Major depressive episodes, social anxiety, generalized anxiety & obsessive-compulsive disorder 10 mg once daily. May increase to a max of 20 mg. Panic disorder w/ or w/o agoraphobia Initially 5 mg daily for the 1st wk then increase to 10 mg daily. May further increase to a max of 20 mg daily depending on individual patient's response. Elderly >65 yr Initially 5 mg. Patient w/ reduced hepatic function & poor metabolisers of CYP2C19 Initially 5 mg during the 1st 2 wk. May increase to 10 mg daily.
Monitor for appearance of suicidal symptoms. Patients w/ CHD; history of mania/hypomania; known bleeding tendencies. A low starting dose is advised to reduce the likelihood of an anxiogenic effect in patients w/ panic disorder. Discontinue in any patient who develops seizures or if there is an increase in seizure frequency; in those entering a manic phase; & if serotonin syndrome develops. Avoid use in patients w/ unstable epilepsy & carefully monitor patients w/ controlled epilepsy. May alter glycaemic control in patients w/ diabetes. Increased risk of suicidal thoughts, self harm & suicide (suicide-related events). Akathisia; hyponatraemia; cutaneous bleeding abnormalities eg, ecchymoses & purpura. Concomitant use of oral anticoagulants; medicinal products known to affect platelet function eg, atypical antipsychotics & phenothiazines, most TCAs, ASA & NSAIDs, ticlopidine & dipyridamole; reversible, selective MAO-A inhibitors; sumatriptan or other triptans, tramadol & tryptophan; St. John's wort. Electroconvulsive therapy. May impair ability to drive & use machines. Renal & hepatic impairment. Pregnancy & lactation. Not to be used in the treatment of childn & adolescents <18 yr. Elderly >65 yr.
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