1 tab 3 times daily. Frail elderly (<55 kg) & those w/ moderate renal failure, severe renal failure (CrCl <19 mL/min) & severe cirrhosis (Child Pugh Score Class C) Restricted to 2 tab daily. Dosage should be gradually reduced over a period of 7-14 days to reduce the risk of w/drawal reaction.
Abrupt discontinuation should be avoided. Closely monitor patients for clinical worsening or appearance of suicidal thoughts/behaviour & any abnormal change of behaviour. If general anaesth is necessary, discontinue use 24 or 48 hr prior to surgery. In case of emergency surgery, pre-op monitoring should be performed. History of drug or alcohol dependence. Risk of w/drawal syndrome at discontinuation. In case of treatment interruption, gradually reduce dose over 7-14 days. Combination w/ MAOI is inadvisable; a wash-out period of 2 wk when tianeptine is used as a replacement of MAOI; a wash-out period of 24 hr when MAOI is used as a replacement of tianeptine. Patients at increased risk for hyponatraemia, eg, elderly, cirrhotic, or dehydrated patients or those treated w/ diuretics. Inadvisable in patients w/ fructose intolerance, glucose & galactose malabsorption syndrome or sucrase-isomaltase deficiency. May affect ability to drive or operate machine. Avoid use during pregnancy. Not recommended during lactation. Should not be used in adolescents 15-18 yr.
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