Ciklox

Major depressive episodes. Panic disorder w/ or w/o agoraphobia. Social anxiety disorder (social phobia). Generalised anxiety disorder. Obsessive-compulsive disorder.

Major depressive episode 10 mg once daily, may be increased to max 20 mg daily. Panic disorder w/ or w/o agoraphobia Initially 5 mg for the 1st wk before increasing to 10 mg daily. May be further increased up to max 20 mg daily. Social anxiety disorder 10 mg once daily, may be decreased to 5 mg or increased to max 20 mg daily. Generalised anxiety disorder & obsessive-compulsive disorder Initially 10 mg once daily, may be increased to max 20 mg daily. Elderly >65 yr Initially 5 mg once daily, may be increased to 10 mg daily. Mild or moderate hepatic impairment & poor CYP2C19 metaboliser Initially 5 mg daily for the 1st 2 wk of treatment, may be increased to 10 mg daily.

May be taken with or without food.

Hypersensitivity. Patients w/ known QT interval prolongation or congenital long QT syndrome. Concomitant use w/ non-selective, irreversible MAOIs; reversible MAO-A inhibitors (eg, moclobemide) or reversible non-selective MAOI linezolid; medicinal products known to prolong QT interval.

Discontinue use if patient develops seizures for the 1st time, or if there is an increase seizure frequency (in patients w/ previous diagnosis of epilepsy); in any patient entering manic phase; if symptoms of serotonin syndrome occur; if signs of cardiac arrhythmia occur during treatment. Avoid use in patients w/ unstable epilepsy. Paradoxical anxiety at beginning of treatment; akathisia/psychomotor restlessness; sexual dysfunction. May alter glycaemic control (hypoglycaemia or hyperglycaemia) in patients w/ diabetes. Patients w/ history of mania/hypomania; at risk of hyponatraemia eg, patients w/ cirrhosis; known bleeding tendencies; CHD; significant bradycardia, or w/ recent acute MI or uncompensated heart failure; angle-closure glaucoma or history of glaucoma. Gradually taper when discontinuing treatment over a period of several wk or mth. Closely monitor patients at increased risk of suicidal thoughts, self-harm & suicide (suicide-related events). Correct electrolyte disturbances (eg, hypokalaemia & hypomagnesaemia) prior to treatment. Consider an ECG review prior to treatment in patients w/ stable cardiac disease. Limited experience in concurrent use w/ electroconvulsive therapy. Concomitant use w/ other medications which may cause hyponatraemia; oral anticoagulants, medicinal products known to affect platelet function eg, atypical antipsychotics, phenothiazines, most TCAs, ASA & NSAIDs, ticlopidine & dipyridamole; medicinal products w/ serotonergic effects eg, sumatriptan or other triptans, tramadol & tryptophan; St. John's wort-containing herbal remedies. Potential risk of influence on ability to drive a car & operate machinery. Severe renal (CrCl <30 mL/min) & hepatic impairment. Not to be used during pregnancy. Not recommended during lactation. Not to be used in childn & adolescents <18 yr. Elderly.

Headache; nausea. Decreased/increased appetite, increased wt; anxiety, restlessness, abnormal dreams, decreased libido; insomnia, somnolence, dizziness, paraesthesia, tremor; sinusitis, yawning; diarrhoea, constipation, vomiting, dry mouth; increased sweating; arthralgia, myalgia; ejaculation disorder & impotence (male); fatigue, pyrexia.

Cases of serious reactions & serotonin syndrome w/ non-selective, irreversible MAOIs. Risk of serotonin syndrome w/ reversible, selective MAO-A inhibitor eg, moclobemide; reversible, non-selective MAOI linezolid; irreversible, selective MAO-B inhibitor eg, selegiline; serotonergic medicinal products eg, tramadol, sumatriptan & other triptans. Potential additive effect on seizure threshold w/ other medicinal products capable of lowering seizure threshold eg, antidepressants (tricyclics, SSRIs), neuroleptics (phenothiazines, thioxanthenes & butyrophenones), mefloquine, bupropion & tramadol. Increased plasma conc w/ CYP2C19 inhibitors (eg, esomeprazole, fluconazole, fluvoxamine, lansoprazole, ticlopidine) or cimetidine. Potential increase in plasma levels of medicinal products mainly metabolised by CYP2D6, & w/ narrow therapeutic index eg, flecainide, propafenone & metoprolol (when used in cardiac failure), or some CNS acting-medicinal products mainly metabolised by CYP2D6 eg, antidepressants (eg, desipramine, clomipramine & nortriptyline) or antipsychotics (eg, risperidone, thioridazine & haloperidol); medicinal products metabolised by CYP2C19. Additive effect on QT prolongation w/ medicinal products that prolong the QT interval eg, class IA & III antiarrhythmics, antipsychotics (eg, phenothiazine derivatives, pimozide, haloperidol), TCAs, certain antimicrobials (eg, sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, anti-malarial treatment particularly halofantrine), certain antihistamines (eg, astemizole, mizolastine). Enhanced effects w/ lithium. May result in increased incidence of adverse reactions w/ St. John's wort-containing herbal remedies. Altered anticoagulant effects of oral anticoagulants. Not advisable in combination w/ alcohol. Increased risk of malignant arrhythmias w/ hypokalaemia/hypomagnesaemia-inducing medicinal products.

Antidepressants

N06AB10 - escitalopram ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.

Rx