By W. Kliff. Providence College.
Dosage for Pediatric Population (Children and Adolescents) Obsessive-Compulsive Disorder -ZOLOFT treatment should be initiated with a dose of 25 mg once daily in children (ages 6-12) and at a dose of 50 mg once daily in adolescents (ages 13-17) buy digoxin 0.25mg with amex. While a relationship between dose and effect has not been established for OCD discount digoxin 0.25mg on-line, patients were dosed in a range of 25-200 mg/day in the clinical trials demonstrating the effectiveness of ZOLOFT for pediatric patients (6-17 years) with OCD generic digoxin 0.25mg. Patients not responding to an initial dose of 25 or 50 mg/day may benefit from dose increases up to a maximum of 200 mg/day buy digoxin 0.25mg line. For children with OCD 0.25 mg digoxin otc, their generally lower body weights compared to adults should be taken into consideration in advancing the dose digoxin 0.25 mg on line, in order to avoid excess dosing. Given the 24 hour elimination half-life of ZOLOFT, dose changes should not occur at intervals of less than 1 week. Maintenance/Continuation/Extended Treatment Major Depressive Disorder -It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode. Systematic evaluation of ZOLOFT has demonstrated that its antidepressant efficacy is maintained for periods of up to 44 weeks following 8 weeks of initial treatment at a dose of 50-200 mg/day (mean dose of 70 mg/day) (see Clinical Trials under CLINICAL PHARMACOLOGY ). It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment. Posttraumatic Stress Disorder -It is generally agreed that PTSD requires several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of ZOLOFT has demonstrated that its efficacy in PTSD is maintained for periods of up to 28 weeks following 24 weeks of treatment at a dose of 50-200 mg/day (see Clinical Trials under CLINICAL PHARMACOLOGY ). It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment. Social Anxiety Disorder -Social anxiety disorder is a chronic condition that may require several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of ZOLOFT has demonstrated that its efficacy in social anxiety disorder is maintained for periods of up to 24 weeks following 20 weeks of treatment at a dose of 50-200 mg/day (see Clinical Trials under CLINICAL PHARMACOLOGY ). Dosage adjustments should be made to maintain patients on the lowest effective dose and patients should be periodically reassessed to determine the need for long-term treatment. Obsessive-Compulsive Disorder and Panic Disorder -It is generally agreed that OCD and Panic Disorder require several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of continuing ZOLOFT for periods of up to 28 weeks in patients with OCD and Panic Disorder who have responded while taking ZOLOFT during initial treatment phases of 24 to 52 weeks of treatment at a dose range of 50-200 mg/day has demonstrated a benefit of such maintenance treatment (see Clinical Trials under CLINICAL PHARMACOLOGY ). It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Nevertheless, patients should be periodically reassessed to determine the need for maintenance treatment. Premenstrual Dysphoric Disorder -The effectiveness of ZOLOFT in long-term use, that is, for more than 3 menstrual cycles, has not been systematically evaluated in controlled trials. However, as women commonly report that symptoms worsen with age until relieved by the onset of menopause, it is reasonable to consider continuation of a responding patient. Dosage adjustments, which may include changes between dosage regimens (e. Switching Patients to or from a Monoamine Oxidase Inhibitor -At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy with ZOLOFT. In addition, at least 14 days should be allowed after stopping ZOLOFT before starting an MAOI (see CONTRAINDICATIONS and WARNINGS ). Dosage for Hepatically Impaired Patients -The use of sertraline in patients with liver disease should be approached with caution. The effects of sertraline in patients with moderate and severe hepatic impairment have not been studied. If sertraline is administered to patients with liver impairment, a lower or less frequent dose should be used (see CLINICAL PHARMACOLOGY and PRECAUTIONS ).
