By G. Lukar. National Technological University. 2019.
In addition buy sildalist 120mg without prescription, she (the non-ADD person) can help out in managing his impulsivity sildalist 120 mg with visa, if that is a problem discount sildalist 120mg amex. For example order sildalist 120 mg with visa, she can send him "silent signals" when he is interrupting or talking too much. My husband is ADD and we use a signal system in social situations where I gently tug on my earlobe, and that is his signal to slow down, take a breath, stop talking, start listening. Once we understand that anger is inevitable, especially in the presence of frustration or fear, then we can focus on what to do with the anger. Anger is not a behavior; aggression (shouting, yelling, cursing, throwing things, etc. Next, we learn to understand what triggers his anger. What are the situations that are "high risk" for anger. Usually they are being tired, hungry, in pain, overwhelmed, or otherwise distressed. It may be necessary to take a time out, leave the arena, and "catch your breath. Leaving an upsetting situation is a behavioral strategy. Another type of coping skill involves thinking--talking oneself down, so to speak, from being angry. Trying to see or understand the situation another way. Dobby: Any suggestions for explaining your Attention Deficit Disorder to your children? Nash: Children are naturally full of energy, at least most of them. Use simple concrete language to explain your ADD to your children. It just means that each of us has to learn different ways to "be good. Nash: Exercise releases endorphins and provides a calming effect. Some ADD people develop a substance abuse problem because they try to medicate away their symptoms that way. David: One of the most common problems adults with ADD experience in their jobs or careers, centers around time management -- getting things done on time. Nash: As to work-related issues, I believe it is really important to learn to PLAY TO YOUR STRENGTHS. I once worked with an attorney who graduated at the bottom of his class but was hired into a firm even so. But he loved constructing and arguing a case in court. I convinced him to start his own firm and hire someone to do the details--remind him of court appearances, etc. At first, he argued that he "should" be able to do these things. He did hire someone finally (part-time), and now he has his own successful law firm with several attorneys working for him. But even if you do work in an organization, learn to delegate, delegate, delegate. Say "no" to jobs that are too detail-oriented or repetitive. An ADD person is usually creative and a "big picture" thinker. There is a saying I like repeating to my ADD clients: "It is easier to ride the horse in the direction it is going. You may have to tinker a bit to find what works for you. David: One of the hallmarks of Attention Deficit Hyperactivity Disorder is forgetting, losing things, not being organized. What can ADDults do to help them remember and keep track of things? Nash: We used to have the problem (more so than now) at our house. We developed a system that works for my ADD husband. We have an "in" drawer and and "out" drawer in the chest in the foyer. Everything in his pockets goes into the in drawer each night and goes into his pockets in the morning. In the morning he also takes anything in the out drawer with him. Periodically, we coordinate calendars, and I play back up. He emails me copies of every communication that relates to both of us. Now, he just forwards emails to me or he emails me anything that comes to his mind. David: Another work difficulty centers on "paperwork"-- trying to keep up with the details. Each ADD person has his or her own presentation of ADD or specific set of symptoms. This is where Obsessive Compulsive Disorder and ADD can overlap. Here again, delegating is a good idea, or finding a simple system of managing paperwork. But if you have paperwork strewn all over the place, piled on the floor, etc. I am sure I have lost a few friends as it is embarrassing for them to come over to an untidy house. If you can afford it, hire someone to clean your house. As usual, the advice is to delegate and create structure that supports you. And thanks to everyone in the audience for coming and participating. Judy Bonnell, host of The Parent Advocate website, has 40 years of experience and knowledge to share when it comes to parenting and advocating for ADHD children. This conference is for parents of children with ADHD, ADD. Our topic tonight is "Advocating for your ADD, ADHD Child". Our guest is Judy Bonnell, owner of The Parent Advocate website here at HealthyPlace. Good Evening Judy, and welcome to and thanks for being our guest this evening. Why is it so darned hard to get the health system, the school system, and others to work with our ADD, ADHD children? If I had an easy answer to your questions, we would indeed have healthy well-educated children. But I find politics and money are often the overriding factors in these services. David: If you had to summarize, what would you say are the one or two more important things parents should know when it comes to advocating for your child?
