Indications & Dose: CATAPLEXY ASSOCIATED WITH NARCOLEPSY Adjuvant therapy PO Adult Initially 10mg/day, gradually increase upto 75mg/day | DEPRESSION PO Adult Initially 10mg/day, increase gradually 30 -150mg/day if needed, in severe cases, >250mg/day may be given Elderly Initially 10mg/day, increase gradually over 10 days to 30-75mg/day if needed | IV Adult Inf: 50-75mg/day over 1.5-3h, switch to oral therapy after satisfactory response is achieved | IM Adult Initially 25-50mg/day, gradually increase to a max of 100-150mg/day, switch to oral therapy as soon as possible | OBSESSIVE-COMPULSIVE DISORDER PO Adult Initially 25mg/day, may gradually increase over the first 2 wk to 100mg/day in divided doses, MD 250mg/day Child >10 yr: Initially: 25mg/day, gradually increase over the first 2-wks to 3mg/kg/day or 100mg/day (whichever is less) in divided doses, MD 3mg/kg/day or 200 mg/day Elderly Initially 10mg/day increased gradually over 2 wk to 100-150mg/day | IV Adult Inf: 50-75mg/day over 1.5 to 3h, switch to oral therapy after satisfactory response is achieved | IM Adult Initially 25-50mg/day, gradually increase to a max of 100-150mg/day, switch to oral therapy as soon as possible | PANIC DISORDER PO Adult Initially 25mg/day increased gradually over 2 wk to 100-150mg/day Elderly Initially 10mg/day increased gradually over 2 wk to 100-150mg/day

Precautions: Glaucoma, hyperthyroidism, pre-existing CVD, elderly, prostatic hypertrophy

ADR: Serious: seizures, arrhythmias, MI, precipitation of heart block, bone marrow depression, paralytic ileus, agranulocytosis, thrombocytopenia, SIADH, leukopenia, tinnitus, blurred vision, Others: dysphagia, pruritus, libido, abnormal taste, chills, edema, lethargy, urinary tract dilation, testicular swelling, breast enlargement, menstrual irregularities, salivation, gynecomastia, stomatitis, parotid gland swelling, male sexual dysfunction, muscle weakness, flushing, increased appetite, weight gain, black tongue, epigastric distress, nasal congestion, laryngitis, nausea, vomiting

DDI: Serious ACEIs enhances risk of postural hypotension, Hormonal Contraceptives increases drug level, Cimetidine/Carbamazepine raises drug level, Oxybutynin reduces drug level, Noradrenaline results in exaggerated response like hypertension, cardiac arrhythmia, Loop diuretics/Corticosteroids/Thiazides results in hypokalemia, MAOIs results in very toxic & fatal reactions like serotonin syndrome

Diet: With food

Monitor: Pulse rate, BP, ECG/cardiac status, suicidal ideation