Indications & Dose: BULIMIA NERVOSA PO Adult 60mg OD | DEPRESSION PO Adult 20mg/day, may increase after several wk by 20mg/day increments, max 80mg/day, doses >20mg may be given OD/BID Child 8-18 yr: 10mg OD increased after 1-2 wk if necessary, max 20mg/day. Lower-weight children can be started at 10mg/day, may increase to 20mg/day after 1 wk if needed | OBSESSIVE-COMPULSIVE DISORDER PO Adult Initially 20mg/day, if inadequate response may increase after several wk upto 20-60mg/day, max 80mg/day Child Initially 10mg/day, may be increase after several wk to 20-30mg/day in low-weight children, if required adolescents & heavier children may be increase to 20mg/day after 2 wk, further increase to 60mg/day may be made after several wk, as necessary | PANIC DISORDER PO Adult Initially 10mg/day after 1 wk increase to 20mg/day, further increased to 60mg/day after several wk if there is no improvement | PREMENSTRUAL DYSPHORIC DISORDER PO Adult 20mg/day continuously/start 14 days prior to menstruation & through first full day of menses (repeat with each cycle)

Precautions: Hepatic/renal impairment, CVD, history of seizures, DM

ADR: Serious: Seizures, suicidal ideation, prolonged QT interval, hypoglycemia, respiratory distress, hypocalcemia, hyponatremia, hypouricemia, Others: Anxiety, drowsiness, headache, insomnia, dizziness, fatigue, nervousness, tremor, visual disturbances, urinary frequency, sexual dysfunction, dysmenorrhea, dyspepsia, dry mouth, anorexia, sinusitis, pharyngitis, nausea, vomiting, diarrhea, constipation, diaphoresis, URTI, dyspnea, flushing, muscle pain, pruritus, flu like symptoms, hot flashes

DDI: Serious Cyproheptadine decrease in or reversal of drug effects, Warfarin/Digoxin increases risk of adverse reactions to either drug, Ritonavir/Efavirenz/Saquinavir increases risk of serotonin syndrome, Sedatives/hypnotics/Antihistamines leads to additive CNS depression, Methadone levels increases, Alprazolam metabolism decreases & effects increases, MAOIs results in confusion, agitation, seizures, hypertension, hyperpyrexia & serotonin syndrome

Diet: With/without food

Monitor: Depression, suicidal ideation, anxiety, social functioning, mania, panic attacks, akathisia, sleep status, blood glucose, LFTs