Classification Antidepressant selective serotonin uptake inhibitor

See also Antidepressants, Tricyclic and Selective Serotonin Reuptake Inhibitors.

Action/Kinetics: Mechanism in obsessive-compulsive disorders is likely due to inhibition of serotonin reup-take in the CNS. Produces few if any anticholinergic, sedative, or orthos-tatic hypotensive effects. Maximum plasma levels: 3-8 hr. About 80% if bound to plasma proteins. tV2: 13.6-15.6 hr. Peak plasma concentration: 88-546 ng/mL. Time to

■ reach steady state: 3-8 hr. Elderly clients manifest higher mean plasma levels and a decreased clearance. Metabolized in the liver and excreted through the urine.

Uses: Obsessive-compulsive disorder (as defined in DSM-III-R) for adults, adolescents, and children. Non-FDA Approved Uses: Treatment of depression.

Contraindications: Concomitant use with astemizole or terfenadine. Alcohol ingestion. Use with MAO inhibitors or within 14 days of discontinuing treatment with an MAO inhibitor. Lactation.

Special Concerns: Use with caution in clients with a history of mania, seizure disorders, and liver dysfunction and in those with diseases that could affect hemodynamic responses or metabolism. Safety and efficacy have not been determined in children less than 18 years of age. Side Effects: Side effects listed occur at an incidence of 0.1% or greater. CNS: Somnolence, insomnia, nervousness, dizziness, tremor, anxiety, hypertonia, agitation, decreased libido, depression, CNS stimulation, amnesia, apathy, hyperkinesia, hy-pokinesia, manic reaction, myoclo-nus, psychoses, fatigue, malaise, agoraphobia, akathisia, ataxia, convulsion, delirium, delusion, de-personalization, drug dependence, dyskinesia, dystonia, emotional lability, euphoria, extrapyramidal syndrome, unsteady gait, hallucinations, hemiplegia, hostility, hyper-somnia, hypochondriasis, hypoto-nia, hysteria, incoordination, increased libido, neuralgia, paralysis, paranoia, phobia, sleep disorders, stupor, twitching, vertigo. Oral: Dry mouth, dysphagia, toothache, tooth caries, gingivitis, glossitis, stomatitis. GI: Nausea, diarrhea, constipation, dyspepsia, anorexia, vomiting, flatulence, dysphagia, colitis, eructation, esophagitis, gastritis, gastroenteritis, GI hemorrhage, GI ulcer, hemorrhoids, melena, rectal hemorrhage. CV: Palpitations, hypertension, postural hypotension, vasodilation, syncope, tachycardia, angina pectoris, bradycardia, cardiomyopathy, CV disease, cold extremities, conduction delay, heart failure, MI, pallor, irregular pulse, ST segment changes. Respiratory: Upper respiratory infection, dyspnea, yawn, increased cough, sinusitis, asthma, bronchitis, epistaxis, hoarseness, hyperventilation. Body as a whole: Headache, asthenia, flu syndrome, chills, malaise, edema, weight gain or loss, dehydration, hypercholesterolemia, allergic reaction, neck pain, neck rigidity, photosensitivity, suicide attempt. Dermatologic: Excessive sweating, acne, alopecia, dry skin, eczema, ex-foliative dermatitis, furunculosis, se-borrhea, skin discoloration, urticaria. Musculoskeletal: Arthralgia, arthritis, bursitis, generalized muscle spasm, myasthenia, tendinous contracture, tenosynovitis. GU: Delayed ejaculation, urinary frequency, impotence, anorgasmia, urinary retention, anu-ria, breast pain, cystitis, delayed menstruation, dysuria, female lactation, hematuria, menopause, menor-rhagia, metrorrhagia, nocturia, poly-uria, PMS, urinary incontinence, UTI, urinary urgency, impaired urination, vaginal hemorrhage, vaginitis. Hematologic: Anemia, ecchymosis, leukocytosis, lymphadenopathy, thrombocytopenia. Ophthalmic: Amblyopia, abnormal accommodation, conjunctivitis, diplopia, dry eyes, eye pain, mydriasis, photophobia, visual field defect. Otic: Deafness, ear pain, otitis media. Miscellaneous: Taste perversion or loss, parosmia, hypothyroidism, hyper-cholesterolemia, dehydration.

Drug Interactions Astemisole / T Risk of severe cardiovascular effects, including QT prolongation, ventricular tachycardia,


and torsades de pointes (may be fatal)

Carbamazepine / T Risk of carba-mazepine toxicity Diazepam / T Effect of diazepam due to l clearance MAO inhibitors / Serious and possibly fatal reactions, including hy-perthermia, rigidity, myoclonus, rapid fluctuations of VS, changes in mental status (agitation, delirium, coma)

Methadone / T Risk of methadone toxicity

Midazolam / T Effect of midazolam due to l clearance Terfenadine / T Risk of severe cardiovascular effects, including QT prolongation, ventricular tachycardia, and torsades de pointes (may be fatal)

Triazolam / T Effect of triazolam due to l clearance Tricyclic antidepressants / Significant T in plasma levels of tricyclic antidepressants

How Supplied: Tablet: 50 mg, 100 mg


Obsessive-compulsive disorder. Adults, initial: 50 mg at bedtime; then, increase the dose in 50-mg increments q 4-7 days, as tolerated, until a maximum benefit is reached, not to exceed 300 mg/day. Children and adolescents: 25 mg at bedtime; then, increase the dose in 25-mg increments q 4-7 days until a maximum benefit is reached, not to exceed 200 mg/day.

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