| Treatment-resistant depression in adults (as monotherapy or with an oral antidepressant); depressive symptoms in adults with MDD with acute suicidal ideation or behavior (with an oral antidepressant); REMS-restricted (label). View labelExact | Administration occurs under direct observation in a certified healthcare setting with post-dose monitoring for at least 2 hours (label/REMS). | Intranasal NMDA receptor antagonist (esketamine) used under a REMS for treatment-resistant depression (as monotherapy or with an oral antidepressant) and depressive symptoms in MDD with acute suicidal ideation/behavior (with an oral antidepressant); administered in a certified healthcare setting due to sedation, dissociation, respiratory depression, and abuse/misuse risk. | CYP2B6, CYP3A4, CYP2C9, CYP2C19 | Single-dose range 7–12 h | No | | - Observe for sedation and dissociation for at least 2 hours after dosing, with assessment of clinical stability before discharge (label/REMS).
- Respiratory status monitoring during the post-dose window (including pulse oximetry) (label).
- Blood pressure checks before dosing and during post-dose observation (label).
- Abuse/misuse risk screening and ongoing monitoring (label/clinical).
- Suicidal thoughts and behaviors monitoring during treatment changes (label).
| No | 2026-03-25 |
|---|
| Major depressive disorder; generalized anxiety disorder; social anxiety disorder; panic disorder. View labelExact | Initiate XR 37.5 mg once daily with food for 4–7 days, then 75 mg/day; increase by 75 mg increments at ≥7-day intervals up to 225 mg/day (300 mg off-label). | Serotonin-norepinephrine reuptake inhibitor (SNRI). | CYP2D6, CYP3A4 (minor), UGT | Single-dose mean 5 h; Single-dose range 4–6 h; Steady-state mean 11 h; Steady-state range 9–13 h | No | — | - Blood pressure and heart rate at baseline and after titration, with extra attention at higher doses.
- Discontinuation symptoms during missed doses or tapering; plan refill timing and taper steps proactively.
- Sodium in older adults or diuretic users if symptoms suggest hyponatremia (confusion, fatigue, falls).
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
- Medication reconciliation to avoid serotonergic combinations and to plan MAOI washouts when regimens change.
| No | 2025-10-05 |
|---|
| Major depressive disorder. View labelExact | Typical adult initiation: 15 mg at bedtime; increase to 30 mg after 1–2 weeks based on response; usual maintenance 15–45 mg nightly. | Central presynaptic alpha-2 antagonist; enhances noradrenergic and serotonergic transmission (NaSSA). | CYP1A2, CYP2D6, CYP3A4 | Single-dose mean 30 h; Single-dose range 20–40 h; Steady-state mean 37 h | No | | - Weight and appetite changes, plus fasting lipids and glucose at baseline and periodically, given weight gain and dyslipidemia risk.
- Daytime sedation and falls risk, especially in older adults and when other sedatives are co-prescribed.
- Infection symptoms (fever, sore throat) given rare neutropenia; prompt evaluation is appropriate when symptoms arise.
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
| No | 2025-10-05 |
|---|
bupropionAdjunctive therapyBrands: WELLBUTRIN | MDD; seasonal affective disorder; smoking cessation (SR). View labelExact | XL: start 150 mg qAM for 3–7 days, increase to 300 mg qAM; may increase to 450 mg qAM if needed. | Norepinephrine–dopamine reuptake inhibitor (NDRI). | CYP2B6 | Steady-state mean 21 h | No | — | - Blood pressure at baseline and after dose changes, especially when nicotine replacement is used.
- Seizure risk factors (eating disorder history, alcohol/benzodiazepine withdrawal, electrolyte disturbances) before initiation and at follow-up.
- Sleep and anxiety during early titration; dose timing and titration speed are common levers for tolerability.
- Mood elevation or agitation in bipolar-spectrum illness; coordinate prevention plans via the bipolar disorder hub.
- Medication list review to ensure only one bupropion-containing product is active (to reduce accidental dose escalation across brands).
| No | 2026-02-12 |
|---|