Dosing & Uses
Dosage Forms & Strengths
Outpatient: 25-50 mg PO qHS initially; increase by 25 mg every 5-7 days to 100-200 mg/day (may divide doses throughout day or give at bedtime); if needed, may increase to 300 mg/day
Inpatient: 100-300 mg PO qDay
Postherpetic Neuralgia (Off-label)
65-100 mg PO qDay for at least 3 weeks
Migraine Prophylaxis (Off-label)
10-25 mg PO qHS; 10-400 mg PO qHS dose range
Eating Disorder (Off-label)
150 mg PO qHS for 8 weeks
10-25 mg PO qHS; may increase by 10-25 mg increments qWeek if needed and as tolerated
Dosage range: 25-150 mg/day
- Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)
- Consider alternatives; if must use, initiate with lower initial dose
Dosage Forms & Strengths
- Initial: 25-50 mg/day PO in divided doses
- Increase gradually to 100 mg/day in divided doses
Analgesia for Chronic Pain (Off-label)
Maintenance: 0.5-2 mg/kg PO qHS
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Extrapyramidal symptoms (EPS)
Ocular pressure increased
Black Box Warnings
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses; this increase was not seen in patients over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years
In children and young adults, the risks must be weighed against the benefits of taking antidepressants
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments; the patient’s family should communicate any abrupt changes in behavior to the healthcare provider
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
This drug is not approved for use in pediatric patients <12 years
Not FDA approved for treatment of bipolar depression
Acute recovery phase following MI
Concurrent use with cisapride
Contraindicated within 14 days of MAOIs; if linezolid or IV methylene blue (MAOIs) must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first
Bone marrow suppression reported
Avoid use in narrow-angle glaucoma
May cause sedation and impair mental and physical abilities
Avoid use with any drugs or conditions that prolong QT interval
May cause orthostatic hypotension
Use caution in patients with cardiovascular disease, diabetes, mania, hepatic and renal impairment, thyroid dysfunction, and seizure disorder
May worsen mania symptoms or precipitate mania in patients with bipolar disorder
Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years)
Risk of anticholinergic side effects; may cause constipation, urinary retention, blurred vision, and xerostomia
Use caution in patients with urinary retention, open-angle glaucoma, BPH, decreased gastrointestinal motility, or paralytic ileus
Possibility of EPS and neuroleptic malignant syndrome
Abrupt discontinuation of therapy not recommended in patients receiving high doses for prolonged periods
Fractures reported with therapy
Pregnancy & Lactation
Pregnancy category: C
Lactation: Distributed in breast milk; do not nurse (AAP states effect on nursing infants is unknown but may be of concern)
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; anticholinergic
Peak serum time: 4 hr
Metabolized by hepatic CYP2C19, CYP3A4
Half-life: 9-27 hr
Excretion: Urine (18%), small amounts in feces
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.