📋 Indications & Clinical Dosage
*Depressive illness, Generalized anxiety disorder, Obsessive-compulsive disorder:*
Adult: 10 mg once daily; increased if necessary up to 20 mg daily.
Elderly: Initially 5 mg once daily; max. 10 mg per day.
*Panic disorder:*
Adult: Initially 5 mg once daily for 7 days, then increased to 10 mg daily; max. 20 mg per day.
Elderly: Initially 2.5 mg once daily; max. 10 mg per day.
*Social anxiety disorder:*
Adult: Initially 10 mg once daily for 2-4 weeks, dose to be adjusted after 2-4 weeks of treatment; usual dose 5-20 mg daily.
⛔ Contraindications
QT-interval prolongation, serotonin syndrome.
⚠️ Precautions & Warnings
Hepatic or renal impairment, Susceptibility to QT-interval prolongation, diabetes, history of mania/hypomania, epilepsy, seizures, hyponatraemia, bleeding disorders. Monitor for suicide risk. ECT. Withdraw gradually
🔄 Drug Interactions
MAOIs, serotonergic agonists, other SSRIs, an-ticoagulants, antiplatelets, lithium, tryptophan, St. Johns Wort, omeprazole, cimetidine. Substrates of CYP2D6 or 2C19, drugs causing hyponatraemia or reducing seizure threshold
⚠️ Adverse Reactions / Side Effects
Abnormal dreams, alopecia bruxism, epistaxis, fatigue, paraesthesia, pyrexia, restlessness, sinusitis, yawning, confusion, menstrual disturbances, mydriasis, oedema, pruritus, syncope, hepatitis, paradoxical increased anxiety during initial treatment of panic disorder (reduce dose), postural hypotension, tachycardia, taste disturbance, tinnitus. Rare: Aggression, bradycardia, depersonalization, QT interval prolongation, thrombocytopenia
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid unless potential benefit outweighs risk
Lactation / Breastfeeding:
Contraindicated, avoid
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.