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Indications:
Obsessive-compulsive disorder (as defined in DSM-IV) for adults, adolescents, and children. Investigational: Treatment of depression.
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Contraindications:
Alcohol ingestion.
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Special Concerns:
Use with caution in clients with a history of mania, seizure disorders, and liver dysfunction and in those with diseases that could affect hemodynamic responses or metabolism.
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Side Effects:
Side effects listed occur at an incidence of 0.1% or greater. CNS: Somnolence, insomnia, nervousness, dizziness, tremor, anxiety, hypertonia, agitation, decreased libido, depression, CNS stimulation, amnesia, apathy, hyperkinesia, hypokinesia, manic reaction, myoclonus, psychoses, fatigue, malaise, agoraphobia, akathisia, ataxia, convulsion delirium, delusion, depersonalization, drug dependence, dyskinesia, dystonia, emotional lability, euphoria, extrapyramidal syndrome, unsteady gait, hallucinations, hemiplegia, hostility, hypersomnia, hypochondriasis, hypotonia, hysteria, incoordination, increased libido, neuralgia, paralysis, paranoia, phobia, sleep disorders, stupor, twitching, vertigo, activation of mania/hypomania, seizures. GI: Nausea, dry mouth, diarrhea, constipation, dyspepsia, anorexia, vomiting, flatulence, toothache, tooth caries, dysphagia, colitis, eructation, esophagitis, gastritis, gastroenteritis, GI hemorrhage GI ulcer, gingivitis, glossitis, hemorrhoids, melena, rectal hemorrhage, stomatitis. CV: Palpitations, hypertension, postural hypotension, vasodilation, syncope, tachycardia, angina pectoris, bradycardia, cardiomyopathy CV disease, cold extremities, conduction delay, heart failure, MI pallor, irregular pulse, ST segment changes. Respiratory: URI, dyspnea, yawn, increased cough, sinusitis, asthma, bronchitis, epistaxis, hoarseness, hyperventilation. Body as a whole: Headache, asthenia, flu syndrome, chills, malaise, edema, weight gain or loss, dehydration, hypercholesterolemia, allergic reaction, neck pain, neck rigidity, photosensitivity, suicide attempt. Dermatologic: Excessive sweating, acne, alopecia, dry skin, eczema, exfoliative dermatitis, furunculosis, seborrhea, skin discoloration, urticaria. Musculoskeletal: Arthralgia, arthritis, bursitis, generalized muscle spasm, myasthenia, tendinous contracture, tenosynovitis. GU: Delayed ejaculation, urinary frequency, impotence, anorgasmia, urinary retention, anuria, breast pain, cystitis, delayed menstruation, dysuria, female lactation, hematuria, menopause, menorrhagia, metrorrhagia, nocturia, polyuria, PMS, urinary incontinence, UTI, urinary urgency, impaired urination, vaginal hemorrhage vaginitis. Hematologic: Anemia, ecchymosis, leukocytosis, lymphadenopathy, thrombocytopenia. Ophthalmic: Amblyopia, abnormal accommodation, conjunctivitis, diplopia, dry eyes, eye pain, mydriasis, photophobia, visual field defect. Otic: Deafness, ear pain, otitis media. Miscellaneous: Taste perversion or loss, parosmia, hypothyroidism, hypercholesterolemia, dehydration.
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Overdose Management:
Treatment: Establish an airway and maintain respiration as needed. Monitor VS and ECG. Activated charcoal may be as effective as emesis or lavage in removing the drug from the GI tract. Since absorption in overdose may be delayed, measures to reduce absorption may be required for up to 24 hr.
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Drug Interactions:
Beta-adrenergic blockers / Possible effects on BP and HR Buspirone / Buspirone effects Carbamazepine / Risk of carbamazepine toxicity Cloxapine / Risk of orthostatic hypotension and seizures Diazepam / Diazepam effect R/T clearance Diltiazem / Risk of bradycardia Haloperidol / Serum haloperidol levels Lithium / Risk of seizures Methadone / Risk of methadone toxicity Midazolam / Midazolam effect R/T clearance Sumatriptan / Risk of weakness, hyperreflexia, incoordination Theophylline / Risk of theophylline toxicity (decrease dose by one-third the usual daily maintenance dose) Triazolam / Triazolam effect R/T clearance
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Dosage:
•Tablets Obsessive-compulsive disorder.

Adults, initial: 50 mg at bedtime; then increase the dose in 50-mg increments q 4-7 days, as tolerated, until a maximum benefit is reached, not to exceed 300 mg/day. Children and adolescents, 8 to 17 years: 25 mg at bedtime; then increase the dose in 25-mg increments q 4-7 days until a maximum benefit is reached, not to exceed 200 mg/day.

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