30–50 20 mg; maximum daily dose 40 mg10–30 20 mg; maximum daily dose 40 mg, use with caution
<10           : 20 mg; maximum daily dose 40 mg, use with caution
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min
HD                     :Unknown dialysability. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in GFR=10–30 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Antibacterials: concentration increased by clarithromycin and erythromycin – avoid concomitant use
Antidepressants: possibly increased serotonergic effects with duloxetine; increased serotonergic effects with St John’s wort – avoid concomitant use
Antifungals: concentration increased by itraconazole and ketoconazole – avoid concomitant use
Antivirals: concentration increased by indinavir, nelfinavir and ritonavir – avoid concomitant use
Ergot alkaloids: increased risk of vasospasm
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
Non-renal clearance accounts for about 90% of the total clearanceManufacturer advises to avoid in severe renal impairment due to enhanced hypertensive effect.