| Depression. View labelExact | Label dosing is individualized. Outpatient adults: typically start 75 mg/day in divided doses, increasing to 150 mg/day; maximum outpatient dose is 200 mg/day. Hospitalized adults: start 100 mg/day, with a maximum of 250–300 mg/day. Adolescent and geriatric patients: start 50 mg/day with a maximum of 100 mg/day. Once at maintenance dose, the total daily amount can often be given as a single bedtime dose (label). | Tertiary-amine tricyclic antidepressant (TCA) with a sedating/anxiolytic clinical profile; mixed monoamine effects plus strong H1/α1/muscarinic antagonism. | CYP2D6, CYP3A4 | Single-dose range 23–24 h | 150–300 ng/mL | | - Baseline and follow-up ECG planning in patients with cardiac history, older age, electrolyte disturbance risk, or multiple QT-active drugs (clinical).
- TDM after steady state or after major interaction changes when response is partial or toxicity is suspected (Hiemke 2018/clinical).
- Orthostatic vitals, falls risk, and anticholinergic burden (bowel and bladder symptoms, cognition), especially in older adults (clinical).
- Suicidality and mood switching surveillance early in treatment and after dose changes, particularly in young adults and bipolar-spectrum illness (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 |
|---|
doxepinAdjunctive therapyBrands: Sinequan, Silenor | Depression and anxiety; low-dose formulation approved for insomnia. View labelExact | Depression/anxiety: typical start is 25–50 mg at bedtime; titrate by 25–50 mg every 3–4 days to 75–150 mg/day (single HS dose or divided BID). Max 300 mg/day inpatient with ECG monitoring. | Tricyclic antidepressant; strong antihistamine with serotonin and norepinephrine reuptake inhibition. | CYP2D6, CYP2C19 | Single-dose mean 28 h; Steady-state mean 31 h | 150–250 ng/mL | | - Sedation, next-day impairment, and falls risk (especially in older adults); driving and occupational safety are often reassessed after dose changes.
- Orthostatic vitals during titration and when combined with other hypotensive medications; hydration and slow position changes are commonly emphasized.
- Anticholinergic burden (constipation, urinary retention, confusion); bowel regimen planning and avoiding additive anticholinergic polypharmacy are common considerations when feasible.
- ECG monitoring for patients with cardiac disease, electrolyte abnormalities, or higher antidepressant doses; repeat ECGs are often considered when adding other QT-active agents.
- Therapeutic drug monitoring can be helpful in higher-dose depression regimens, drug interactions (CYP2D6/2C19 inhibitors), unexpected nonresponse, or suspected toxicity.
- Mood activation (mania/hypomania) in bipolar-spectrum illness and suicidal thinking during initiation; coordination via the bipolar disorder hub can support planning.
| No | 2025-12-29 |
|---|