- **Initial dose:** 5 mg per day (split into 2–3 smaller doses). - **Maximum recommended dose:** 10 mg per day (to reduce side‑effects). - **Cycle length:** 4–6 weeks on, followed by a break of at least 2 weeks.
**Note:** Dosage may vary depending on body weight and sensitivity; always start low and titrate gradually.
---
## 4. Common Side‑Effects
| Symptom | Severity | Typical Onset | |---------|----------|---------------| | Headache | Mild–moderate | Often in first few days | | Dizziness | Mild | Usually within first week | | Nausea / GI upset | Mild | Can occur anytime | | Sleep disturbances (insomnia or vivid dreams) | Moderate | Usually during first week | | Increased heart rate / palpitations | Mild‑moderate | Variable |
If symptoms become severe or persist beyond two weeks, consult a healthcare professional.
---
## 5. Precautions and Contraindications
- **Cardiovascular conditions:** Avoid if you have arrhythmias, uncontrolled hypertension, or recent myocardial infarction. - **Pregnancy / breastfeeding:** Limited data; avoid unless medically indicated and supervised by a clinician. - **Concurrent medications:** Be cautious with stimulants (e.g., ADHD meds), MAO inhibitors, or drugs affecting CNS excitability—may increase risk of serotonin syndrome or hypertensive crisis. - **Mental health disorders:** Those with severe anxiety, panic disorder, bipolar disorder, or psychosis should avoid due to potential symptom exacerbation.
---
## 6. Suggested Protocol for Safe Use
| Step | Timing (Day) | Action | |------|--------------|--------| | **1** | 0 | Obtain baseline vitals: BP (systolic/diastolic), HR, RR; complete mental status exam. | | **2** | 0-30 min after ingestion | Monitor for immediate effects: tremor, palpitations, increased BP/HR. | | **3** | 1–4 h post-ingestion | Record vitals every 15–30 min if elevated; assess anxiety levels. | | **4** | 6–8 h | Check BP/HR again; if stable and normal, discontinue monitoring. | | **5** | 12 h | Final check of vitals; ensure no delayed tachycardia or hypertension. | | **6** | 24 h | Re-evaluate for any lingering symptoms (headache, palpitations). |
- If at any point BP ≥ 160/100 mmHg or HR ≥ 120 bpm, consider antihypertensive agents such as low‑dose clonidine or propranolol, after ruling out contraindications. - Maintain a record of all readings; this data informs the next monitoring plan.
---
## 3. Decision Flow for Extending Monitoring Duration
| **Condition** | **Action** | |---------------|------------| | **Any of the following during initial 24 h** | • **Blood pressure ≥ 150/100 mmHg** (sustained > 5 min) or **≥ 160 mmHg systolic**. • **Heart rate > 110 bpm** (lasting > 10 min). • **Symptoms of headache, visual disturbance, chest pain, palpitations, shortness of breath, or dizziness.** | **Extend monitoring to 48–72 h.** Provide additional BP and HR checks every 6 h; consider ambulatory BP monitoring. | | If any of the above criteria are met at 48 h: | **Continue for an additional 24–48 h** (total 96–120 h). Evaluate for arrhythmias, sustained hypertension, or other complications. | | If no further symptoms or abnormal readings after 72 h: | **Discharge home with BP and HR monitoring instructions.** Provide clear guidance on when to seek care. |
---
## 5. Discharge / Transition to Primary Care
### 5.1 Discharge Criteria - Stable vital signs for ≥4 h (HR 60‑100 bpm, BP
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