Anxiety Drug Summary

Last updated: 23 October 2025
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Anticonvulsants

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Anticonvulsants

Anticonvulsants


Drug Dosage Remarks
Pregabalin General Anxiety Disorder:
Initial dose: 150 mg PO 24 hourly in 2-3 divided doses 
May increase to 300 mg/day after 1 week. Dose may be further increased to 450 mg/day after an additional week
Max dose: 600 mg/day after an additional week
 Adverse Reactions
  • CNS effects (somnolence, dizziness, fatigue, amnesia, headache, anxiety, drowsiness); GI effects (weight gain, dyspepsia, nausea/vomiting, diarrhea); Hematologic effects (decrease in WBC, leukopenia); Respiratory effects (respiratory infection, cough); Ophthalmologic effects (nystagmus, diplopia); Other effects (peripheral edema, ataxia, tremor, arthralgia, myalgia, purpura, weakness, viral infection)
  • May increase CPK
  • Rarely, pancreatitis, altered LFTs, Stevens-Johnson syndrome, and blood glucose fluctuations in DM
Special Instructions
  • Use with caution in patients with severe renal impairment, history of psychotic illness, with congestive heart failure (CHF), AV block, hypertension, DM, with history of angioedema episodes
  • Monitor for any emergence or worsening of depression, suicidal tendency, unusual changes in mood or behavior
  • Withdraw drug gradually (recommended ≥7 days) 

Anxiolytics


Drug Dosage Remarks
Etifoxine  150-200 mg/day PO in 2-3 divided doses Adverse Reactions
  • CNS effect (drowsiness); Dermatologic effects (rashes, pruritus, edema, urticaria); GI effects (hepatitis, lymphocytic colitis)
Special Instructions
  • Contraindicated in patients with severe hepatic or renal impairment, myasthenia gravis
  • Treatment should be discontinued in case of cutaneous or allergic reactions, hepatic impairment
Hydroxyzine
(Hydroxyzine pamoate) 		 25-100 mg PO 6-8 hourly 
Max single dose: 100 mg/day 		 Adverse Reactions
  • Drowsiness, sedation, dizziness, lassitude, CNS depression which may diminish over time
  • CNS effects (headache, psychomotor impairment); Antimuscarinic effects (dry mouth, blurred vision, urinary retention, constipation, gastroesophageal reflux disease [GERD]); Other effects (nausea/vomiting, sweating, myalgia, rash) 
Special Instructions
  • Use with caution in patients with glaucoma, prostatic hyperplasia and/or urinary stricture, asthma or COPD, CV disease, uncompensated heart failure or recent MI
  • Contraindicated in patients with or are predisposed to QT prolongation, severe liver disease
  • Monitor for any emergence or worsening of depression 

Atypical/2nd Generation Antipsychotics


Drug Dosage Remarks
Quetiapine  General Anxiety Disorder:
Extended-release:
Initial dose: : 50 mg PO 24 hourly in the evening (day 1 and 2), increase to 150 mg PO 24 hourly in the evening (day 3 and 4)
Recommended dose range:
50-150 mg depending on the clinical response and tolerability of the patient 
 Adverse Reactions
  • CNS effects (somnolence, dizziness, mild asthenia, syncope, neuroleptic malignant syndrome [NMS], EPS); GI effects (dry mouth, constipation, dyspepsia); CV effects (tachycardia, orthostatic hypotension); Other effects (peripheral edema, rhinitis, blurred vision)
Special Instructions
  • Should be administered prior to bedtime
  • Use with caution in combination with centrally acting drugs and alcohol, in CV and cerebrovascular diseases, conditions predisposing to hypotension, in seizures, EPS, tardive dyskinesia, and NMS, in patients with increased risk of suicidal thoughts, self-harm and suicide-related events

Azaspirodecanedione


Drug Dosage Remarks
Buspirone General Anxiety Disorder:
Initial dose: 10-15 mg or 5-7.5 mg PO 8-12 hourly
Increase gradually by 5-mg increments every 2-3 days based on patient’s response
Maintenance dose:  15-30 mg PO 24 hourly in 2-3 divided doses
Max dose: 60 mg/day 
 Adverse Reactions
  • CNS effects (dizziness, headache, nervousness, excitement, lightheadedness, sleep disturbances); GI effects (nausea/vomiting, diarrhea); Other effects (tinnitus, blurred vision, dry mouth) 
Special Instructions
  • Use with caution in patients with renal or hepatic dysfunction
  • Avoid in patients with epilepsy and severe hepatic or renal failure
  • Concurrent use with MAO inhibitors is not recommended

