Type of Drug:

Central nervous system stimulant.

How the Drug Works:

Dexmethylphenidate is thought to block reuptake of norepinephrine and dopamine in the brain, but the exact mechanism of action is not known.

Uses:

Dexmethylphenidate is indicated for the treatment of attention deficit hyperactivity disorder (ADHD).

Precautions:

Drug Dependence: Dexmethylphenidate should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic, abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Psychotic episodes can occur.

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

Breastfeeding: It is not known if dexmethylphenidate is excreted in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and efficacy in children younger than 6 years of age have not been established.

Drug Interactions:

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

• Anticonvulsants (eg, phenytoin)
• Antidepressants (eg, amitriptyline, sertraline)
• Centrally acting alpha-2 agonists (eg, clonidine)
• Coumarin anticoagulants (eg, warfarin)
• Dopamine (eg, Inotrpin)
• Epinephrine (eg, Adrenalin Chloride)
• Phenylephrine (eg, Rhinall)

Side Effects:

Every drug is capable of producing side effects. Many patients 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; stomach pain; appetite loss.

Nervous System: Dizziness; drowsiness; sleeplessness; headache; nervousness; Tourette syndrome; involuntary movements; abnormal thinking or hallucinations.

Circulatory System: Irregular heartbeat; pulse increased or decreased; chest pain; pounding in the chest (palpitations); changes in blood pressure.

Other: Fever; weight loss; skin rash; joint pain.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not take more frequently than prescribed. This drug can be addicting.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed 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.
• May be administered with or without food.
• Tell your doctor if you have ever abused or been dependent on alcohol or drugs, or if you are now abusing or dependent on alcohol or drugs.
• May cause sleeplessness. Avoid taking these medications late in the day.
• Notify your doctor if you experience blurred vision.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Growth (weight gain and height ) will be monitored by a doctor during therapy. Bb to keep appointments
• Store at room temperature (59 0 to 86°F).

Type of Drug:

Nonbarbiturate sedative/hypnotics. Central nervous system depressant. Short-term sleep aid.

How the Drug Works:

Nonbarbiturate sedatives and hypnotics act on the central nervous system (brain), causing drowsiness to aid in falling asleep, They are less likely to cause a slower breathing rate than barbiturate-type sedative hypnotics.

Should sleeplessness persist, a drug-free interval of 1 or more weeks should elapse before retreatment is considered. An attempt should be made to find alternative non drug therapy in chronic sleeplessness.

Uses

Chloral hydrate: To lessen anxiety and produce sleep before surgery. After surgery, chloral hydrate may be used with other medications to control pain. Also used to prevent or suppress alcohol withdrawal symptoms (suppositories).

Unlabeled Uses: Occasionally doctors may prescribe ethchlorvynol as a sedative at doses of 100 mg to 200 mg 2 or 3 times daily.

Precautions:

Dependence: Long-term use may result in dependence. Withdrawal symptoms (eg, rebound insomnia) may occur when the drug is stopped abruptly after long-term use.

Ethchlorvynol: Patients who exhibit unpredictable behavior, restlessness, or excitement in response to barbiturates or alcohol may react in this manner to ethchlorvynol. This drug should not be used for the management of insomnia in the presence of pain, unless sleep loss persists after pain is controlled with pain relievers.

Triazolam: Short-term episodes of significant memory loss have been reported with the use of triazolam. Patients, especially the elderly, may become confused or disoriented and may attempt to wander after taking the drug. Upon waking in the morning, the patient may not remember the episode.

Pregnancy: Do not use benzodiazepines during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Use of ethchlorvynol is not recommended during the first and second trirmesters of pregnancy. Use during the third trimester of pregnancy may produce. Symptoms in the newborn (eg, jitteriness, hyperactivity, restlessness, irrtability, disturbed sleep, hunger). There are no adequate and well controlled studies for other sedative/hypnotics in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Benzodiazepines, chloral hydrate, zaleplon, and zolpidem appear in breast milk. It is not known if the other sedative/hypnotics appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of estazolam, ethchlorvynol, quazepam, temazepam, triazolam, zaleplon, and zolpidem have not been established in patients younger than 18 years of age. Safety and effectiveness of flurazepam have not been established in patients younger than 15 years of age. These drugs are generally not recommended for use in children.

Elderly: Use with caution. Elderly patients may be more sensitive to these drugs. There is a risk of over sedation, “morning hangover” (grogginess in the morning), dizziness, and confusion. Smaller doses may be needed. See triazolam precaution.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include blood counts, urinalysis, blood chemistry, and liver and kidney function tests.

