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Medicines > fda max : 1000 mg/d (osteoarthritis); 1200 mg/d (rheumatoid arthritis) or 20 mg/d or 40 mg/d

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mechanism:
None (5) · Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. (1) · Highly β1-selective adrenergic antagonist. Greater selectivity than metoprolol or atenolol. (1) · Selective alpha-1 adrenergic receptor antagonist. Lowers peripheral vascular resistance via vasodilation; in the CNS, blunts noradrenergic hyperarousal thought to drive trauma-related nightmares. (1) · Selective inhibitor of PDE5. Slightly higher PDE5/PDE6 selectivity vs sildenafil (less visual side effect) but more PDE1 cross-activity (occasional QT effects at high doses). (1) · The d-enantiomer is a highly β1-selective antagonist; the l-enantiomer triggers endothelial nitric-oxide–mediated vasodilation. Unique among beta blockers for this NO mechanism. (1) · TrkB/BDNF'"`UNIQ--ref-00000047-QINU`"' '"`UNIQ--vote-00000048-QINU`"' (1) · '"`UNIQ--vote-0000111B-QINU`"' Intraoperative floppy iris syndrome is a recognized class effect. Recently emerging evidence (observational) suggests possible Parkinson's disease risk reduction via PGK1 binding — investigational and not a clinical indication'"`UNIQ--ref-0000111C-QINU`"'. (1) · '"`UNIQ--vote-00001269-QINU`"' Renal, GI, hypertensive, and CV effects parallel the class profile; modest COX-2 preference may underlie some literature suggesting slightly better GI tolerability than non-selective NSAIDs, though clinically the difference is small'"`UNIQ--ref-0000126A-QINU`"'. (1)
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