Benzodiazepines


Drug Dosage Remarks
Alprazolam  Regular-release
General Anxiety Disorder: 
Initial dose: 0.75-1.5 mg PO 24 hourly in divided doses 
Maintenance dose: 0.5-4 mg PO 24 hourly in divided doses 
Panic disorder: 
Initial dose: 0.5 mg PO 8 hourly or 0.5-1 mg PO at bedtime
Increase dose not exceeding 1 mg at intervals of 3-4 days
Max dose: 10 mg/day 
Regular-release
General Anxiety Disorder: 
Initial dose: 1 mg PO 24 hourly in 1-2 divided doses
Usual dose: 0.5-4 mg PO 24 hourly in 1-2 divided doses
Panic disorder: 
Initial dose: 0.5-1 mg PO at bedtime or 0.5 mg PO 12 hourly 
Increase dose not exceeding 1 mg at intervals of 3-4 days 		 Adverse Reactions
  • Dose-dependent adverse CNS effects are common. Other adverse reactions have been reported but they are exceedingly rare
  • Benzodiazepines have been associated with anterograde amnesia and paradoxical reactions
  • CNS and behavioral effects (drowsiness, ataxia, fatigue, confusion, dizziness, vertigo, syncope, headache, slurred speech, depression, aggression, hostility); Respiratory effects (respiratory depression, apnea, cough, bronchial hypersecretion); CV effect (hypotension); GI effects (nausea/vomiting, change in appetite, weight gain/loss, changes in salivation); Other effects (injection site reaction, anaphylaxis, hypersensitivity reactions, muscle tremor, weakness, changes in libido, urinary retention, visual disturbances)
  • Thrombophlebitis and increase in liver enzymes with some IV formulations
  • Tofisopam: Non-sedative, with no anticonvulsant and muscle relaxant properties
Special Instructions
  • Avoid use in patients with preexisting CNS depression, acute and chronic respiratory insufficiency, sleep apnea, acute narrow-angle glaucoma, and history of drug or alcohol dependence
  • Use with extreme caution, particularly in noncritical care settings, as these may cause severe respiratory depression, respiratory arrest or sleep apnea
  • Use with caution in patients with chronic muscle weakness, renal or hepatic impairment, in patients receiving other CNS depressants and in the elderly
  • Start with low dose and increase slowly based on patient response
  • Elderly patients should receive lower doses
  • Short-term use is preferred to avoid dependence and withdrawal symptoms
  • To avoid rebound or withdrawal symptoms, discontinue medication gradually over several weeks or more
  • At the end of dosing interval, breakthrough anxiety may occur
  • Monitor for any emergence or worsening of depression, suicidal tendency, unusual changes in mood or behavior
Bromazepam 1.5-3 mg or 6-12 mg PO in divided doses
Max dose: 60 mg/day 
Chlordiazepoxide1  5-25 mg PO 6-12 hourly
Max dose: 100 mg/day 
Clobazam  Initial dose: 20-30 mg PO 24 hourly in divided doses 
Dose may be given as a single dose at bedtime 
Clonazepam  Panic disorder:
Initial dose: 0.25 mg PO 12 hourly
May increase in increments of 0.125-0.25 mg PO 12 hourly every 3 days 
Dose may be given as a single dose at bedtime 
Maintenance dose: 1 mg/day 
Max dose: 4 mg/day 
Diazepam
 2-10 mg PO 6-12 hourly depending on severity or
2-10 mg IM or slow IV may be repeated 3-6 hours as needed
Max dose: 40 mg/day PO in 2-4 divided doses
Dipotassium clorazepate  30 mg PO 24 hourly in divided doses or 7.5-15 mg PO 12 hourly or 15 mg PO at bedtime 
Usual dose: 15-60 mg/day
Ethyl loflazepate  1-3 mg PO 24 hourly or in divided doses 
Fludiazepam  0.75 mg PO 24 hourly in 3 divided doses
Lorazepam  Initial dose: 2-3 mg PO 24 hourly in divided doses
Increase or decrease by 0.5 mg or 0.025-0.03 mg IM/IV may be repeated 6 hourly
Maintenance dose: 1-4 mg PO 24 hourly
Max dose: 6 mg/day 
Medazepam  10-30 mg PO 8-12 hourly
Max dose: 60 mg/day
Nordazepam  7.5-15 mg PO at bedtime 
Oxazepam
 10-30 mg PO 6-8 hourly 
Pinazepam  10 mg PO 12 hourly 
May increase to 20 mg/day in severe cases 
Prazepam  30 mg PO 24 hourly at bedtime or in divided doses
Max dose: 60 mg/day
Tofisopam
50 mg PO 8 hourly
1Chlordiazepoxide is also available in combination with Amitriptyline and Clidinium bromide. Please see the latest MIMS for specific formulations.

