bedtime take 1 capsule (50 mg) by oral route 2 times per day with meals take 1 capsule (50 mg) by oral route 3 times per day with meals take 2 capsules (100 mg) by oral route 2 times per day with meals take 5 capsules (250 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route 2 times per day with meals take 1 capsule (75 mg) by oral route 3 times per day with meals take 2 capsules (150 mg) by oral route once daily at bedtime
Panic Disorder	take 1 capsule (25 mg) by oral route once daily at bedtime take 2 capsules (50 mg) by oral route once daily at bedtime take 1 capsule (25 mg) by oral route 2 times per day with meals take 1 capsule (25 mg) by oral route 3 times per day with meals take 2 capsules (50 mg) by oral route 2 times per day with meals take 2 capsules (50 mg) by oral route 3 times per day with meals take 1 capsule (50 mg) by oral route once daily at bedtime take 2 capsules (100 mg) by oral route once daily at bedtime take 1 capsule (50 mg) by oral route 2 times per day with meals take 1 capsule (50 mg) by oral route 3 times per day with meals take 2 capsules (100 mg) by oral route 2 times per day with meals take 4 capsules (200 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route once daily at bedtime take 1 capsule (75 mg) by oral route 2 times per day with meals take 2 capsules (150 mg) by oral route once daily at bedtime

All Labeled Uses: Obsessive-Compulsive Disorder
Unlabeled Uses: Anxiety, Cataplexy Syndrome, Depression, Panic Disorder

Contraindicated Drug Combination:
Clearly contraindicated in all cases and should not be dispensed or administered to the same patient:
TRI; TETRACYCLIC COMPOUNDS/MAOI'S - 
SELECTED TRICYCLIC COMPOUNDS/LUMEFANTRINE - Increased effect of the former drug
QT PROLONGING AGENTS/DRONEDARONE - Additive side effects from both drugs
QT PROLONGING AGENTS/DISOPYRAMIDE - Additive side effects from both drugs
ANTIDEPRESSANTS/SIBUTRAMINE - Adverse reaction of the latter drug
TRICYCLIC & TETRACYCLIC COMPOUNDS/CISAPRIDE - Adverse reaction with both drugs
TRICYCLIC COMPOUNDS/ARBUTAMINE - Adverse reaction with both drugs
TRICYCLIC COMPOUNDS/PIMOZIDE - Adverse reaction with both drugs
TRICYCLIC COMPOUNDS/HALOFANTRINE - Adverse reaction with both drugs
TRICYCLIC COMPOUNDS/GREPAFLOXACIN; SPARFLOXACIN - Adverse reaction with both drugs

Severe Interaction:
Action is required to reduce the risk of severe adverse interaction.
TRICYCLIC COMPOUNDS; CARBAMAZEPINE/TRAMADOL - Adverse reaction with both drugs
TRICYCLIC COMPOUNDS/SELECTED SYMPATHOMIMETICS - Mixed effects of the latter drug
TRICYCLIC COMPOUNDS/GUANETHIDINE; GUANADREL - 

Moderate Interaction:
Assess the risk to the patient and take action as needed.
TRICYCLIC COMPOUNDS/CIMETIDINE - Increased effect of the former drug
TRICYCLIC COMPOUNDS/AMPRENAVIR; FOSAMPRENAVIR - Increased effect of the former drug
TRICYCLIC COMPOUNDS/TERBINAFINE - Increased effect of the former drug
AMITRIPTYLINE; CLOMIPRAMINE; NORTRIPTYLINE/VALPROIC ACID - Increased effect of the former drug
TRICYCLIC COMPOUNDS/INHALED SYMPATHOMIMETICS - Mixed effects of the latter drug
QT PROLONGING AGENTS/GATIFLOXACIN - Additive side effects from both drugs
ANTIDEPRESSANTS/BUPROPION - Additive side effects from both drugs
TRICYCLIC COMPOUNDS; TRAZODONE/SSRI'S; SELECTED SNRIS - Increased effect of the former drug
TRICYCLIC COMPOUNDS; MIRTAZAPINE/CLONIDINE - Decreased effect of the latter drug

Pediatric
Relative Contraindication: POSSIBLE INCR. SUICIDAL IDEATION & ATTEMPT IN PEDS. W/MAJOR DEPRESSION

Lactation
Precaution: EFFECT UNKNOWN BUT MAY BE OF CONCERN PER AAP

Pregnancy
Only When Necessary

Geriatric
Contraindication: (SOM)(BEERS02)HYPOTENSION, SEDATION, FALLS, ANTICHOLINERGIC & CV EFX

Most Frequent:
Anorexia, Constipation, Dizziness, Drowsy, Dysgeusia, Dyspepsia, Fatigue, Headache Disorder, Increased Appetite, Weight Gain, Xerostomia

Less Frequent:
Abdominal Pain with Cramps, Abnormal Sexual Function, Blurred Vision, Bradycardia, Conduction Disorder of the Heart, Diarrhea, Dysuria, Erectile Dysfunction, Flatulence, Flushing, Hallucinations, Heartburn, Hyperhidrosis, Hypotension, Impaired Cognition, Insomnia, Irregular Menstrual Periods, Memory Impairment, Myalgia, Myoclonus, Nausea, Nervousness, Orthostatic Hypotension, Paresthesia, Parkinsonism, Pharyngitis, Rhinitis, Tremors, Vomiting

Rare:
Agranulocytosis, Allergic Dermatitis, Allergic Reactions, Alopecia, Angioedema, Anxiety, Blood Dyscrasias, Dry Eye, Galactorrhea not associated with Childbirth, Gynecomastia, Hyperbilirubinemia, Pruritus of Skin, Purpura, Seizure Disorder, SIADH Syndrome, Sinusitis, Skin Photosensitivity, Skin Rash, Suicidal Ideation, Testicular Swelling, Tinnitus

Most Significant
Malignant Hyperthermia, Recovery Phase Following Myocardial Infarct

Significant
Epilepsy, Glaucoma, Severe Renal Disease, Suicidal Ideation

Possibly Significant
Alcoholism, Atrioventricular Conduction Defect, Disease of Liver, Hyperthyroidism, Manic Bipolar Disorder, Neuroblastoma, Pheochromocytoma, Urinary Retention