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DOSAGE AND ADMINISTRATION ------------------------------------------------------- Children: Enuresis: /= 6 years: Initial: 25 mg at bedtime, if inadequate response still seen after 1 week of therapy, increase by 25 mg/day; dose should not exceed 2.5 mg/kg/day or 50 mg at bedtime if 6-12 years of age or 75 mg at bedtime if /= 12 years of age Adolescents: Depression: Initial: 30-40 mg/day; increase gradually; maximum: 100 mg/day in single or divided doses Adults: Depression: Initial: 25 mg 3-4 times/day, increase dose gradually, total dose may be given at bedtime; maximum: 300 mg/day Elderly: Initial: 10-25 mg at bedtime; increase by 10-25 mg every 3 days for inpatients and weekly for outpatients if tolerated; average daily dose to achieve a therapeutic concentration: 100 mg/day; range: 50-150 mg/day Mechanism of Action: Evidence gathered in preclinical studies suggests that mirtazapine enhances central noradrenergic and serotonergic activity.These studies have shown that mirtazapine acts as an antagonist at central presynaptic 2 adrenergic inhibitory autoreceptors and heteroreceptors, an action that is postulated to result in an increase in central noradrenergic and serotonergic activity.Subsequently, the physician may continue decreasing the dose but at a more gradual rate.(Adults): Initially, 25 mg orally at bedtime, increase gradually to usual effective dose 50-300 mg/day.When treating pregnant women with fluvoxamine maleate tablets during the third trimester, the physician should carefully consider the potential risks and benefits of treatment.
It is advisable that a total daily dose of more than 50 mg should be given in two divided doses.
Dosage for Pediatric Population (children and adolescents) The recommended starting dose for Fluvoxamine Maleate Tablets in pediatric populations (ages 8-17 years) is 25 mg, administered as a single daily dose at bedtime.
In a controlled clinical trial establishing the effectiveness of Fluvoxamine Maleate Tablets in OCD, pediatric patients (ages 8-17) were titrated within a dose range of 50 to 200 mg/day.
Lower initial doses may be considered in patients where tolerability is a concern and/or renal impairment is present. In the controlled clinical trials establishing the effectiveness of Fluvoxamine Maleate Tablets in OCD, patients were titrated within a dose range of 100 to 300 mg/day.
Management of chronic pain syndromes (unlabeled use): 60 mg once daily Management of stress incontinence (unlabeled use): 40 mg twice daily Cymbalta should generally be administered once daily without regard to meals. PMDD: 20 mg/day continuously, or 20 mg/day starting 14 days prior to menstruation and through first full day of menses (repeat with each cycle). Consequently, the dose should be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day.
If the two divided doses are not equal, the larger dose should be given at bedtime.