Drug reference
Depressive illness (particularly where sedation is required) ▶BY MOUTH ▶Adult: Initially 30–40 mg daily in divided doses, alternatively initially 30–40 mg once daily, dose to be taken at bedtime, increase dose gradually as necessary; usual dose 30–90 mg ▶Elderly: Initially 30 mg daily in divided doses, alternatively initially 30 mg once daily, dose to be taken at bedtime, increase dose gradually as necessary; usual dose 30–90 mg
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Acute porphyrias p. 1120. during the manic phase of bipolar disorder
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Arrhythmias. cardiovascular disease. chronic constipation. diabetes. epilepsy. heart block. history of bipolar disorder. history of psychosis. hyperthyroidism (risk of arrhythmias). immediate recovery period after myocardial infarction. increased intra-ocular pressure. patients with a significant risk of suicide. phaeochromocytoma (risk of arrhythmias). prostatic hypertrophy. susceptibility to angle-closure glaucoma. urinary retention CAUTIONS, FURTHER INFORMATION Treatment should be stopped if the patient enters a manic phase. Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.
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Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.
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→Appendix 1: mianserin
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Agranulocytosis. arthritis. bone marrow disorders. breast abnormalities. dizziness. granulocytopenia. gynaecomastia. hepatic disorders. hyperhidrosis. hyponatraemia. joint disorders. lactation in absence of pregnancy. leucopenia. mood altered. neuromuscular irritability. oedema. paranoid delusions. postural hypotension. psychosis. rash. seizure. sexual dysfunction. suicidal tendencies. tremor. withdrawal syndrome SIDE-EFFECTS, FURTHER INFORMATION The risk of side- effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days). Consider using a lower starting dose in elderly patients. Overdose The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage. Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning p. 1430.
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Avoid.
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The amount secreted into breast milk is too small to be harmful. Nervous system
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Manufacturer advises caution; avoid in severe impairment.
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Dose adjustments Caution in renal impairment.
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A full blood count is recommended every 4 weeks during the first 3 months of treatment; clinical monitoring should continue subsequently and treatment should be stopped and a full blood count obtained if fever, sore throat, stomatitis, or other signs of infection develop.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 2, 25 ▶Mianserin hydrochloride (Non-proprietary) Mianserin hydrochloride 10 mg Mianserin 10mg tablets | 28 tablet P £14.53 DT = £14.35 Mianserin hydrochloride 30 mg Mianserin 30mg tablets | 28 tablet P £36.99 DT = £36.99
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Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment). If possible tricyclic and related antidepressants should be withdrawn slowly.
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Driving and skilled tasks Drowsiness may affect the performance of skilled tasks (e.g. driving). Effects of alcohol enhanced.
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Initially 30–40 mg daily in divided doses,
First-line fragment. Read the complete Indications and Dose section above.
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