| Depression (label). View labelExact | Label initiation is typically 200 mg/day divided BID, with titration toward 300–600 mg/day as tolerated; dose increases are commonly spaced at one-week intervals in labeling (label). | Serotonin antagonist and reuptake inhibitor (SARI-like): inhibits serotonin/norepinephrine uptake with 5-HT2 and α1 antagonism; notable for rare but life-threatening hepatic failure and strong CYP3A4 inhibition. | CYP3A4 | Single-dose range 2–4 h | No | | - Baseline assessment for liver disease and review of hepatic warning signs/symptoms at follow-up (label/clinical).
- Medication reconciliation focused on CYP3A4 interactions, including sedative-hypnotics and common non-psychiatric drugs (label/clinical).
- Orthostatic vitals and functional safety (falls risk), especially in older adults and polypharmacy (clinical).
- Suicidality and mood switching surveillance early in treatment and after dose changes (label/clinical).
| No | 2025-12-30 |
|---|
trazodoneAdjunctive therapyBrands: DESYREL, OLEPTRO | Major depressive disorder (label); commonly used off label for insomnia. View labelExact | Insomnia (off label): start 25–50 mg at bedtime; typical 50–150 mg nightly based on tolerability; reassess frequently and avoid open-ended dose escalation. | Serotonin antagonist and reuptake inhibitor (SARI); 5-HT2 antagonism with weak SERT inhibition plus H1/α1 effects. | CYP3A4 | Single-dose mean 7 h; Single-dose range 5–13 h | No | | - Monitor orthostatic symptoms and falls risk during initiation and after dose increases, especially in older adults or those on antihypertensives.
- Reassess mood and suicidality during antidepressant initiation and titration; ensure the dose matches the target (sleep vs depression).
- Review QT-risk co-medications and consider ECG/electrolytes when risk factors stack.
- If used primarily for insomnia, document a stop plan and reassess regularly rather than continuing indefinitely.
| No | 2026-02-22 |
|---|
| 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 |
|---|