Inhibition of bleomycin-induced toxic effects by antioxidants in human malignant melanoma cells sildalist 120mg low price. Recent nutritional approaches to the prevention and therapy of cardiovascular disease sildalist 120 mg sale. Serum selenium buy sildalist 120 mg on-line, serum alpha-tocopherol discount sildalist 120 mg fast delivery, and the risk of rheumatoid arthritis. Mannisto S, Alfthan G, Virtanen M, Kataja V, Uusitupa M, Pietinen P. Toenail selenium and breast cancer - a case-control study in Finland. Erythrocyte glutathione peroxidase activity in acne vulgaris and the effect of selenium and vitamin E treatment. Essentiality of selenium in the human body: relationship with different diseases. Olivieri O, Girelli D, Stanzial AM, Rossi L, Bassi A, Corrocher R. Selenium, zinc, and thyroid hormones in healthy subjects: low T3/T4 ratio in the elderly is related to impaired selenium status. Nutrients and HIV: part one -- beta carotene and selenium. Psathakis D, Wedemeyer N, Oevermann E, Krug F, Siegers CP, Bruch HP. Blood selenium and glutathione peroxidase status in patients with colorectal cancer. Rannem T, Ladefoged K, Hylander E, Hegnhshj, J, Staun M. Selenium depletion in patients with gastrointestinal diseases: are there any predictive factors? Russo MW, Murray SC, Wurzelmann JI, Woosley JT, Sandler RS. Plasma selenium levels and the risk of colorectal adenomas. Sahl WJ, Glore S, Garrison P, Oakleaf K, Johnson SD. Selenomethionine: a review of its nutritional significance, metabolism, and toxicity. The effect of oral selenium supplementation on human sperm motility. Glutamine antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Simsek M, Naziroglu M, Simsek H, Cay M, Aksakal M, Kumru S. Blood plasma levels of lipoperoxides, glutathione peroxidase, beta carotene, vitamin A and E in women with habitual abortion. Male infertility: nutritional and environmental considerations. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Supplementation with selenium, vitamin E and their combination in gynaecological cancer during cytotoxic chemotherapy. Tissue antioxidants and postmenopausal breast cancer: the European Community Multicentre Sudy on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC). Reduction of cisplatin nephrotoxicity by sodium selenite. Lack of interaction at the pharmacokinetic level of both compounds. Selenium concentration and glutathione peroxidase activity in blood of children with cancer. Dietary supplementation of selenomethionine reduces metastasis of melanoma cells in mice. Studies on human dietary requirements and safe range of dietary intakes of selenium in China and their application in the prevention of related endemic diseases. Studies of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. Yu MW, Horng IS, Hsu KH, Chiang YC, Liaw YF, Chen CJ. Plasma selenium levels and risk of hepatocellular carcinoma among men with chronic hepatitis viral infection. Melatonin is a hormone secreted at night by the pineal gland. It participates in multiple body processes, including regulation of the sleep/wake cycle. Because many children and adults who have ADHD also have sleep problems, melatonin can be an important part of an integrative therapy. By some estimates, up to 25 percent of children with ADHD also have sleep disorders. Unfortunately, however, conventional therapy treats the hyperactivity portion of the disease but neglects the sleep disorder (Betancourt-Fursow de Jimenez YM et al 2006). In one study of 27 children with ADHD and insomnia, 5 milligrams (mg) of melatonin, combined with sleep therapy, helped reduce insomnia (Weiss MD et al 2006). DHEA is an important neuroactive steroid hormone that may be involved in ADHD, although researchers are still trying to understand the relationship. ADHD is associated with low blood levels of DHEA, its principal precursor pregnenolone, and its principal metabolite dehydroepiandrosterone-sulfate (DHEA-S). Higher blood levels of these neurosteroids are associated with fewer symptoms (Strous RD et al 2001). A combination of these two herbs has been studied for its ability to improve symptoms among patients with ADHD. In a study of 36 children ranging in age from 3 to 17 years old, a combination of Ginkgo biloba and American ginseng was administered twice a day on an empty stomach for 4 weeks. At the end of the study, more than 70 percent of patients had experienced improvement on a widely used measure of ADHD symptoms (Lyon MR et al 2001). Alternative treatments for adults with attention-deficit hyperactivity disorderBiederman J. He began his career at CBS News in 1953 and joined NPR as its senior news analyst at 69, an age at which many of his colleagues had long been put out to pasture. Schorr pulls off the challenge with effortless grace. Because of advances in medical science, people are living much longer than ever before. The US Census Bureau projects that the number of elderly aged 85 and older will more than triple from about 4 million today to about 14 million by 2040. Some of us will live out our dotage without all our marbles. Lots of indicators point toward a health regimen that may preserve your mental capacities well into old age, and perhaps indefinitely. Other studies corroborate this connection by showing that controlling cholesterol and blood pressure levels helps keep the brain healthy. The social implications for the US look ominous given the fact that many more people currently suffer from pre-diabetes than Type 2 diabetes, which currently runs rampant in this country, the end result of the obesity epidemic. The essential message to the public is clear: If you protect yourself against diabetes by controlling your weight, exercising, and eating a healthy diet (see below), you may as a bonus preserve your gray matter, as well. Students of healthy living will find the laundry list that follows pretty darn familiar, at least those items related to diet and exercise. When it comes to these two lifestyle categories, one size seems to fit nearly all. For instance, a previous article in this magazine (Fall 2006) suggested that a heart-healthy diet not only offers protection against cardiovascular disease but also colon cancer, diabetes, and prostate cancer. Cold-water fish such as halibut, mackerel, salmon, trout, and tuna. And recent research suggests that your brain will thank you.
