| Depression; nocturnal enuresis in children (lower doses). View labelExact | Depression (adult): typical starting doses are 25–50 mg at bedtime, with increases of 25–50 mg every 3–7 days to 150–200 mg/day (single bedtime dose or divided). Maximum 300 mg/day is typically reserved for inpatient settings with monitoring. | Tricyclic antidepressant; blocks serotonin and norepinephrine reuptake with anticholinergic effects. | CYP2D6, CYP1A2 | Single-dose mean 19 h; Steady-state mean 24 h | 150–300 ng/mL | | - Baseline ECG and electrolytes when cardiac risk is present or when higher doses are used; recheck ECG when symptoms (palpitations, syncope) occur or when QT-active drugs are added.
- Anticholinergic adverse effects (constipation, urinary retention, delirium), especially in older adults; dose reduction is often safer than adding more anticholinergics.
- TDM for suspected toxicity, nonadherence, or poor response, particularly when CYP2D6 inhibitors are co-prescribed.
| No | 2025-12-29 |
|---|
| 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 |
|---|
| Obsessive-compulsive disorder; depression when other treatments fail. View labelExact | Typical initiation is 25 mg at bedtime; increase by 25 mg every 3–4 days as tolerated. | Tricyclic antidepressant; potent serotonin reuptake inhibition. | CYP2D6, CYP3A4 | Single-dose mean 32 h; Steady-state mean 37 h | 150–300 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 | 2025-10-05 |
|---|