| Depression, including depression with anxiety or agitation (label). View labelExact | Label dosing is individualized. A common initiation is 50 mg two or three times daily with gradual increases based on response and tolerability (label). | Dibenzoxazepine antidepressant with norepinephrine/serotonin reuptake inhibition and clinically meaningful dopamine receptor blockade (EPS/TD risk). | CYP2D6 | Single-dose mean 8 h | No | | - Movement-disorder screening for EPS (rigidity, tremor, akathisia) and abnormal movements concerning for tardive dyskinesia, especially during titration and at higher doses (label/clinical).
- Seizure risk review (history, co-medications) and reassessment when dose escalation is considered (label/clinical).
- Orthostatic vitals, falls risk, and anticholinergic burden (bowel and bladder symptoms, cognition), especially in older adults (clinical).
- ECG planning in patients with cardiac history, older age, electrolyte disturbance risk, or multiple QT-active drugs (clinical).
- Suicidality and mood switching surveillance early in treatment and after dose changes (label/clinical).
| No | 2026-03-31 |
|---|
| 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 |
|---|
| Schizophrenia; acute manic/mixed episodes; bipolar depression; adjunct for major depressive disorder. View labelExact | Schizophrenia (IR): day 1 25 mg BID, titrate to 300–400 mg/day by day 4; maintenance 300–800 mg/day divided BID. | Antagonist at 5‑HT2A and D2 (transient), strong H1 and alpha‑1 activity. | CYP3A4 | Steady-state mean 6 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| No | 2025-09-23 |
|---|