Highly selective serotonin reuptake inhibitor (SSRI) with minimal effects on neuronal reuptake of norepinephrine (NE) and dopamine (DA). It acts as an antidepressant by potentiating the serotonergic activity in the CNS.


  • Initial 20 mg/day PO as a single dose in the morning or evening
  • Dose increases should usually occur in increments of 20 mg at intervals of no less than one week
  • Maintenance: 40 mg/day PO. Maximum dose 60 mg/day


  • Lightheadedness
  • Syncope
  • Nausea
  • Dry mouth
  • Confusion
  • Dizziness
  • Somnolence


This information is drawn from a number of sources (see below). The reader is encouraged to access these and other relevant literature for more detail. As always, sound clinical judgment should be used in individual clinical cases. In particular, it should be remembered that there may be significant variation in the pharmokinetics of a drug resulting from a number of factors, including the individual patient’s metabolism/disease status and how the medication has been formulated.


  1. Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 11th ed. McGraw-Hill Professional; 2006.
  2. Twycross R, Wilcock A. Palliative care formulary. 3rd ed. Radcliffe Medical Press Ltd; 2008.
  3. Repchinsky C, editor. Compendium of pharmaceuticals and specialties (CPS): The Canadian drug reference for health professionals. 44th ed. Canadian Pharmacists Association; 2009.
  4. Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children. 1st ed. Oxford University Press 2006.
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