Mosby's 2014 Nursing Drug Reference (417 page)

Black Box Warning:

Children, suicidal ideation

• Adult:
PO
75 mg/day in 2-3 divided doses; taken with food, may be increased to 150 mg/day; if needed, may be further increased to 225 mg/day; increments of 75 mg/day at intervals of ≥4 days; some hospitalized patients may require up to 375 mg/day in 3 divided doses;
EXT REL
37.5-75 mg PO daily, max 225 mg/day; give XR daily

• Adult:
PO
75 mg/day or 37.5 mg/day × 4-7 days initially, max 225 mg/day

• Adult:
PO
CCr 10-70 ml/min, reduce dose by 25%-50%; CCr <10 ml/min, reduce dose by 50%

• Adult:
PO
Moderate impairment, 50% of dose

• Adult (male, prostate cancer):
PO
12.5 mg bid × 4 wk; females 37.5-75 mg/day

• Adult:
PO
37.5-75 mg/day, max 75 mg bid (regular rel) or 150 mg/day (ext rel)

• Adult female:
PO
50-200 mg/day, start at 50 mg/day for 1st cycle, titrate upward

• 
With food, milk for GI symptoms; do not crush, chew caps; caps can be opened and contents sprinkled on applesauce, given with full glass of water

• 
Sugarless gum, hard candy, frequent sips of water for dry mouth

• 
Avoid use with CNS depressants

• 
In small amounts because of suicide potential, especially at beginning of therapy

Increase:
bleeding risk—salicylates, NSAIDs, platelet inhibitors, anticoagulants

Increase:
venlafaxine effect—cimetidine

Increase:
CNS depression—alcohol, opioids, antihistamines, sedative/hypnotics

Increase:
levels of cloZAPine, desipramine, haloperidol, warfarin

Increase:
serotonin syndrome—sibutramine, SUMAtriptan, traZODone, traMADol, SSRIs, serotonin receptor agonist, linezolid, methylene blue, tryptophan

Decrease:
effect of indinavir

Decrease:
venlafaxine effect—cyproheptadine

• 
Serotonin syndrome: St. John’s wort, tryptophan

Increase:
CNS depression—kava, valerian

Increase:
alk phos, bilirubin, AST, ALT, BUN, creatinine, serum cholesterol, CPK, LDH

False positive:
amphetamines, phencyclidine

Black Box Warning:

Mental status: mood, sensorium, affect, increase in psychiatric symptoms; depression, panic; assess for suicidal ideation in children/adolescents

• 
B/P lying, standing; pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take VS q4hr in patients with CV disease

 
Bleeding:
GI, ecchymosis, epistaxis, hematomas, petechiae, hemorrhage

• 
Blood studies: CBC, differential, leukocytes, cardiac enzymes if patient is receiving long-term therapy

• 
Hepatic studies: AST, ALT, bilirubin

• 
Weight weekly; weight loss or gain; appetite may increase; peripheral edema may occur; monitor cholesterol

• 
Withdrawal symptoms:
flulike symptoms, headache, nervousness, agitation, nausea, vomiting, muscle pain, weakness; not usual unless product is discontinued abruptly

 
Serotonin syndrome, neuroleptic malignant syndrome:
increased heart rate, shivering, sweating, dilated pupils, tremors, high B/P, hyperthermia, head
ache, confusion; if these occur, stop product, administer serotonin antagonist if needed, usually worse if given with linezolid, methylene blue, tryptophan

• 
Storage in tight container at room temp; do not freeze

• 
Assistance with ambulation during beginning therapy because drowsiness, dizziness occur

• 
Therapeutic response: decreased depression, anxiety; increased well-being

• 
To notify prescriber of rash, hives, allergic reactions, bleeding

• 
To use with caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision

Black Box Warning:

That worsening of symptoms, suicidal thoughts/behaviors may occur in children/young adults

• 
To avoid alcohol ingestion

• 
Not to discontinue medication abruptly after long-term use; may cause nausea, headache, malaise

• 
To wear sunscreen or large hat because photosensitivity occurs

• 
To avoid pregnancy or breastfeeding while taking this product, birth defects have occurred when used in the 3rd trimester

• 
To monitor B/P with hypertension