Beta-blocker


Drug Dosage Remarks
Propranolol Social Anxiety Disorder:
Initial dose: 40 mg PO 8-12 hourly
May increase by the same amount at weekly interval according to response
Usual dose: 80-160 mg/day
 Adverse Reactions
  • Not usually significant when only taken on an as-needed basis
  • CV effects (bradycardia, hypotension, heart block and heart failure in patients with preexisting CV disorders, Raynaud’s phenomenon); CNS and mental effects (fatigue, depression, dizziness, sleep disturbances); Other effects (bronchospasm, rash)
  • May interfere with carbohydrate and lipid metabolism
Special Instructions
  • Use with caution in patients with asthma, COPD, DM, renal or hepatic impairment, heart conduction problems (eg 2nd- or 3rd- degree heart blocks), uncontrolled heart failure

Conventional/1st Generation/Typical Antipsychotics


Drug Dosage Remarks
Benzamide
Sulpiride 50-150 mg/day PO Adverse Reactions
  • Same as Chlorpromazine
  • CNS effects (insomnia, drowsiness, EPS [tardive dyskinesia]); Endocrine effects (hyperprolactinemia, amenorrhea); Other effects (weight gain, increased liver enzymes)
  • Sleep disturbances, agitation, over stimulation, EPS occurs as often as with Chlorpromazine but may be milder
  • Less likely to cause sedation and hypotension; antimuscarinic effects are minimal
  • May exacerbate mania or hypomania
Special Instructions
  • Same as Chlorpromazine
  • Use with caution in manic or hypomanic patients, patients with pheochromocytoma, acute porphyria, prolactin-dependent tumors, epilepsy
  • Avoid use in patients with moderate-severe renal impairment
Butyrophenone
Haloperidol
 0.5 mg PO 12  hourly

Adverse Reactions

  • Same as Chlorpromazine
  • Less likely to cause sedation, hypotension and antimuscarinic side effects but EPS are more common

Special Instructions

  • Same as Chlorpromazine
  • Use with caution in children and adolescents due to increased risk of severe dystonic reactions
  • May cause severe EPS in patients with hyperthyroidism
Phenothiazines
Chlorpromazine 10 mg PO 6-8 hourly or
25 mg PO 8-12 hourly or 
75 mg PO at bedtime
Severe cases: 25 mg PO 8 hourly 
May be increased to 20-50 mg semi-weekly after 1-2 days 
Continue optimum dose for 2 weeks then gradually reduce to maintenance level 
Maintenance dose: 
75-300 mg/day 
Max dose: 1 g/day

Adverse Reactions

  • CV effects (orthostatic hypotension, tachycardia, cardiac arrhythmias); CNS effects (drowsiness, dystonia, akathisia, NMS, tardive dyskinesia, seizures); Dermatologic effects (skin pigmentation, allergic rashes); GI effects (xerostomia, nausea, constipation, weight gain); Hematologic effects (agranulocytosis, leukopenia; blood dyscrasias); Ophthalmologic effects (pigmentary retinopathy, corneal opacities, blurred vision); Other effects (galactorrhea, oligomenorrhea, urinary retention, sexual function disturbances, jaundice, EEG abnormalities, lowered seizure threshold)
  • Photosensitivity reactions are more common with Chlorpromazine than with other antipsychotics
  • Prochlorperazine, Flupentixol: Less likely to cause sedation or antimuscarinic effects but EPS are more common
  • Trifluoperazine, Fluphenazine: Less likely to cause sedation, hypotension, hypothermia or antimuscarinic effects but EPS are more common (especially if doses >6 mg/day)

