Indications & Dose: GENERALIZED ANXIETY DISORDER PO Adult Initially 20mg OD, increase in increments of 10mg/day at 1-wk intervals if needed, max 50mg Elderly Initially 10mg/day, increase if needed by 10mg/day increments at intervals of at least 1wk, max 40mg/day | MAJOR DEPRESSIVE DISORDER PO Adult Initially 20mg OD, preferably in the morning; increase if needed by 10mg/day increments at intervals of at least 1wk, max 50mg/day Elderly Initially 10mg/day, increase if needed by 10mg/day increments at intervals of at least 1wk, max 40mg/day | OBSESSIVE-COMPULSIVE DISORDER PO Adult Initially 20mg OD, increase if needed by 10mg/day increments at intervals of at least 1-wk, MD 40mg/day, max 60mg/day Elderly Initially 10mg/day, increase if needed by 10mg/day increments at intervals of at least 1wk, max 40mg/day | PANIC DISORDER PO Adult Initially 10mg OD, increase if needed by 10mg/day increments at intervals of at least 1 wk, MD 40-60mg/day | POST-TRAUMATIC STRESS DISORDER PO Adult Initially 20mg OD, increase if needed by 10mg/day increments at intervals of at least 1 wk upto 20-50mg Elderly Initially 10mg/day, increase if needed by 10mg/day increments at intervals of at least 1wk, max 40mg/day | PREMENSTRUAL DYSPHORIC DISORDER PO Adult Modified preparation: Initially 12.5mg OD, may be increased to 25mg/day at wkly intervals. Treatment may be continued throughout the menstrual cycle/limited to the luteal phase | SOCIAL ANXIETY DISORDER PO Adult Initially 20mg OD, increase by 10mg/day increments after several wks, max 50/60mg daily

Precautions: Severe renal/hepatic impairment, narrow-angle glaucoma, history of seizures, increased risk of suicide attempt, hyponatremia, elderly/debilitated patients, diseases/conditions that affect metabolism/hemodynamic responses, abnormal bleeding, avoid abrupt withdrawal

ADR: Serious: Cerebral ischemia, suicidal behavior/ideation, thrombophlebitis, myocardial ischemia, HTN, orthostatic hypotension, angina pectoris, tachycardia, supraventricular extrasystoles, myalgia, hypotension, UTI, blurred vision, Others: fatigue, ejaculatory disturbances, myopathy, joint pain, bronchitis, respiratory disorders, photosensitivity, pruritus, chills, edema, anxiety, agitation, dizziness, drowsiness, asthenia, vascular headache

DDI: Serious Cimetidine increases drug level, Tryptophan leads to adverse effects, Thioridazine leads to serious ventricular arrhythmias, sudden death, TCAs/Sumatriptan leads to serotonin syndrome, Amphetamine metabolism is reduced by drug, Theophylline toxicity raises

Diet: With/without food

Monitor: Clinical worsening or suicidal ideation