Tartrazine: Some of these products may contain tartrazine dye (FD&C Yellow No.5), which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over the-counter or prescription medications with non barbiturate sedatives. 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 non barbiturate sedatives:

• Azole antifungal agents (eg, ketoconazole)
• Cimetidine (eg, Tagamet)
• Contraceptives, oral (eg, Ortho-Novum)

Side Effects:

Every drug is capable of producing side effects. Many nonbarbiturate sedative 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: Stomach pain or upset; vomiting; nausea; diarrhea; constipation; indigestion; appetite loss; gastric irritation; colitis.

Nervous System: Confusion; drowsiness; dizziness; hallucinations; headache; anxiety; depression; facial numbness; nervousness; vertigo (feeling of whirling motion); memory loss; drugged feeling; lethargy; sleeplessness; abnormal thinking; depersonalization; agitation; light­headedness; abnormal dreams; sleep disorder; euphoria (exaggerated sense of well being); incoordination; weakness; tremor.

Circulatory System: Abnormal blood counts; palpitations (pounding in the chest).

Skin: Jaundice (yellowing of skin or eyes); rash; hives; itching; abnormal skin sensations.

Other: Allergy; back pain; chest pain; fatigue; flu-like symptoms; blurred vision; mild “hangover”; aftertaste; dry mouth; urinary tract infection; conjunctivitis; migraine; arthritis; fever; double vision; abnormal vision; muscle, joint, ear, or eye pain; swelling of the arms or legs; general body discomfort; photosensitivity; sinus infection; sore throat; runny nose; bronchitis; distorted sense of smell; nosebleed; painful menstruation; abnormal acuteness of hearing; muscle tension; muscle pain; falling.

Benzodiazepines only

Digestive Tract: Heartburn; appetite loss; nausea; vomiting; diarrhea; constipation; stomach pain; indigestion; taste alterations; dry mouth.

Nervous System: Drowsiness; nervousness; talkativeness; apprehension; irritability; euphoria (exaggerated sense of well being); relaxed feeling; tremor; memory loss; tiredness; general body discomfort; dreaming or nightmares; depression; in coordination; confusion; hangover; abnormal thinking; anxiety; dizziness; disorientation; weakness; agitation; speech disorder; daytime drowsiness; feeling of whirling motion.

Circulatory System: Palpitations (pounding in the chest); chest pain.

Other: Abnormal skin sensations; joint or body pain; weakness; headache; genitourinary complaints;falling; staggering; rash; itching; leg or back pain stiffness.

Guidelines for Use:

• Dosage is individualized.
• Do not change the dose or stop taking unless advised by your doctor.
• Take immediately before going to bed.
• May cause dizziness, drowsiness, or blurred vision. Do not drive or per­form other tasks requiring alertness, coordination, or physical dexterity.
• Avoid alcohol and other drugs that cause drowsiness (eg, pain relievers, sedatives).
• Contact your doctor if you notice any unusual or disturbing thoughts or behaviors during treatment with any sleep medicine.
• Do not take any sleep medicine unless you are able to get a full night of sleep before you must be active again.
• May cause photosensitivity (sensitivity to light). Avoid prolonged expo­sure to the sun. Use sunscreens and wear protective clothing until tolerance is determined.
• May be habit forming. Do not discontinue drug abruptly after prolonged use, especially if you have a history of seizures, regardless of other anti seizure medications you may be taking.
• Contact your doctor if visual changes, irregular heartbeats, chest pains, yellowing of skin or eyes, rash, or unusual bleeding or bruising occurs.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Benzodiazepines – Nighttime sleep may be disturbed for 1 or 2 nights following stopping of the drug. Tell your doctor if you are pregnant, plan to become pregnant, or become pregnant while taking this medicine.
• Chloral hydrate May cause stomach upset. Take capsules with a full glass of water or other liquid. Swallow capsules whole. Do not crush or chew. Dilute syrup in a half glass of water, ginger ale, or fruit juice.
• Ethchlorvynol- Symptoms of giddiness, incoordination, and stomach upset may be reduced if medication is taken with food.
• Triazolam – Do not take when a full night’s sleep and elimination of the drug from the body are not possible before the need to be active and functional. May cause amnesia.
• Zaleplon – Do not take with or immediately following a high fat or heavy meal. May cause sleepiness during the day. Daytime drowsiness can be best avoided by taking the lowest possible dose. May cause amnesia. In most cases, memory problems can be avoided if zaleplon is taken only when you are able to get 4 hours or more of sleep before being active.
• Zolpidem – For faster sleep onset, do not take with or immediately after a meal.

