Educational only — not medical advice.If you’re in crisis or thinking about suicide: call or text 988 (U.S.) or your local emergency number. Support resources.Under construction and review—see the updates log.
Typical dose range: 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).
Therapeutic drug monitoring recommended; reference range 200–400 ng/mL.
Last reviewed: 2025-10-05
Dosing & forms
Forms/strengths: Tablets: 25 mg, 50 mg, 75 mg.
Frequency: 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).
Typical range: 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).
Therapeutic range: 200–400 ng/mL
Mechanism (brief)
Tetracyclic antidepressant; potent norepinephrine reuptake inhibitor with antihistamine activity.
Metabolism & Half‑life
Metabolism: CYP2D6
Half‑life: Single-dose mean 51 h; Steady-state mean 52 h
Therapeutic Drug Monitoring (TDM)
Recommended: Yes
Reference range: 200–400 ng/mL
Label unavailableUnavailable
Monitoring highlights
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.