Major depressive episodes 10 mg daily. Dose may be further increased to a max of 20 mg. Panic disorder w/ or w/o agoraphobia Initially 5 mg in the 1st wk before increasing to 10 mg daily. Dose may be further increased up to a max of 20 mg daily. Generalized anxiety disorder & obsessive-compulsive disorder Initially 10 mg once daily. Max: 20 mg daily. Social anxiety 10 mg once daily for 2-4 wk. Dose may be subsequently decreased to 5 mg or increased to a max of 20 mg daily.
Do not use in treatment of childn & adolescents <18 yr.
Special Precautions
Increased anxiety symptoms at the start of treatment in some patients w/ panic disorder. Discontinue use when seizure or increase in seizure frequency (in patients w/ epilepsy) occurs. Patients w/ history of mania/hypomania, diabetes; or those taking oral anticoagulants or w/ known bleeding. Concomitant use w/ serotonergic drugs eg, sumatriptan or other triptans, tramadol & tryptophan; St. John's wort-containing prep. Pregnancy & lactation.
Synergism w/ MAOIs. Increased anticoagulant activity of some anticoagulants including acenocoumarol & warfarin or drugs that are known to affect platelet function. May antagonize effects of antiepileptics. Increased risk of ventricular arrhythmias w/ astemizole or terfenadine. Rapid development of delirium w/ clarithromycin when added to the existing regiment of fluoxetine-nitrazepam combination; increased plasma-fluoxetine conc (by CYP450 inhibition). Caution when in concomitant w/ medicines w/ serotonergic effects eg, sumatriptans or other triptans, tramadol & tryptophan. Increased incidence of adverse reactions w/ St. John's wort-containing prep.
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