Pregnancy: Risk cannot be ruled out.
Lactation: Caution advised or effect undetermined.
Contraindications: Within 2 weeks of stopping MAOIs or 1 day of stopping moclobemide or linezolid.
Precautions: Hepatic or severe renal (CrCl, 30 mL/min) impairment, serotonin syndrome, cardiovascular disease, bleeding disorders, glaucoma, epilepsy (discontinue if new or increased seizures), ECT, diabetes, hyponatraemia. History of mania; discontinue if patient enters a manic phase. History of suicide-related events; monitor for suicidal ideation. Withdraw gradually.
All types of depressive illness, depression accompanied by anxiety. Obsessive compulsive disorder. Panic disorder with or without agoraphobia. Symptoms of social phobia.
Depression: Adults: Initially 20 mg once daily in the morning with food. If necessary increase gradually after minimum 2 weeks in 10 mg increments; maximum 50 mg daily.
Obsessive compulsive disorder: Adults: Initially 20 mg once daily in the morning with food. Increase weekly 10 mg increments to 40 mg daily; maximum 60 mg daily.
MAOIs, pimozide, linezolid, moclobemide, perphenazine, risperidone, other antipsychotics, atomoxetine, classic antiarrhythmics, metoprolol, tramadol, tryptophan, lithium, phenytoin, TCADs, fosamprenavir, ritonavir, drug affecting liver enzymes (e.g. phenytoin, carbamazepine, phenobarbital, rifampicin), oral anticoagulants, NSAIDs, drugs that increase risk of bleeding, procyclidine, alcohol, St. John's Wort, other SSRIs, SNRIs, 5HT1 agonists/triptans, other serotonergic drugs, tamoxifen. Liquid only: drugs affecting gastric pH.
GI upset, decreased appetite, somnolence, sweating, tremor, headache, asthenia, dry mouth, dizziness, blurred vision, yawning, abnormal dreams, insomnia, agitation, weight gain, elevated cholesterol levels, sexual dysfunction, dystonic reactions, akathisia. Rarely, serotonin or neuroleptic malignant syndrome, hyponatraemia, haemorrhage.