📋 Indications & Clinical Dosage
*Major depression, Social anxiety disorder, Post-traumatic stress disorder, Generalized anxiety disorder:*
Adult: 20 mg daily in the morning; max.50 mg per day.
*Obsessive-compulsive disorder:*
Adult: Initially 20 mg daily in the morning, increased in steps of 10 mg, dose to be increased gradually, increased to 40 mg daily; max.60 mg per day.
Elderly: Initially 20 mg daily in the morning, increased in steps of 10 mg; max. 40 mg per day.
*Panic disorder:*
Adult: Initially 10 mg daily in the morning, increased in steps of 10 mg, dose to be increased gradually, increased to 40 mg daily; max.60 mg per day.
Elderly: Initially 10 mg daily in the morning, increased in steps of 10 mg; max. 40 mg per day.
⚠️ Precautions & Warnings
Hepatic or severe renal impairment, achlorhydria, high gastric pH, serotonin syndrome, cardiovascular disease, bleeding disorders, glaucoma, epilepsy (discontinue if new or increased seizures), ECT, diabetes, hyponatraemia, history of mania; discontinue if patient enters a manic phase. History of suicide-related events; monitor for suicidal idea-tion. Withdraw gradually.
🔄 Drug Interactions
MAOls, pimozide, linezolid, moclobemide, per-phenazine, risperidone, other antipsychotics, atomoxetine, classic antiarrhythmics, metoprolol, tramadol, tryptophan, lithium, phenytoin, TCADs, fosamprenavir, ritonavir, drug affecting liver enzymes (e.g. phenytoin, carbamazepine, phe-nobarbital, rifampicin), oral anticoagulants, NSAIDs, drugs that increase risk of bleeding, procyclidine, alcohol, St. Johns Wort, other SSR1s, SNRIs, 5HT1 agonists/triptans, other serotonergic drugs, tamoxifen. Liquid only: Drugs affecting gastric pH.
⚠️ Adverse Reactions / Side Effects
Arrhythmias, abnormal dreams, raised cholesterol, confusion, urinary incontinence, extrapyramidal reactions, orofacial dystonias, tinnitus, withdrawal reactions. Rare: Depersonalisation, neuroleptic malignant syndrome-like event, panic attacks, paradoxical increased anxiety during initial treatment of panic disorder (reduce dose), restless legs syndrome, hepatic disorders, hepatitis, peripheral oedema, priapism, glaucoma (very rare)
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid unless potential benefit outweighs risk
Lactation / Breastfeeding:
Contraindicated, avoid