| Depression; off-label for neuropathic pain and migraine prophylaxis. View labelExact | Major depressive disorder: start 25–50 mg at bedtime; increase by 25–50 mg every 3–7 days toward 100–150 mg/day in divided doses or as a single nightly dose. Maximum 300 mg/day under specialist supervision with ECG monitoring. | Tertiary-amine tricyclic antidepressant that inhibits serotonin and norepinephrine reuptake while strongly antagonising histamine H1, muscarinic, and α1-adrenergic receptors; sodium-channel blockade contributes to analgesia. | CYP2D6, CYP2C19, CYP3A4, CYP1A2 | Single-dose mean 21 h; Steady-state mean 24 h | 80–250 ng/mL | | - Sedation: assess next-day impairment and fall risk, especially with other CNS depressants.
- QTc: consider ECG monitoring when risk factors or QT-prolongers are present.
- Metabolic: monitor weight/BMI and metabolic parameters when clinically relevant.
| No | 2026-02-22 |
|---|
| Depression; use with caution in adolescents and patients with cardiac disease. View labelExact | Typical start is 25 mg HS with titration every 3–7 days as tolerated to 75–100 mg/day (single HS or divided). | Tricyclic antidepressant (TCA); predominantly norepinephrine reuptake inhibition. | CYP2D6 | Single-dose mean 36 h; Single-dose range 18–90 h | 50–150 ng/mL | | - Baseline ECG for patients >40 years, cardiac disease, electrolyte abnormalities, or higher target doses; repeat after major dose changes or when adding QT-active medications.
- TDM after steady state (about 7–10 days) and after dose adjustments; track both symptom response and adverse effects when interpreting levels.
- Orthostatic vitals, falls risk, and anticholinergic burden (bowel and bladder symptoms), especially in older adults or when adding anticholinergic co-medications.
- Mood activation and suicidality during initiation and titration, particularly in adolescents/young adults and in bipolar-spectrum illness.
- Medication reconciliation for CYP2D6 inhibitors/inducers, QT-active agents, and serotonergic combinations; include OTC antihistamines and decongestants.
| No | 2025-12-29 |
|---|
| Major depressive disorder; generalized anxiety disorder; diabetic peripheral neuropathic pain; fibromyalgia; chronic musculoskeletal pain. View labelExact | Major depressive disorder (clinical depression) and generalized anxiety disorder: typical initiation is 30 mg once daily for one week for tolerability, then 60 mg once daily. If needed, 90–120 mg/day is sometimes used (divide when >60 mg/day), though antidepressant benefit often plateaus beyond 60 mg/day. | Serotonin-norepinephrine reuptake inhibitor (SNRI). | CYP1A2, CYP2D6 | Single-dose mean 12 h; Single-dose range 8–17 h; Steady-state mean 12 h | No | — | - Blood pressure and heart rate at baseline and periodically, especially during titration and at higher doses.
- Liver-injury symptoms (jaundice, dark urine, abdominal pain, pruritus), particularly in patients with alcohol use disorder or hepatic disease; LFTs are obtained when clinically indicated.
- Sodium in older adults or diuretic users if symptoms suggest hyponatremia (confusion, fatigue, falls).
- Medication reconciliation for serotonergic combinations and for CYP2D6 substrates (TCAs, antipsychotics, beta-blockers, tamoxifen).
| No | 2025-10-05 |
|---|