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Flashcards in Antidepressants Deck (37):
0

Celexa

Citalopram
SSRI
Initial: 20mg Maintenance: 20-40mg (20mg of celexa=10mg of lexapro)
QT prolongation. Avoid in hepatic impairment and FQs(other QT prolonging drugs)

1

Lexapro

Escitalopram
SSRI
Initial: 10mg Maintenance: 10-20mg

2

Zoloft

Sertraline
SSRI
Initial: 50mg Maintenance: 50-200mg
Improves energy, increases DA: activating

3

Prozac

Fluoxetine
SSRI
Initial: 20mg Maintenance: 20-80mg
Strong CYP2D6 inhibitor

4

Paxil, Brisdelle, Pexeva

Paroxetine
SSRI
Initial: IR=20mg CR=25mg Maintenance: IR=20-50mg CR=25-62.5
Strong CYP2D6 inhibitor
Pregnancy category D
Sedation, sexual dysfxn, anticholinergic SEs , weight gain, withdrawal SEs

5

Luvox

Fluvoxamine
SSRI
Initial: 50mg Maintenance: 50-300mg
Strong CYP1A2 inhibitor

6

Effexor

Venalfaxine
SNRI
Prodrug
Initial: IR-75mg, XR-75mg
Maintenance: IR 75-375mg/day, XR 75-225mg/day
Acts like SSRI at low doses. Higher doses will start the block NET
SEs: GI upset, increase blood pressure, sweating and weight loss
Withdrawal syndrome bc of short half life

7

Pristiq, Khedezla

Desvenlafaxine
SNRI
Initial: 50mg Maintenance: 50-400mg/day
Active metabolite of Effexor. Initial dose will block SERT and NET
Empty capsule may be present in stool

8

Cymbalta

Duloxetine
SNRI
Initial: 30mg Maintenance: 30-120mg/day
Approved for fibromyalgia and neuropathic pain
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risks

9

Savella

Milnacipran
SNRI
Initial: 12.5 mg on day 1 than titrate per PI
Maintenance: 50-100mg BID
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risk
SEs: headache, constipation, nausea, HTN

10

Fetzima

Levomilnacipran
SNRI
Initial: 20 mg daily for 2-4 days increase to 40mg
Maintenance: 40-120mg/day take doses at same time qd
SEs: diaphoresis, constipation and nausea

11

Remeron

Mirtazapine
Atypical (Seretonin receptor modulator)
Initial: 15mg QHS. Maintenance: 15-45mg/day
Increases lipids
Adjunct to treat: anxiety, insomnia, sexual dysfunction, GI SEs
Using with clonidine can cause rebound HTN

12

Wellbutrin, Aplenzin, Forfivo

Bupropion
Atypical (NE, DA re uptake inhibitor)
Strong CYP2D6 inhibitor
Contraindicated in: epilepsy, eating disorders, abrupt discontinuation of alcohol or sedatives
Use as adjunct therapy to treat; lack of weight gain, sexual dysfxn, sedation
*lowers seizure threshold

13

Desyrel, Oletro

Trazodone
Atypical (Seretonin receptor modulator)
3A4 metabolism to iminoquinone/reactive species leads to hepatotoxicity
SEs: priapism, orthostasis, sedation, dry mouth, nausea
Take on empty stomach. Used as adjunct therapy bc high doses as mono therapy lead to increased SEs
IR:300-600 mg/day
XR: 150-375 mg/day

14

Serzone

Nefazodone
Atypical
BLACK BOX WARNING: life threatening hepatic failure

15

Viibryd

Vilazodone
Atypical
Initial: 10mg. Maintenance: 40mg
Take with food

16

Buspar

Buspirone
Atypical

17

Brintellix

Vortioxetine
Atypical
Initial: 10mg. Maintenance: 5-20mg
SE: nausea

18

Sinequan, Silenor

Doxepin
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

19

Anafranil

Clomipramine
TCA-tertiary amine
Initial: 25mg QD. Maintenance:100-200mg/day

20

Elavil

Amitriptyline
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

21

Tofranil

Imipramine
TCA-tertiary amine
Initial: 75mg QHS. Maintenance:75-300mg/day

22

Norpramin

Desipramine
TCA- secondary amine
Initial: 25mg QHS. Maintenance:50-150mg/day

23

Pamelor

Nortriptyline
TCA-secondary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

24

Emsam

Selegiline patch
MAOI
Initial 6mg/24hours. Maintenance:6-12mg/24hours
Selectively inhibits MAO-B in the gut so not dietary restrictions required

25

Nardil

Phenelzine
MAOI
Initial:15mg/day. Maintenance: 30-90 mg/day

26

Parnate

Tranylcypromine
MAOI
Initial:10 mg/day. Maintenance:30-60 mg/day in 2-4 divided doses

27

Marplan

Isocarboxazid
MAOI
Initial:10mg BID Maintenance: 10-60 mg/ day in 2-4 divided doses

28

Common side effects of SSRIs

Nausea, diarrhea, vomiting, sleep disturbances,headache and sexual dysfunction

29

Bupropion IR dose

Initial: 100mg BID
Maintenance: 150mg TID

30

Bupropion SR dose

Initial: 150 mg in AM
Maintenance: 150-200 mg BID

31

Bupropion XL dose

Initial: 150mg daily
Maintenance: 150-300mg/day

32

Common side effects of SNRIs

GI, nausea,vomiting, constipation
Insomnia/activation
Sexual dysfunction
Increased HR, BP
Dilated pupils
Dry mouth
Excessive sweating

33

TCA tertiary side effects

Sedation, anticholinergic, weight gain, conduction abnormalities
SERT inhibition > NET
Imipramine (Tofranil)
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Silenor)

34

TCA secondary amine

Less side effects
Norpramin (desipramine), Pamelor (nortriptyline)

35

MAOIs common side effects

Orthostasis
Sedation
Insomnia
Headache
Weight gain
Sexual dysfunction
Peripheral edema
Constipation
Hypertensive crisis from MAO-A inhibition in gut and tyramine.mavoid eating tyramine containing foods 14 days after MAOI D/C
Seretonin syndrome

36

Discontinuation syndrome

Avoid by tapering antidepressant dose by no more than 25%/week
Onset is 1-3 days upon abrupt discontinuation
Don't need to taper MAOIs upon d/c