Because there are only sparse data on its reproductive safety digoxin 0.25mg discount, we discourage use of this drug during pregnancy order digoxin 0.25mg on-line. Wellbutrin is a pregnancy category B compound discount digoxin 0.25mg line, meaning that it has been categorized as fairly safe in pregnancy buy digoxin 0.25mg. However discount 0.25mg digoxin free shipping, this categorization is based on limited information that does not indicate a risk but is insufficient to rule risk out entirely discount 0.25mg digoxin otc. There are some data suggesting that selective serotonin reuptake inhibitors (SSRIs) are effective for ADHD in some people, but most studies do not show efficacy. For those who have responded to an SSRI, the safest such agents to use during pregnancy are fluoxetine (Prozac) or citalopram (Celexa). Still, the use of a stimulant is not absolutely contraindicated during pregnancy. We occasionally have a treatment-dependent woman with ADHD who did not tolerate or respond to treatment with an antidepressant but was stabilized on a stimulant. We have not observed any problems using stimulants in pregnancy over the past 15 years, but the sample size is small and we have not investigated this question in a controlled fashion. There are no data on the postpartum course of ADHD, but since worsening of psychiatric disorders during the postpartum period is the rule, we typically reintroduce medications at this time in women who went off them before or during pregnancy. We do not counsel women who have remained on stimulants, tricyclics, or Wellbutrin to defer breast-feeding. The data on stimulant use during breast-feeding are incomplete. At our center we would not consider a stimulant as absolutely contraindicated in women who are breast-feeding, because the amount of the drug secreted into breast milk is small. Lee Cohen is a psychiatrist and director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. He is a consultant for and has received research support from manufacturers of several SSRIs. He is also a consultant to Astra Zeneca, Lilly and Jannsen - manufacturers of atypical antipsychotics. Eating disorders are highly prevalent in the general population, certainly more so in women, appearing to peak during the childbearing years. While we tend not to see pregnant women with anorexia nervosa because they have secondary reproductive endocrine dysfunction, we do see those who have been successfully treated and are contemplating pregnancy or who are pregnant. Far more often, we see patients with bulimia or other binge-eating disorders on the less severe end of the spectrum. There is very little information in the literature on the course of these disorders as women try to conceive or in pregnancy--and even less on the treatment of symptomatic women during pregnancy or the postpartum period. The few data that are available include studies reported in the last several years suggesting that pregnancy is associated with improvements in eating disorders followed by postpartum exacerbation of symptoms. A limitation of these studies was that there were very few women included in the samples with active illness who were on medication. The two drug classes used most frequently in patients with eating disorders are selective serotonin reuptake inhibitors (SSRIs), most commonly fluoxetineantianxiety agents, typically lorazepam and clonazepam. In our experience, many women have a recurren and sertraline, and ce of symptoms of the eating disorder when they stop their medication while trying to conceive or while pregnant-consistent with what we see when women with mood and anxiety disorders stop their medications. There are two avenues of treatment, group- and individual-based cognitive-behavioral therapy and pharmacologic interventions. We have found that patients who have been on pharmacologic therapy may be able to successfully switch from medication to cognitive-behavioral therapy in conjunction with state-of-the-art nutritional counseling while trying to conceive or during pregnancy. Patients who do well using this approach are on the less severe ends of the spectrum, for example those who engage in some binge-eating behaviors, followed by some restrictivelike behavior (calorie restriction), or who have intermittent bulimic symptoms when they experience anxiety. Cognitive-behavioral interventions can help these patients justify the need to consume calories and gain weight to sustain a healthy pregnancy. SSRI doses used to treat eating disorders are frequently higher than those used to treat depression, but the risk of adverse fetal effects, including fetal malformations, is not dose related.
Investigating your health benefits for HIVMedical treatments for HIV are very expensive discount 0.25mg digoxin overnight delivery. It is extremely important to be knowledgeable about your health insurance options order digoxin 0.25 mg fast delivery. If you are currently covered by an insurance plan discount 0.25 mg digoxin fast delivery, investigate the limits of your policy cheap digoxin 0.25 mg mastercard. Explore whether or not you have access to an HIV specialist order 0.25 mg digoxin free shipping. Some people worry about their insurance companies learning about their HIV status discount digoxin 0.25 mg line. By law, if you are currently insured and test positive, you cannot be discharged from your insurance plan. If you have specific questions about your policy and do not feel comfortable talking with your employer or company representative you should consider contacting the National AIDS hotline at 1-800-342-2437 (AIDS). Hotline staff will try to locate a local case manager in your area who can help you investigate your plan. You may find that your health plan has a cap on annual medication costs. For some people who do not have adequate prescription drug coverage, there is a federal program called the AIDS Drug Assistance Program (ADAP). ADAP was designed to provide access to expensive HIV medications for people who are considered to be underinsured or have no insurance. Eligibility for ADAP is determined based on your financial situation. Eligibility will also vary from state to state, as will the number of medications covered. States with larger numbers of people living with HIV tend to have a larger list of covered medications. If you are currently unemployed or have a low income, you may be eligible for Medicaid. Medicaid is a federal program that provides health care for people who cannot afford to purchase insurance on their own. If you qualify for supplemental security income (SSI), you will automatically receive Medicaid. In order to transmit HIV, there must be an exchange of body fluids, blood, semen, vaginal secretions, or breast milk. HIV is often transmitted through unprotected sexual contact. Using condoms will significantly reduce the risk of transmitting HIV to a sexual partner. If you are using intravenous drugs, do not share needles with others. HIV can be transmitted through breast milk, therefore new mothers are advised against breast-feeding. Women who are pregnant can take medications to reduce the risk of transmission to their child. We are learning more each day about HIV and its treatment. Evaluate which methods of information gathering work best for you. Many people living with HIV continue to lead active lives after they are diagnosed. By working closely with your doctor and leading a healthy lifestyle, you can continue to lead a happy and productive life.