Type of Drug:

Drugs used to elevate blood pressure.

How the Midodrine Product Works:

Midodrine causes blood vessels to constrict (become smaller), resulting in an increase in blood pressure

Uses of The Midodrine:

To treat symptoms of orthostatic hypotension (feeling dizzy or lightheaded when rising from a sitting or standing position, or feelings of dizziness while standing). Use only in patients whose lives are considerably impaired despite standard clinical care, such as support stockings, fluid expansion and lifestyle changes.

Unlabeled Uses: To manage urinary incontinence

Precautions:

Supine hypertension is the most potentially serious side effect of midodrine. Supine (lying) and sitting blood pressures should be monitored. Supine hypertension can often be controlled by not lying totally flat (eg, sleeping with the head of the bed elevated).

Pregnancy: Adequate studies have not been done in pregnant women, or animal studies may have shown a risk to the fetus. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if midodrine appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness are not established.

Lab Tests: Lab tests will be required to monitor therapy. Lab tests may include blood pressure tests kidney and liver function tests.

Drug Interactions:

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

• Alpha-adrenergic blockers (eg, doxazoxin)
• Cardiac glycosides (eg, digoxin)
• Phenylephrine phenylpropanolamine (eg, Contac)
• Metformin (Glucophage)
• Ranitidine (eg, Zantac)

Side Effects:

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

Nervous System: Numbness or tingling in scalp, hands or feet; pain; headache; feeling of pressure/fullness in the head; facial flushing; confusion; abnormal thinking; nervousness; anxiety.

Skin: Goosebumps; itching; rash.

Other: Painful or difficult urination; high blood pressure while lying or sitting; chills; dry mouth.

Guidelines for Use:

• Use exactly as prescribed.
• Usual dose is 10 mg, taken three times daily. Take during the daytime hours when you are upright and pursuing daily activities. A suggested dosing schedule of approximately 4 hour intervals is: Shortly before or upon arising in the morning, midday and late afternoon (not later than 6 pm). Doses may be taken in 3 hour intervals if required to control symptoms, but not more frequently. Do not take after the evening meal or less than 4 hours before bedtime.
• 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 in order to “catch up” (unless advised to do so 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.
• Supine (lying down) hypertension can often be controlled by not lying totally flat (eg, sleeping with the head of the bed elevated).
• Tell your doctor or pharmacist about any over-the-counter medications you are taking (eg, cold remedies, diet aids); they can increase the side effects of this medicine.
• Contact your doctor if you experience pounding in the ears, headache, blurred vision, slow pulse, increased dizziness, fainting, cardiac awareness, goosebumps, sensation of coldness or urinary retention.
• Continue taking this medicine, even if your symptoms of low blood pressure are controlled.
• Monitor blood pressure in both the lying and sitting positions.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59 to 77°F), out of the reach of children.

Diflunisal – Type of Drug – Some Interactions occurring with Diflunisal

Type of Drug:

Anti-inflammatory; analgesic (pain reliever).

How the Drug Works:

Diflunisal decreases inflammation and relieves pain by inhibiting prostaglandin synthesis. It is not a steroid or a narcotic.

Uses:

To relieve mild to moderate pain, inflammation, and rheumatoid arthritis and osteopathic pain.

Precautions:

• Pregnancy: Safety for use during pregnancy has not been established. Use with caution during the first and second trimesters. Do not use during the third trimester.

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

• Children: Safety and effectiveness have not been established. Use in children younger than 12 years of age is not recommended. Acetylsalicylic acid has been associated with Reye syndrome. Since diflunisal is a salicylic acid derivative, the possibility of its association with Reye syndrome cannot be excluded. Consult your doctor.

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 diflunisal. 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 diflunisal:

• Acetaminophen (eg, Tylenol)
• Hydrochlorothiazide (eg, Hydro)
• Antacids (eg, Tums) DIURIL)

Side Effects:

Every drug is capable of producing side effects. Many diflunisal 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: Stomach pain; gas; diarrhea; nausea; constipation; ulcers; indigestion; vomiting.

• Nervous System: Headache; dizziness; nervousness; sleeplessness; confusion; fatigue or tiredness.

• Skin: Rash; itching; sweating; sensitivity to light.

• Other: Ringing in the ears or difficulty hearing; edema (fluid retention); swelling.