Because aging is associated with reduced renal function cheap sildalist 120mg on-line, Metaglip should be used with caution as age increases proven 120 mg sildalist. Care should be taken in dose selection and should be based on careful and regular monitoring of renal function discount sildalist 120mg on-line. Generally order sildalist 120 mg fast delivery, elderly patients should not be titrated to the maximum dose of Metaglip (see also WARNINGS and DOSAGE AND ADMINISTRATION ). In a double-blind 24-week clinical trial involving Metaglip as initial therapy, a total of 172 patients received Metaglip 2. The most common clinical adverse events in these treatment groups are listed in Table 4. Table 4: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Initial Therapy StudyUpper respiratory infectionIn a double-blind 18-week clinical trial involving Metaglip as second-line therapy, a total of 87 patients received Metaglip, 84 received glipizide, and 75 received metformin. The most common clinical adverse events in this clinical trial are listed in Table 5. Table 5: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Second-Line Therapy StudyThe dose of glipizide was fixed at 30 mg daily; doses of metformin and Metaglip were titrated. In a controlled initial therapy trial of Metaglip 2. In a controlled second-line therapy trial of Metaglip 5 mg/500 mg, the numbers of patients with hypoglycemia documented by symptoms and a fingerstick blood glucose measurement ?-T50 mg/dL were 0 (0%) for glipizide, 1 (1. Gastrointestinal symptoms of diarrhea, nausea/vomiting, and abdominal pain were comparable among Metaglip, glipizide and metformin in the second-line therapy trial. Overdosage of sulfonylureas, including glipizide, can produce hypoglycemia. Mild hypoglycemic symptoms, without loss of consciousness or neurological findings, should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours, since hypoglycemia may recur after apparent clinical recovery. Clearance of glipizide from plasma would be prolonged in persons with liver disease. Because of the extensive protein binding of glipizide, dialysis is unlikely to be of benefit. Overdose of metformin hydrochloride has occurred, including ingestion of amounts >50 g. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin hydrochloride has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases (see WARNINGS ). Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected. Dosage of Metaglip must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended daily dose of 20 mg glipizide/2000 mg metformin. Metaglip should be given with meals and should be initiated at a low dose, with gradual dose escalation as described below, in order to avoid hypoglycemia (largely due to glipizide), reduce GI side effects (largely due to metformin), and permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient. With initial treatment and during dose titration, appropriate blood glucose monitoring should be used to determine the therapeutic response to Metaglip and to identify the minimum effective dose for the patient. Thereafter, HbAshould be measured at intervals of approximately 3 months to assess the effectiveness of therapy. The therapeutic goal in all patients with type 2 diabetes is to decrease FPG, PPG, and HbAto normal or as near normal as possible. Ideally, the response to therapy should be evaluated using HbA, which is a better indicator of long-term glycemic control than FPG alone. No studies have been performed specifically examining the safety and efficacy of switching to Metaglip therapy in patients taking concomitant glipizide (or other sulfonylurea) plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring. For patients with type 2 diabetes whose hyperglycemia cannot be satisfactorily managed with diet and exercise alone, the recommended starting dose of Metaglip is 2. For patients whose FPG is 280 mg/dL to 320 mg/dL a starting dose of Metaglip 2. The efficacy of Metaglip in patients whose FPG exceeds 320 mg/dL has not been established. Dosage increases to achieve adequate glycemic control should be made in increments of 1 tablet per day every 2 weeks up to maximum of 10 mg/1000 mg or 10 mg/2000 mg Metaglip per day given in divided doses. In clinical trials of Metaglip as initial therapy, there was no experience with total daily doses >10 mg/2000 mg per day. For patients not adequately controlled on either glipizide (or another sulfonylurea) or metformin alone, the recommended starting dose of Metaglip is 2. In order to avoid hypoglycemia, the starting dose of Metaglip should not exceed the daily doses of glipizide or metformin already being taken. The daily dose should be titrated in increments of no more than 5 mg/500 mg up to the minimum effective dose to achieve adequate control of blood glucose or to a maximum dose of 20 mg/2000 mg per day. Patients previously treated with combination therapy of glipizide (or another sulfonylurea) plus metformin may be switched to Metaglip 