Gepirone ($ Exxua)

Novel (serotonin receptor partial agonist (5-HT1A))

Dosing

Start 18.2 mg/day x4days, 36.3 mg/d x 3 days (can use 2 of 18.2), 54.5 mg/d x 7 days, then 72.6 mg/d.

Take with food (levels 30-50% higher with food). Avoid with grapefruit.

INTERACTIONS: Lower 50% with strong CYP3A4 inhibitors (nefazodone, antibiotics, antifungals, HIV meds, diltiazem, verapamil, grapefruit juice). May also need to lower dose with moderate inhibitors (every SSRI except citalopram and escitalopram). Raise dose with inducers (carbamazepine, oxcarbazepine ≥ 1200 mg, topiramate ≥ 200 mg, St John’s wort, and possibly modafinils).

Management

Not very effective as an antidepressant, and has cardiac warning requiring EKG before starting so rarely is useful. Similar to buspirone, which is preferable.

EMR Text