Guidelines for Use:

• May cause stomach upset. Take with water, milk, or meals.
• Chronic gastrointestinal upset or any signs of bleeding should be reported to your doctor.
• Swallow tablets whole. Do not crush or chew.
• Do not take aspirin or acetaminophen with diflunisal. Consult your doctor.
• 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 1 dose is missed, contact your doctor or pharmacist.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun. Use sunscreens and wear protective clothing until tolerance is determined.

Allopurinol – Type of Drug – Some Interactions occurring with Allopurinol

Type of Drug:

Agent for gout; xanthine oxidase inhibitor.

How the Allopurinol Product Works:

Gout is a hereditary form of arthritis caused by increased uric acid levels in the blood. Allopurinol prevents the formation of uric acid in the body by inhibiting an enzyme (xanthine oxidase) involved in the production of uric acid.

Uses of The Allopurinol:

To prevent the signs and symptoms of primary or secondary gout (eg, acute attacks, tophi, joint destruction, uric acid kidney stones, kidney damage).

To manage uric acid elevations in serum (hyperuricemia) and urine (uricosuria) in patients treated for leukemia, lymphoma, and other malignancies.

Precautions:

Do not use in the following situations: Allergy or severe reaction to allopurinol.

Use with caution in the following situations:

Acute attacks of gout may increase during the early stages of allopurinol use. The attacks usually become shorter and less severe after several months of therapy. Even with adequate therapy, it may require several months to deplete the uric acid pool sufficiently to control acute episodes.

Fluid intake: Drink a sufficient amount of fluid to yield a urinary output of at least 2 quarts a day and to maintain a neutral or slightly alkaline urine. This will help prevent the formation of kidney stones while taking allopurinol.

Allergy: Discontinue at the first appearance of rash or other signs of an allergic reaction. In some instances, rash may be followed by more severe reactions such as itching; hives; red lesions; and loss of hair, skin, or fingernails.

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

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

Children: Allopurinol is rarely used in children with the exception of those with hyperuricemia secondary to malignancy or to certain rare inborn errors of purine metabolism.

Lab Tests: Lab tests will be required during treatment with allopurinol. Tests may include uric acid level, blood counts, and kidney and liver function tests.

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 allopurinol. 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 allopurinol.

• Aamoxicillin (eg, Amoxil)
• Ampicillin (eg, Principen)
• Anticoagulants (eg, dicumarol)
• Azathioprine (eg, Imuran)
• Chlorpropamide (eg, oiabinese)

Side Effects:

Every drug is capable of producing side effects. Many allopurinol 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: Stomach upset; diarrhea; nausea.

Skin: Chills; rash; scaling or sloughing of skin.

Other: Acute gout attacks; joint pain; drowsiness.

Guidelines for Use:

• Gout and secondary hyperuricemia (maintenance) – The average dose of allopurinol is 200 to 300 mg/day for patients with mild gout and 400 to 600 mg/day for those with moderate-to-severe gout. The dose may be administered in divided doses or as a single equivalent dose with the 300 mg tablet. Daily doses more than 300 mg should be administered in divided doses. The minimum effective dose is 100 to 200 mg/day, and the maximum recommended dose is 800 mg/day. It is recommended that the patient be started with a low dose (100 mg) and increased at weekly intervals by 100 mg until a serum uric acid level of 6 mg/dL or less is attained, not exceeding the maximum recommended dose.
• Prevention of uric acid kidney disease during the vigorous chemotherapy of tumors – 600 to 800 mg/day for 2 or 3 days along with a high fluid intake.
• Recurrent kidney stones in patients with high levels of uric acid in the urine – 200 to 300 mg/day in single or divided doses.
• Secondary hyperuricemia in children – Children 6 to 10 years of age with secondary hyperuricemia (increased uric acid in the blood) associated with severe diseases may be given 300 mg/day, while those less than 6 years of age are generally given 150 mg/day.
• To minimize stomach upset, take after meals.
• If a dose is missed, simply take your next dose at the regularly scheduled time. Do not attempt to make up for the missed dose.
• May take 2 to 6 weeks to become effective. Do not skip doses or stop taking this drug prematurely.
• Drink plenty of fluids while taking allopurinol, at least 10 to 12 full (8 oz) glasses a day, to prevent kidney stones.
• May cause drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Discontinue allopurinol and notify your doctor immediately at the first sign of appetite loss, weight loss, rash, painful urination, blood in the urine, irritation of the eyes, or swelling of the lips or mouth.
• Avoid large doses of vitamin C as this may increase the possibility of kidney stone formation.
• Allopurinol does not treat acute gout attacks. Other medications (eg, colchicine, indomethacin) are used to treat the acute attack.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at 59° to 77° F in a dry place. Protect from light.

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.