Special Instructions

  • Contraindicated in patients with preexisting CNS depression or coma, bone marrow suppression, pheochromocytoma, prolactin-dependent tumors
  • Use with caution in patients with impaired liver, kidney, CV, cerebrovascular and respiratory function, angle-closure glaucoma, history of jaundice, Parkinson’s disease, hypothyroidism, myasthenia gravis (MG), paralytic ileus, prostatic hyperplasia, urinary retention, epilepsy, seizures, in the presence of acute infection or leukopenia
  • Flupentixol: Not recommended in states of over-activity or excitement, including mania
  • The sedative effects are most marked during the first few days of administration
  • Regular eye examinations are recommended for patients on long-term therapy
  • Monitor CBC in patients with fever or unexplained infection, LFTs
  • Patient should remain supine for at least 30 minutes after parenteral administration of Chlorpromazine; monitor BP during administration
  • Avoid abrupt withdrawal
Fluphenazine Severe anxiety: 
Initial dose: 12.5 mg deep IM injection
Subsequent adjustments in the amounts and the dosage interval should be made according to the patient’s response; the amounts required may range from 12.5-100 mg and the intervals required may range from 2 weeks to 5 or 6 weeks 
Prochlorperazine Adjunct in severe anxiety:
15-20 mg PO in divided doses
Max dose: 4-6 mg/day
 Trifluoperazine 1-2 mg PO 12-24 hourly
Max dose: 4-6 mg/day 
Max treatment duration: 12 weeks 
 Thioxanthene
Flupentixol1
(Flupenthixol) 		 0.5 mg PO 12 hourly 
May increase to 2 mg after 1 week if no adequate response
Max dose: 3 mg PO 24 hourly in divided doses 
1Flupentixol is also available in combination with Melitracen. Please see the latest MIMS for specific formulations.

Monoamine Oxidase Inhibitors (MAOIs)*


Drug Dosage Remarks
Reversible, Selective Inhibitor
Moclobemide  Social Anxiety Disorder: 
Initial dose: 300 mg PO 24 hourly 
May increase up to 600 mg PO 24 hourly in 2 divided doses after 3 days 
Continue for 8-12 weeks 		 Adverse Reactions
  • CNS and mental effects (dizziness, headache, drowsiness, fatigue, nervousness, agitation, euphoria, insomnia, convulsion, hyperreflexia); GI effects (dry mouth, constipation, nausea/vomiting); CV effects (orthostatic hypotension, edema, tachycardia); Other effects (skin rash, edema, muscle tremors, weakness, sweating, sexual dysfunction)
  • Side effects are frequent and more severe than other antidepressants
Special Instructions
  • Avoid in patients with liver disease, cerebrovascular disease
  • Contraindicated in patients with pheochromocytoma, acute confusional states, congestive heart failure
  • Use with caution in patients with CV disease, DM, hyperthyroidism, blood disorders, renal and hepatic diseases, elderly and agitated patients
  • Potentially fatal hypertensive crises may occur if combined with foods containing tyramine and these foods should be avoided while taking MAOIs and for 14 days after discontinuation (eg cheeses, meat/yeast extracts, smoked foods, pickled herrings, broad bean pods, fermented soya products, alcoholic beverages)
  • Potentially fatal drug interactions occur with sympathomimetics, TCAs, SSRIs, SNRIs, Nefazodone and Trazodone and may occur up to 14 days after discontinuing MAOIs
  • Monitor patients for suicidal behavior, development of mania/hypomania, bipolar disorder
  • Taper dose slowly (4 weeks recommended) to prevent withdrawal symptoms of GI effects, nausea/vomiting, dizziness, headache and CNS effects
  • Monitor BP in all patients
*Antidepressant therapy in children, adolescents and young adults is associated with clinical worsening, suicidality or unusual changes in behavior. Close observation of the patient and communication with the prescribing physician is warranted.

