| Depression; off-label adjunct for narcolepsy-related cataplexy. View labelExact | Initiate 5 mg three to four times daily (15–20 mg/day) and increase by 5 mg every 3–5 days as tolerated to a usual target of 20–40 mg/day (maximum 60 mg/day). | Secondary amine tricyclic antidepressant; enhances norepinephrine with minimal sedative effect. | CYP2D6, CYP2C19 | Single-dose mean 54 h | 70–250 ng/mL | | - QTc: consider ECG monitoring when risk factors or QT-prolongers are present.
| No | 2025-10-05 |
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maprotilineAdjunctive therapyBrands: LudiomilLabel unavailableUnavailable | Depression, especially with neurovegetative symptoms. Label unavailableUnavailable | Common initiation pattern: 25 mg at bedtime with 25 mg increases every 3–7 days based on tolerability to a typical maintenance dose of 75–150 mg/day (single HS or divided). | Tetracyclic antidepressant; potent norepinephrine reuptake inhibitor with antihistamine activity. | CYP2D6 | Single-dose mean 51 h; Steady-state mean 52 h | 200–400 ng/mL | | - Baseline and follow-up ECGs (QRS/QT) for patients with cardiac disease, electrolyte abnormalities, doses >150 mg/day, or QT-active co-medications; urgent evaluation is warranted for syncope or palpitations.
- Therapeutic drug monitoring at steady state (≥10 days), after dose changes, and after starting/stopping CYP2D6 inhibitors is commonly used to stay within the therapeutic window and avoid high plasma levels.
- Seizure risk review at each visit: prior seizure history, sleep deprivation, alcohol use, and other seizure-threshold–lowering drugs (bupropion, tramadol, antipsychotics).
- Orthostatic vitals, sedation, and falls risk—especially in older adults and during titration; dose timing changes and driving precautions are commonly discussed.
- Anticholinergic burden (constipation, urinary retention, confusion); bowel regimens and reduction of additive anticholinergic polypharmacy are often considered when feasible.
- Suicide risk and overdose safety: dispense limited quantities when risk is elevated and include locked-storage counseling.
| No | 2025-10-05 |
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| 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 |
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