2. The decision to switch to the nearest equivalent dose or to titrate should be based on clinical judgment. Patients should be monitored closely for signs and symptoms of hypoglycemia following such a switch and the dose of Metaglip should be titrated as described above to achieve adequate control of blood glucose. Metaglip is not recommended for use during pregnancy or for use in pediatric patients. The initial and maintenance dosing of Metaglip should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment requires a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of Metaglip to avoid the risk of hypoglycemia. Monitoring of renal function is necessary to aid in prevention of metformin-associated lactic acidosis, particularly in the elderly. Metaglip 5 mg/500 mg tablet is a pink oval-shaped, biconvex film-coated tablet with "BMS" debossed on one side and "6078" debossed on the opposite side. NDC 0087-xxxx-xx for unit of useMetformin hydrochloride (mg)Store at 20?-25?C (68?-77?F); excursions permitted to 15?-30?C (59?-86?F). Bristol-Myers Squibb CompanyMetaglip is an oral medication used to control blood sugar levels in people with type 2 (non-insulin-dependent) diabetes. It contains two drugs commonly used to lower blood sugar, glipizide and metformin. Metaglip replaces the need to take these two drugs separately. It is prescribed when diet and exercise alone do not control blood sugar levels, or when treatment with another antidiabetic medication does not work. People who have type 2 diabetes do not make enough insulin or do not respond normally to the insulin their bodies make, causing a buildup of unused sugar in the bloodstream. Metaglip helps remedy this problem in two ways: by causing your body to release more insulin and by helping your body use insulin more effectively. Metaglip could cause a very rare?but potentially fatal?side effect known as lactic acidosis. It is caused by a buildup of lactic acid in the blood.
Based on the pharmacokinetic results discount 120mgmg sildalist amex, there is no need for dosage adjustment in patients with renal impairment (see CLINICAL PHARMACOLOGY ) discount 120 mg sildalist free shipping. Interference with Cognitive and Motor Performance -In controlled studies purchase sildalist 120mg with visa, ZOLOFT did not cause sedation and did not interfere with psychomotor performance cheap sildalist 120 mg with visa. Some cases were possibly due to the syndrome of inappropriate antidiuretic hormone secretion. The majority of these occurrences have been in elderly individuals, some in patients taking diuretics or who were otherwise volume depleted. Platelet Function -There have been rare reports of altered platelet function and/or abnormal results from laboratory studies in patients taking ZOLOFT. While there have been reports of abnormal bleeding or purpura in several patients taking ZOLOFT, it is unclear whether ZOLOFT had a causative role. Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Zoloft and should counsel them in its appropriate use. A patient Medication Guide About Using Antidepressants in Children and Teenagers is available for ZOLOFT. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking ZOLOFT. Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. Patients should be cautioned about the risk of serotonin syndrome with the concomitant use of SNRIs and SSRIs, including Zoloft, and triptans, tramadol, or other serotonergic agents. Patients should be told that although ZOLOFT has not been shown to impair the ability of normal subjects to perform tasks requiring complex motor and mental skills in laboratory experiments, drugs that act upon the central nervous system may affect some individuals adversely. Therefore, patients should be told that until they learn how they respond to ZOLOFT they should be careful doing activities when they need to be alert, such as driving a car or operating machinery. Patients should be cautioned about the concomitant use of ZOLOFT and non-selective NSAIDs (i. Patients should be told that although ZOLOFT has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of ZOLOFT and alcohol is not advised. Patients should be told that while no adverse interaction of ZOLOFT with over-the-counter (OTC) drug products is known to occur, the potential for interaction exists. Thus, the use of any OTC product should be initiated cautiously according to the directions of use given for the OTC product. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Patients should be advised to notify their physician if they are breast feeding an infant. ZOLOFT Oral Concentrate contains 20 mg/mL of sertraline (as the hydrochloride) as the active ingredient and 12% alcohol. Just before taking, use the dropper provided to remove the required amount of ZOLOFT Oral Concentrate and mix with 4 oz (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade or orange juice ONLY. Do not mix ZOLOFT Oral Concentrate with anything other than the liquids listed. At times, a slight haze may appear after mixing; this is normal. Note that caution should be exercised for persons with latex sensitivity, as the dropper dispenser contains dry natural rubber. Potential Effects of Coadministration of Drugs Highly Bound to Plasma Proteins -Because sertraline is tightly bound to plasma protein, the administration of ZOLOFT ^ (sertraline hydrochloride) to a patient taking another drug which is tightly bound to protein (e. Conversely, adverse effects may result from displacement of protein bound ZOLOFT by other tightly bound drugs. In a study comparing prothrombin time AUC (0-120 hr) following dosing with warfarin (0. The normalization of prothrombin time for the ZOLOFT group was delayed compared to the placebo group. The clinical significance of this change is unknown. Accordingly, prothrombin time should be carefully monitored when ZOLOFT therapy is initiated or stopped. Cimetidine -In a study assessing disposition of ZOLOFT (100 mg) on the second of 8 days of cimetidine administration (800 mg daily), there were significant increases in ZOLOFT mean AUC (50%), Cmax (24%) and half-life (26%) compared to the placebo group. The clinical significance of these changes is unknown. CNS Active Drugs -In a study comparing the disposition of intravenously administered diazepam before and after 21 days of dosing with either ZOLOFT (50 to 200 mg/day escalating dose) or placebo, there was a 32% decrease relative to baseline in diazepam clearance for the ZOLOFT group compared to a 19% decrease relative to baseline for the placebo group (p<0. There was a 23% increase in Tmax for desmethyldiazepam in the ZOLOFT group compared to a 20% decrease in the placebo group (p<0. The clinical significance of these changes is unknown. In a placebo-controlled trial in normal volunteers, the administration of two doses of ZOLOFT did not significantly alter steady-state lithium levels or the renal clearance of lithium. Nonetheless, at this time, it is recommended that plasma lithium levels be monitored following initiation of ZOLOFT therapy with appropriate adjustments to the lithium dose. In a controlled study of a single dose (2 mg) of pimozide, 200 mg sertraline (q. Since the highest recommended pimozide dose (10 mg) has not been evaluated in combination with sertraline, the effect on QT interval and PK parameters at doses higher than 2 mg at this time are not known. While the mechanism of this interaction is unknown, due to the narrow therapeutic index of pimozide and due to the interaction noted at a low dose of pimozide, concomitant administration of ZOLOFT and pimozide should be contraindicated (see CONTRAINDICATIONS ). The risk of using ZOLOFT in combination with other CNS active drugs has not been systematically evaluated. Consequently, caution is advised if the concomitant administration of ZOLOFT and such drugs is required. There is limited controlled experience regarding the optimal timing of switching from other drugs effective in the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder and social anxiety disorder to ZOLOFT. Care and prudent medical judgment should be exercised when switching, particularly from long-acting agents. The duration of an appropriate washout period which should intervene before switching from one selective serotonin reuptake inhibitor (SSRI) to another has not been established. Drugs Metabolized by P450 3A4 -In three separate in vivo interaction studies, sertraline was co-administered with cytochrome P450 3A4 substrates, terfenadine, carbamazepine, or cisapride under steady-state conditions. The results of these studies indicated that sertraline did not increase plasma concentrations of terfenadine, carbamazepine, or cisapride. Results of the interaction study with cisapride indicate that sertraline 200 mg (q. Drugs Metabolized by P450 2D6 -Many drugs effective in the treatment of major depressive disorder, e. The drugs for which this potential interaction is of greatest concern are those metabolized primarily by 2D6 and which have a narrow therapeutic index, e. The extent to which this interaction is an important clinical problem depends on the extent of the inhibition of P450 2D6 by the antidepressant and the therapeutic index of the co-administered drug. There is variability among the drugs effective in the treatment of major depressive disorder in the extent of clinically important 2D6 inhibition, and in fact sertraline at lower doses has a less prominent inhibitory effect on 2D6 than some others in the class. Nevertheless, even sertraline has the potential for clinically important 2D6 inhibition. Consequently, concomitant use of a drug metabolized by P450 2D6 with ZOLOFT may require lower doses than usually prescribed for the other drug. Furthermore, whenever ZOLOFT is withdrawn from co-therapy, an increased dose of the co-administered drug may be required (see Tricyclic Antidepressant Drugs Effective in the Treatment of Major Depressive Disorder under PRECAUTIONS ).