CrCl > 80: 600 mg po or iv q 12 h.
CrCl < 10:
Important side effects
Cytopenias and cannot have a high tyrosine diet (smoked sausage and red wines, usually not an issue in my hospital); optic and peripheral neuropathy (rare but not reversible).
Important drug interactions
Citalopram, clovoxamine, dopamine, epinephrine, escitalopram, femoxetine, flesinoxan, fluoxetine, fluvoxamine, nefazodone, paroxetine, phenylpropanolamine, pseudoephedrine, sertraline, trazodone, venlafaxine, zimeldine. They get a serotonin syndrome)PubMed) (altered MS, agitation, fevers) with concomitant SSRI's but in most patients the drug can be continued without stopping the SSRI as long as they are watched closely (PubMed).
Rants and Screeds
Waaaaayyyyyyyy expensive ($1500 American dollars for a 10 day course), but, hey, someone needs to pay for that pizza at lunch conference.
Treatment of choice
Don't use for