| Symptoms |
Comments and Management Strategies |
| Gastrointestinal |
|
| Nausea, loss of appetite |
Usually short-lived and dose-related; consider temporary dose reduction or administration with food and antacids |
| Diarrhea |
Famotidine, 20 - 40 mg/d |
| Constipation |
Wait for tolerance; try diet change, stool softener, exercise; avoid laxatives |
| Sexual dysfunction |
Consider dose reduction; drug holiday |
| Anorgasmia/impotence; impaired ejaculation |
Bethanechol, 10 - 20 mg, 2 h before activity, or cyproheptadine, 4 - 8 mg 2 h before activity, or bupropion, 100 mg bid or amantadine, 100 mg bid/tid |
| Orthostasis |
Tolerance unlikely; increase fluid intake, use calf exercises/support hose; fludrocortisone, 0.025 mg/d |
| Anticholinergic |
Wait for tolerance |
| Dry mouth, eyes |
Maintain good oral hygiene; use artificial tears, sugar-free gum |
| Tremor/jitteriness |
Antiparkinsonian drugs not effective; use dose reduction/slow increase; lorazepam, 0.5 mg bid, or propranolol, 10 - 20 mg bid |
| Insomnia |
Schedule all doses for the morning; trazodone, 50 - 100 mg qhs |
| Sedation |
Caffeine; schedule all dosing for bedtime; bupropion, 75 - 100 mg in afternoon |
| Headache |
Evaluate diet, stress, other drugs; try dose reduction; amitriptyline, 50 mg/d |
| Weight gain |
Decrease carbohydrates; exercise; consider fluoxetine |
| Loss of therapeutic benefit over time |
Related to tolerance? Increase dose or drug holiday; add amantadine, 100 mg bid, buspirone, 10 mg tid, or pindolol, 2.5 mg bid |
