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Medicines > classes : Dissociative or Stimulant or [[:Category:Cardiovascular_agents|Cardiovascular agent]]

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generic:
brand:
None (59) · Benzedrex (1) · Cordarone, Pacerone, Nexterone (IV) (1) · DXM (1) · DXO (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
Monoamine releasing agent (8) · Dopamine/norepinephrine reuptake inhibitor (5) · NMDA antagonist (3) · None (2) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Norepinephrine–dopamine reuptake inhibitor (2)
uses:
None (62) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-00000CB0-QINU`"', '"`UNIQ--vote-00000CB1-QINU`"', '"`UNIQ--vote-00000CB2-QINU`"' (1)
starting dose:
None (62) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · Oral load 800-1600 mg/d in divided doses for 1-3 weeks, then 600-800 mg/d for 1 month, then 200-400 mg/d maintenance; IV 150 mg over 10 min then 1 mg/min for 6 hours then 0.5 mg/min (1)
preparations:
None (62) · 100, 200, 400 mg tablets; 50 mg/mL IV (with polysorbate 80 in older formulations causing hypotension); 1.5 mg/mL Nexterone IV (PVC-free, lower hypotension risk) (1) · 28 mg/device (each dose uses 2 devices) (1)
fda max:
None (62) · 84 mg per session (1) · Oral maintenance 400 mg/d typical; higher in refractory cases (1)
routes:
None (62) · Intranasal (under direct medical supervision) (1) · IV (1) · Oral (1)
onset:
None (62) · IV: minutes; oral: weeks to load (1) · Within hours of first administration (1)
duration:
None (62) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · Weeks after discontinuation (extremely long half-life) (1)
halflife:
None (62) · ~58 days (parent); ~61 days (desethylamiodarone, active metabolite)'"`UNIQ--ref-00000CB3-QINU`"' (1) · ~7-12 hours (1)
bioavailability:
None (62) · ~48% intranasal (1) · ~50% (oral; highly variable)'"`UNIQ--ref-00000CB4-QINU`"' (1)
pregnancy:
None (62) · Avoid; may cause fetal harm (1) · Generally avoided; fetal goiter/hypothyroidism risk (iodine load). Used only for life-threatening arrhythmia.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (62) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries '''Boxed Warnings''' for pulmonary toxicity (interstitial pneumonitis, fibrosis), hepatotoxicity, and proarrhythmia'"`UNIQ--ref-00000CB5-QINU`"' (1)

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