Mipramine HCI:

• Usual initial adult dose for outpatients is 75 mg/day increased to 150 mg/day. Doses over 200 mg/day are not recommended. Maintenance dose is 50 to 150 mg/day.
• For hospitalized patients, usual initial adult dosage is 100 mg/day in divided doses gradually increased to 200 mg/day as required. If no response occurs after 2 weeks, increase dose to 250 to 300 mg/day.
• For adolescents and elderly patients, usual initial dose is 30 to 40 mg/day, not to exceed 100 mg/day.
• Childhood bed wetting - An oral dosage of 25 mg/day given 1 hour before bedtime should be tried in children 6 years of age and older.
• If satisfactory response does not occur within 1 week, increase the dose to 50 mg nightly in children younger than 12 years of age; children older than 12 may receive up to 75 mg nightly.
• Doses larger than 75 mg do not work better and tend to incense the side effects.

Imipramine HCI (cant.):

• Consider instituting a drug-free period following an adequate therapeutic trial with a favorable response.
• To reduce the tendency to relapse, taper dosage gradually rather than discontinue abruptly.

Imipramine pamaate:

• Initiate adult dose for outpatients at 75 mg/day and increase to 150 mg/day, which is the dose level at which optimum response is usually obtained. If necessary, dose may be increased to 200 mg/day. Doses higher than 75 mg/day may also be administered on a once-a­day basis at bedtime after the optimum dosage and tolerance have been determined.
• Maintenance dosage is usually 75 to 150 mg/day administered on a once-a-day basis, preferably at bedtime.

Nortriptyline:

• Usual adult dosage is 25 mg 3 to 4 times daily. As an alternative regimen, the total daily dose may be given once a day.
• Doses above 150 mg/day per day are not recommended.
• Usual dosage in elderly patients is 30 to 50 mg/day in divided doses.

Protriptyline:

• Usual adult dosage is 15 to 40 mg/day divided into 3 or 4 doses. If necessary, dose may be increased to 60 mg/day. Make dose increases with the morning dose.
• Doses above 60 mg/day are not recommended.
• For elderly patients, the usual dosage is 5 mg 3 times a day initially and is increased gradually. The cardiovascular system must be monitored closely if the daily dose exceeds 20 mg.

Trimipramine:

• Usual initial adult dosage for outpatients is 75 mg/day in divided doses. May be increased to 150 mg/day if needed.
• Doses over 200 mg/day are not recommended.
• Hospitalized patients may be given 100 mg/day initially in divided doses, increased gradually in a few days to 200 mg/day. If improvement does not occur in 2 to 3 weeks, the dose may be increased to the maxi­mum recommended dose of 250 to 300 mg/day.
• Usual initial dose for adolescents and elderly patients is 50 mg/day, increasing in gradual increments up to 100 mg/day.

Type of drug:

Antidepressants; mood-elevating agents.

How the Drug Works:

Tricyclic antidepressants (TCAs) appear to adjust or rebalance the brain’s own natural chemicals (neurotransmitters), which control mood, feelings, and behaviors. The effect may take a few weeks (1 to 4) to be noticed.

Uses:

For the relief of symptoms of depression (except clomipramine).

Clomipramine: Only for the treatment of obsessive-compulsive disorder.

Doxepin: To treat anxiety.

Imipramine: For the treatment of bedwetting in children 6 years of age and older after possible organic causes have been excluded by appropriate tests.

Unlabeled Uses: Occasionally doctors may prescribe doxepin, clomipramine, imipramine, or amitriptyline to control chronic pain and to treat bulimia. Imipramine, clomipramine, nortriptyline, and other tricyclic anti­depressants have also been used to treat panic disorder. Amitriptyline has been used to prevent the onset of cluster and migraine headaches and to treat pathologic weeping and laughing secondary to forebrain disease. Protriptyline has been used in the treatment of obstructive sleep apnea. Trimipramine and doxepin have been studied in the treatment of peptic ulcer disease and to treat skin disorders. Desipramine has been used to facilitate cocaine withdrawal and to treat bulimia. Clomipramine and nortriptyline have been used to treat panic disorder. Nortriptyline has also been used to treat skin disorders and premenstrual depression.

Precautions:

Tardive Dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with these drugs. Occurrence is highest among the elderly, especially women. The risk of developing these involuntary movements and the likelihood that they will become permanent are increased as the length of treatment and the total amount of drug given increases. However, it is possible to develop these symptoms after short-term treatment at low doses.

