Feza

# Feza ## Overview - **Classification**: Selective Serotonin Reuptake Inhibitor (SSRI) - **Mechanism**: Potently inhibits serotonin reuptake in the neuronal synapse, leading to increased serotonin availability. ## Primary Indications 1. **Major Depressive Disorder (MDD)** - Treatment of depressive episodes 2. **Generalized Anxiety Disorder (GAD)** - Management of chronic anxiety 3. **Panic Disorder** - Reduction of panic attack frequency and severity ## Adult Dosing ### Standard Dosing **Major Depressive Disorder (MDD)** - **Dose**: **20 mg** - **Frequency**: Once daily - **Route**: Oral - **Duration**: Typically long-term, reassess after 6-12 months **Generalized Anxiety Disorder (GAD)** - **Dose**: Start **10 mg** once daily for 1 week, then increase to **20 mg** - **Frequency**: Once daily - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: - CrCl 30-60 mL/min: No adjustment needed. - CrCl <30 mL/min: Consider lower starting dose (**10 mg**) and titrate cautiously. - **Hepatic Impairment**: - Mild-Moderate: Start **10 mg** once daily. Max **20 mg**/day. - Severe: Not recommended. - **Elderly Patients**: Start with lower dose (**10 mg** once daily) due to decreased clearance and increased sensitivity. Max **40 mg**/day. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Not recommended. - **Special Notes**: Safety and efficacy not established. Potential for persistent pulmonary hypertension of the newborn (PPHN) if maternal use in late pregnancy. ### Infants (1-12 months) - **Dose**: Not recommended. - **Special Notes**: Safety and efficacy not established. Alternative treatments should be considered. ### Children (1-12 years) **Major Depressive Disorder / Generalized Anxiety Disorder** (Off-label/Specialist use) - **Dose**: Start **5 mg** once daily for 1 week, then increase to **10 mg** once daily. - **Frequency**: Once daily - **Maximum**: **20 mg**/day - **Special Notes**: Closely monitor for suicidal ideation, especially during initiation. ### Adolescents (13-18 years) **Major Depressive Disorder / Generalized Anxiety Disorder** - **Dose**: Start **10 mg** once daily for 1-2 weeks, then increase to **20 mg** once daily. - **Frequency**: Once daily - **Maximum**: **40 mg**/day - **Special Notes**: Monitor closely for worsening depression and suicidality. ## Safety Information ### Contraindications - **Absolute**: Concomitant use with MAO inhibitors (MAOIs) or within 14 days of discontinuing an MAOI. - **Absolute**: Hypersensitivity to Feza or any component. - **Relative**: Concomitant use with pimozide or thioridazine (QT prolongation risk). ### Common Adverse Effects - **Very Common (>10%)**: Nausea, insomnia, somnolence, headache, diarrhea. - **Common (1-10%)**: Dry mouth, sweating, dizziness, sexual dysfunction, tremor. - **Serious but Rare**: Serotonin syndrome, suicidal ideation, QT prolongation, hyponatremia. ### Key Drug Interactions - **MAO Inhibitors**: Risk of **serotonin syndrome**. Contraindicated. - **Tricyclic Antidepressants (TCAs)**: Increased TCA plasma levels. Monitor for toxicity. - **NSAIDs/Anticoagulants**: Increased bleeding risk. Use with caution. - **QT-prolonging drugs**: Increased risk of Torsades de Pointes. Avoid co-administration. ## Monitoring & Follow-up - **Before Treatment**: Baseline weight, height (peds), suicidal ideation assessment. ECG if cardiac risk factors present. - **During Treatment**: - **Weekly for first 4 weeks**: Monitor for suicidality, anxiety, agitation. - **Bi-weekly for next 4 weeks**: Continue symptom and adverse effect monitoring. - **Periodically thereafter**: As clinically indicated. - **Electrolytes**: Monitor sodium, especially in elderly or those on diuretics. - **Clinical Signs**: Watch for agitation, hallucinations, rapid heart rate, fever (serotonin syndrome). ## Clinical Pearls - 💡 **Tip 1**: Administer Feza in the morning to minimize insomnia if activating. If sedating, consider evening dose. - 💡 **Tip 2**: Taper dose slowly over several weeks when discontinuing to avoid withdrawal symptoms (e.g., dizziness, paresthesias). - 💡 **Tip 3**: Counsel patients that full therapeutic effects may take 2-4 weeks to become apparent. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.