Indications & Dose: DIABETIC NEUROPATHY PO Adult 60mg OD | FIBROMYALGIA PO Adult 30mg OD for 1wk, increase to 60mg ODchronic musculoskeletal pain | GENERALIZED ANXIETY DISORDER PO Adult Initially 30-60mg/day as single dose; patients initiated at 30mg/day should be titrated to 60mg/day after 1 wk, max 120mg/day | MAJOR DEPRESSIVE DISORDER PO Adult Initially 40-60mg/day in 2 divided doses or given as a single daily dose of 60mg, MD 60mg OD; for doses >60mg/day, titrate dose in increments of 30mg/day over 1 wk as tolerated, max 120mg/day | STRESS URINARY INCONTINENCE Moderate-to-severe PO Adult 40mg BIDin women

Precautions: Hepatic insufficiency, severe renal impairment, hyponatremia, history of mania, seizures, heavy alcohol use, children, concurrent use of potent CYP1A2 inhibitors

ADR: Serious: Serotonin syndrome, life-threatening hemorrhage, hepatotoxicity, increased risk of suicidal ideation, orthostatic hypotension, syncope, blurred vision, Others: mydriasis, fatigue, somnolence, dizziness, asthenia, headache, agitation, tremor, insomnia, anxiety, nasopharyngitis, dyspepsia, nausea, vomiting, diarrhea, constipation, erectile/ejaculatory dysfunction, decreased libido, muscle cramps, URTI, hot flashes, decreased appetite, pruritus, seasonal allergy, abnormal bleeding, pyrexia

DDI: Serious MAOIs/Linezolid causes serotonin syndrome, Paroxetine/Fluvoxamine increases AUC of drug level, Ciprofloxacin/Cimetidine increases drug level, TCAs increases risk of serotonin syndrome, Lorazepam increases sedation, Tolterodine level increases

Diet: With/without food

Monitor: BP, mental status for depression, suicidal ideation anxiety, social functioning, mania, panic attacks, glucose levels & HbA1c levels in diabetic patients, SeCr, BUN, transaminases