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Older adults may be more sensitive to the side effects of this drugespecially bleeding and QT prolongationsee aboveOlder adults may also be more likely to develop low sodium in the bloodespecially if they are takingwater pillsdiuretics

Tell the doctor right away if you notice worsening depression/other psychiatric conditionsunusual behavior changesincluding possible suicidal thoughts/attemptsor other mental/mood changesincluding new/worsening anxietypanic attackstrouble sleepingirritabilityhostile/angry feelingsimpulsive actionssevere restlessnessvery rapid speechBe especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

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Patients should be advised of the signs and symptoms associated with serotonin syndrome that may include mental status changesfor exampleagitationhallucinationsdeliriumand comaautonomic instabilityfor exampletachycardialabile blood pressuredizzinessdiaphoresisflushinghyperthermianeuromuscular changesfor exampletremorrigiditymyoclonushyperreflexiaincoordinationseizuresand/or gastrointestinal symptomsfor examplenauseavomitingdiarrheaPatients should be cautioned to seek medical care immediately if they experience these symptoms.

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