Neuroleptic Malignant Syndrome (NMS) Is a potentially fatal syndrome associated with use of tricyclic antidepressants. Symptoms include increased body heat, muscle rigidity, altered mental abilities including catatonia, irregular pulse or irregular blood pressure, increased heart rate, sweating, and irregular heart rhythm.

Withdrawal Symptoms: Stopping abruptly after prolonged therapy may pro­duce nausea, headache, dizziness, nightmares, and malaise. Clomipramine may also cause vomiting, sleep disturbances, hyperthermia (abnormally high temperature), and irritability. Gradual dose reduction may produce, within 2 weeks, transient symptoms including irritability, restlessness, dreams, and sleep disturbances.

Sensitivity to sunlight: May occur. Avoid prolonged exposure to the sun. Use sunscreens and wear protective clothing until tolerance is determined. These drugs may reduce tolerance to hot weather.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus. There have been a few reports of birth defects associated with use of imipramine and amitriptyline. Withdrawal symptoms have been seen in newborns of mothers who have taken clomipramine, desipramine, or imipramine until delivery.

Breastfeeding: Tricyclic antidepressants appear in breast milk. Because of the potential for adverse reactions, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Amitriptyline and doxepin are not recommended for patients younger than 12 years of age. Safety and effectiveness have not been established for amoxapine in children younger than 16 years of age. Imipramine HCI use in bed wetting should be limited to children 6 years of age or older. The safety and effectiveness of imipramine HCI in children with conditions other than bed wetting have not been established. Safety and effectiveness have not been established for clomipramine in children younger than 10 years of age. Trimipramine, nortriptyline, desipramine, imipramine pamoate, and protriptyline are not recommended for use in children.

Elderly: Elderly patients are particularly sensitive to the anticholinergic effects (eg, constipation; difficulty urinating; confusion) of tricyclic antideprossants and may be at increased risk for falls. Lower than normal adult doses are generally used when starting therapy.

Type of Drug:

Antidepressant; mood-elevating agent
How the Venlafaxie Product Works:

Venlafaxine inhibits neuronal uptake of serotonin and norepinephrine in the central nervous system, which is believed to combat depression and other behavioral disorders.
Uses of The Venlafaxie:

The treatment of depression. The extended-release form is also used to treat generalized anxiety disorder.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Venlafaxine appears the breast milk. A decision should be made to either discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Children: Safety and effectiveness in children younger than 18 years of age have not been established.
Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with venlafaxine HCI. Doses of one or both drugs may need to be modified or a different drug may need to be prescribod. The following drugs and drug classes interact with venlafaxino HCl.

*

MAOls (eg, phenelzine)
* Sibutramine (Meridia)

Side Effects:

Every drug is capable of producing side effects. Many venlafaxine HCI users experience no or minor side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Circulatory System: Increased blood pressure; increased heart rate; decreased blood pressure upon rising; flushing.

Digestive Tract: Nausea; constipation; appetite loss; diarrhea; vomiting; indigestion; stomach pain; gas; difficulty swallowing; dry mouth;belching.

Nervous System: Drowsiness; sleeplessness; dizziness; nervousness; headache; vertigo (feeling of whirling motion); migraine; anxiety; tremor; abnormal dreams; abnormal skin sensations; agitation; confusion; impaired memory; depression; abnormal thinking; unstable emotions; lockjaw; twitching; depersonalization; decreased sex drive; muscle stiffness.

Respiratory System: Yawning; bronchitis; difficulty breathing; runny nose; cough.

Senses: Blurred vision; taste changes; ringing in the ears; dilated pupils; ear pain; vision changes.

Skin: Sweating; rash; itching; flushing.

Urinary and Reproductive Tract: Abnormal ejaculation or orgasm; impotence; impaired urination; urinary frequency; menstrual disorders; blood in the urine; painful or difficult urination; irregular bleeding between periods; inflammation of the vagina with itching or abnormal discharge; urinary retention.

Other: Weakness; infection; chills; chest pain; weight gain or loss; accidental injury; general body discomfort; neck pain; muscle pain; joint pain; swelling of hands or feet; unusual bruising.
Guidelines for Use:

*

Tablets - Usual adult starting dose is 75 mg/day, taken in 2 or 3 divided doses. Dosage may be gradually increased to achieve the desired effect.
*

Extended-release capsules - Usual adult starting dose is 75 mg/day taken as a single dose.
*

Take each dose with food.
*

Do not crush, chew, or dissolve extended-release capsules in water. Swallow extended-release capsules whole, with fluid.
*

If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If several doses are missed or it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist. Use exactly as prescribed.
*

Do not change the dose or stop taking venlafaxine unless advised to do so by your doctor.
*

If venlafaxine therapy is discontinued, the dose should be gradually reduced over a 2-week period.
*

