Patient/Family Teaching

• Instruct patient to take medication exactly as directed. If a dose is missed, take as soon as possible unless almost time for next dose; if regimen is a single dose at bedtime, do not take in the morning because of side effects. Advise patient that drug effects may not be noticed for at least 2 wk. Abrupt discontinuation may cause nausea, vomiting, diarrhea, headache, trouble sleeping with vivid dreams, and irritability

• May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known

• Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in geriatric patients. Protect patient from falls and advise patient to make position changes slowly. Institute fall precautions. Advise patient to make position changes slowly. Refer as appropriate for nutrition/weight management and medical management

• Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy has been discontinued

• Instruct patient to notify health care professional if urinary retention, dry mouth, or constipation persists. Sugarless candy or gum may diminish dry mouth, and an increase in fluid intake or bulk may prevent constipation. If symptoms persist, dose reduction or discontinuation may be necessary. Consult health care professional if dry mouth persists for >2 wk

• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Alert patient that medication may turn urine blue-green in color

• Inform patient of need to monitor dietary intake. Increase in appetite may lead to undesired weight gain

• Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding

• Advise patient to notify health care professional of medication regimen before treatment or surgery. Medication should be discontinued as long as possible before surgery

• Therapy for depression is usually prolonged and should be continued for at least 3 months to prevent relapse. Emphasize the importance of follow-up exams to monitor effectiveness, side effects, and improve coping skills. Advise patient and family that treatment is not a cure and symptoms can recur after discontinuation of medication. Refer patient to local support group

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