Miscellaneous Antidepressants

The miscellaneous antidepressant drugs are contraindicated in patients with known hypersensitivity to the drugs. Among the miscellaneous antidepressants, bupropion and maprotiline are Pregnancy Category B drugs. Other miscellaneous antidepressants discussed in this chapter are Pregnancy Category C drugs. Safe use of the antidepressants during pregnancy has not been established. They should be used during pregnancy only when the potential benefits outweigh the potential hazards to the developing fetus. These drugs are used cautiously in patients with liver or kidney impairment and during lactation. The miscellaneous antidepressants are given with caution to patients taking alcohol or other CNS depressants.

The effects of buspirone are decreased when the drug is administered with fluoxetine. Increased serum levels of buspirone occur if the drug is taken with erythromy-cin or itraconazole. Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered with MAOIs or cimetidine. There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of tra-zodone when it is administered with carbamazepine. Increased serum digoxin levels have occurred when digoxin is administered with trazodone. There is a risk for increased phenytoin levels when phenytoin is administered with trazodone.

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