Smaller doses should be used in patients with moderate liver or kidney impairment.
*

Venlafaxine should not be used in combination with an MAOI, or within at least 14 days of discontinuing treatment with an MAOI. After stop­ping venlafaxine, at least 7 days should elapse before starting an MAOI.
*

Because any psychoactive drug may impair judgment, thinking, or motor skills, do not operate hazardous machinery, including automobiles, until you are reasonably certain that venlafaxine does not adversely affect your ability to engage in such activities.
*

Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding during therapy.
*

Notify your doctor if rash, hives, or other allergic reactions occur.
*

Blood pressure will be monitored during treatment.
*

Notify your doctor or pharmacist if you are taking other prescription drugs, over-the-counter drugs, or supplements.
*

Avoid alcohol use during venlafaxine therapy.
*

Store at room temperature (68 to 77°F). Keep container tightly closed.

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Fluvoxamine - Guidelines for Using Fluvoxamine - Uses and Benefits

Type of Drug:

Antidepressant; mood elevating agent.

How the Fluvoxamine Works:

It is believed that fluvoxamine maleate adjusts or balances how the brain and nervous system produce and respond to their natural chemicals (called neurotransmitters). Fluvoxamine maleate inhibits the reuptake of serotonin by the brain.

Uses of The Fluvoxamine:

For the treatment of obsessions and compulsions in patients with obsessive-compulsive disorder (OCD)

Smoking: This medicine may not be as effective if you are a smoker.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Fluvoxamine appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness are not established in children younger than 8 years of age.

Elderly: Use lower initial doses; then increase gradually if necessary.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking fluvoxamine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with fluvoxamine:

• Benzodiazepines propranolol (eg, Inderal)
• Diltiazem (eg, Cardizem)
• Iithium (eg, Lithobid)
• Phenytoin (eg, oilantin)
• Sumatriptan (Imitrex)
• Theophylline (eg, Theo-our)
• Thioridazine (eg, Mellaril)

Side Effects:

Every drug is capable of producing side effects. Many fluvoxamine users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; constipation; indigestion; diarrhea; stomach pain; appetite loss; gas; dry mouth; difficulty swallowing; tooth disorder; sore throat.

Nervous System: Headache; memory loss; apathy; twitching; sleepless­ness; nervousness; agitation; anxiety; dizziness; drowsiness; depression; weakness; tremors; mania; unstable emotions; CNS stimulation; abnormal thinking; psychotic reaction.

Circulatory System: Rapid heart beat; changes in blood pressure; fainting; flushing; palpitations (pounding in the chest).

Respiratory System: Nasal congestion; yawn; difficulty breathing; cough; sinus problems; upper respiratory tract infection.

Other: Sweating; taste changes; vision problems; frequent urination; decreased sex drive; inability to achieve orgasm; abnormal ejaculation; painful menstruation; muscular hyperactivity; infection; leg cramps; rash; muscle tension; urinary retention; muscle pain; unusual bruising; nosebleed; abnormal liver enzymes; decreased mobility or movement; general body discomfort; flu-like syndrome; weight changes; chills; swelling of feet, ankles, or hands.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Usual adult starting dose is 50 mg, taken as a single dose at bedtime. The dosage may be increased by 50 mg/day every 4 to 7 days, if necessary, to achieve maximum benefit. The total dosage should not exceed 300 mg/day. Total doses greater than 100 mg should be taken in 2 divided doses. If the doses are not equal, the larger dose should be taken at bedtime.
• Usual pediatric (8 to 17 years of age) starting dose is 25 mg at bed­time. The dosage may be increased by 25 mg/day every 4 to 7 days, if necessary, to achieve maximum benefit. The total dosage should not exceed 200 mg/day. Total doses greater than 50 mg should be taken in 2 divided doses. If the doses are not equal, the larger dose should be given at bedtime.
• Do not discontinue the medication or change the dose unless directed by your doctor.
• May be taken without regard to food.
• If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Contact your doctor if you develop a rash, hives, other allergic reactions, or seizures. Also contact your doctor if nausea, dry mouth, sleeplessness, or drowsiness become troublesome.
• May cause drowsiness, dizziness, or impaired judgement. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Do not use in combination with MAOls or within 14 days of discontinuing treatment with an MAOI. After stopping treatment with this medication, wait at least 2 weeks before starting an MAOI.
• Avoid alcohol and smoking while using this medication. Smoking may reduce the effectiveness of the medication.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or if you are breastfeeding.
• Store at controlled room temperature (59° to 86°F) in a tightly closed container. Protect from moisture.