Selective Serotonin Reuptake Inhibitors (SSRIs)*


Drug Dosage Remarks
Citalopram Panic disorder: 
Initial dose: 10 mg PO 24 hourly 
May increase to 20 mg PO 24 hourly after 7 days
Usual dose: 20-30 mg/day
Max dose: 40 mg/day		 Adverse Reactions
  • Dose-related: Increased sweating, dry mouth, insomnia, somnolence, diarrhea, nausea, fatigue
  • GI effects (dyspepsia, abdominal pain, constipation); CNS and mental effects (tremor, anxiety, apathy, paresthesias); Other effects (sexual dysfunction, yawning, myalgia)
Special Instructions
  • US FDA issued a warning that doses >40 mg/day should not be used due to dosage-related prolongation of the QT interval and increased risk of cardiac arrhythmia, including torsades de pointes. Patients with heart failure, bradyarrhythmia, or those receiving concomitant medications known to prolong QT intervals should be monitored closely with ECG. Patients at risk for hypokalemia or hypomagnesemia are also at risk of torsades de pointes
  • Contraindicated in patients with congenital long QT syndrome, patients concomitantly taking Pimozide or MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
  • Use with caution in patients with hepatic or renal dysfunction, angle-closure glaucoma and in patients with seizure disorders
  • Avoid concomitant use of herbal medicinal products (eg St. John’s wort) with serotonergic effects
  • Use with caution in patients taking medications that will affect clotting of blood
  • Initial feeling of increased anxiety may occur with SSRIs; therefore, initial dose should be lower than normally prescribed for depression and increased slowly
  • Monitor patients for suicidality risk and screen for mania activation, diabetes, serotonin syndrome
  • If discontinued after long-term use, taper dose over several weeks
  • Monitor ECG and serum magnesium and potassium levels
Escitalopram General Anxiety Disorder:
 10-20 mg PO 24 hourly
Panic disorder:
Initial dose: 5 mg PO 24 hourly
May increase dose after 1 week to 10 mg PO daily
Social Anxiety Disorder: 
10-20 mg PO 24 hourly
May be decreased to 5 mg
Max dose (all indications): 
20 mg/day		 Adverse Reactions
  • CNS and mental effects (somnolence, dizziness, insomnia, yawning, headache, decreased appetite); GI effects (nausea, constipation, diarrhea); Other effects (sweating, sexual dysfunction, fatigue, pyrexia)
Special Instructions
  • Same as Citalopram
Fluoxetine Panic disorder: 
Initial dose: 5-10 mg PO 24 hourly
Increase dose to 20 mg/day after 1 week or 5-10 mg increments after 3-7 days then at 1 week interval
Usual dose: 20-40 mg/day
Max dose: 60 mg/day 		 Adverse Reactions
  • Dose related: Nervousness, anxiety, insomnia
  • CNS and mental effects (headache, drowsiness, fatigue, tremor, dizziness, sensation disturbance, abnormal dreams, mania); GI effects (nausea, diarrhea, anorexia, xerostomia); CV effects (chest pain, hypertension, palpitation, orthostatic hypotension); Other effects (pharyngitis, blurred vision, sexual dysfunction) 
Special Instructions
  • Same as Citalopram
Paroxetine General Anxiety Disorder:
Initial dose: 20 mg PO 24 hourly
Increase by 10 mg/day at weekly intervals
Max dose: 50 mg/day
Social Anxiety Disorder:
Initial dose: 20 mg PO 24 hourly
Increase by 10 mg/day at weekly intervals
Max dose: 50-60 mg/day
Panic disorder: 
Initial dose: 10 mg PO 24 hourly
Increase dose by 10 mg/week to maintenance dose of 40 mg/day
Max dose: 60 mg/day
Extended-release:
Panic disorder and Social Anxiety Disorder:
Initial dose: 12.5 mg PO 24 hourly
Increase dose by 12.5 mg/week based on patient response
Max dose (Panic disorder):
75 mg/day
Max dose (Social Anxiety Disorder): 37.5 mg/day 		 Adverse Reactions
  • Dose-related: Somnolence, asthenia, dizziness, tremor, nausea
  • CNS and mental effects (headache, insomnia, nervousness, anxiety, suicidal thoughts or behavior); GI effects (dry mouth, constipation, diarrhea); CV effect (sinus tachycardia); Other effects (sexual dysfunction, oropharyngeal disorders, myopathy)
  • Potentially fatal: NMS, serotonin syndrome
Special Instructions
  • Same as Citalopram
Sertraline General Anxiety Disorder, Panic disorder and Social Anxiety Disorder: 
Initial dose: 25 mg PO 24 hourly
Increase dose to 50 mg PO 24 hourly after 1 week
Dose changes may be made at least weekly interval
Maintenance dose: 50-100 mg/day
Max dose: 200 mg/day 		 Adverse Reactions
  • CNS and mental effects (headache, somnolence, drowsiness, fatigue, dizziness, insomnia, tremor, anxiety, paresthesia, agitation); GI effects (nausea/vomiting, dry mouth, diarrhea, constipation); Other effects (sexual dysfunction, abnormal vision, torsades de pointes)
  • Potentially fatal: NMS, serotonin syndrome, suicidal thoughts/behavior
Special Instructions
  • Same as Citalopram
*Antidepressant therapy in children, adolescents and young adults is associated with clinical worsening, suicidality or unusual changes in behavior. Close observation of the patient and communication with the prescribing physician is warranted.

Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)*


Drug Dosage Remarks
Duloxetine
(Duloxetine hydrochloride)		 General anxiety disorder: 
Initial dose: 30-60 mg PO 24 hourly
Max dose: 120 mg/day		 Adverse Reactions
  • CNS effects (somnolence, headache, fatigue, dizziness, insomnia, abnormal dreams, sleep disorder, yawning, anxiety, suicidal ideation); GI effects (nausea, dry mouth, dose-related constipation, diarrhea, increased appetite, weight gain); CV effects (palpitation, hypertension); Other effects (sexual dysfunction, tremor, blurred vision, increased sweating) 
Special Instructions
  • Contraindicated in patients with narrow-angle glaucoma, severe renal impairment, patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
  • Use with caution in patients with seizure disorder, renal and hepatic impairment
  • Start with low dose to minimize side effects and titrate upward to the desired response
  • Do not stop medication abruptly; taper dose over several weeks
  • Monitor patients for suicidality risk
Venlafaxine Extended-release:
General Anxiety Disorder:
 Initial dose: 75 mg PO 24 hourly
In patients initiated at 37.5 mg PO 24 hourly, may increase to 75 mg PO 24 hourly after 4-7 days
May then be increased by ≤75 mg/day every ≥4 days based on patient response
Max dose: 225 mg/ day
Panic disorder:
Initial dose: 37.5 mg PO 24 hourly for 4-7 days followed by 75 mg/day
May increase dose by 75 mg/day every ≥7 days based on patient response
Max dose: 225 mg/day
Social Anxiety Disorder: 
75 mg PO 24 hourly or 
37.5 mg PO 24 hourly for 4-7 days then 75 mg PO 24 hourly
Max dose: 75 mg/day		 Adverse Reactions
  • CNS effects (somnolence, headache, fatigue, dizziness, insomnia, abnormal dreams, sleep disorder, yawning, anxiety); GI effects (nausea, dry mouth, dose-related constipation, diarrhea, increased appetite, weight gain); CV effect (palpitation); Other effects (sexual dysfunction, tremor, blurred vision, increased sweating)
  • Dose-related: Vasodilation, hypertension
  • Potentially fatal: Serotonin syndrome
Special Instructions
  • Contraindicated in patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
  • Use with caution in patients with seizure disorder, narrow-angle glaucoma, recent history of MI, hepatic and renal impairment
  • Monitor patients for suicidality risk and worsening of symptoms
  • Start with low dose to minimize side effects and titrate upward to the desired response
  • If discontinued after long-term use, taper dose over several weeks
*Antidepressant therapy in children, adolescents and young adults is associated with clinical worsening, suicidality or unusual changes in behavior. Close observation of the patient and communication with the prescribing physician is warranted.

Tricyclic Antidepressant (TCA)*


Drug Dosage Remarks
Clomipramine Panic Disorder:
Initial dose: 10 mg PO 24 hourly
Usual dose: 25-100 mg PO 24 hourly
Max dose: 150 mg PO 24 hourly
 Adverse Reactions
  • Side effects are mostly due to antimuscarinic actions and may be decreased if started at low dose and increased gradually
  • CNS and mental effects (drowsiness, nervousness, insomnia, headache, peripheral neuropathy, ataxia, tremor, confusion/delirium can occur especially in older patients); GI effects (dry mouth, constipation which may lead to paralytic ileus, nausea/vomiting, gastric irritation, weight gain); CV effects (hypotension, tachycardia); Other effects (blurred vision, increased intraocular pressure, urinary retention, sweating, hyperthermia)
Special Instructions
  • Use with caution in patients with urinary retention, prostatic hyperplasia, chronic constipation, untreated angle-closure glaucoma, patients with CV disease, history of epilepsy, DM, impaired hepatic function
  • Start with low dose to minimize side effects and titrate upward to the desired response
  • Elderly patients may be sensitive to side effects, lower dose should be used
  • Do not stop medication abruptly, taper dose over several weeks
  • Monitor patients for suicidal risk, clinical worsening, and other psychiatric symptoms
  • Contraindicated in patients concomitantly taking MAO inhibitors or within 2 weeks of discontinuing MAO inhibitors
*Antidepressant therapy in children, adolescents and young adults is associated with clinical worsening, suicidality or unusual changes in behavior. Close observation of the patient and communication with the prescribing physician is warranted.

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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