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Antidepressants (Adult dosing)
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Approximate equivalent dosages of SSRIs: citalopram 20mg escitalopram 5 mg fluoxetine 20mg paroxetine 20mg sertraline 50mg |
amitriptyline (Elavil ®):
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Class: Tricyclic - Tertiary Amine |
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Dosing (Adults): Depression: Initially, 25-100 mg orally at bedtime or give in divided doses. Gradually increase to usual effective dose of 50 to 300mg/day. Chronic pain (adjunct): Initially, 25 mg at bedtime - may increase as tolerated to 100 mg/day. Migraine prophylaxis: Oral: Initial: 10-25 mg at bedtime; usual dose: 150 mg; reported dosing ranges: 10-400 mg/day. Elderly: Depression: Oral: Initial: 10-25 mg at bedtime; dose should be increased in 10-25 mg increments every week if tolerated; dose range: 25-150 mg/day Dosing interval in hepatic impairment: Use with caution and monitor plasma levels and patient response Supplied: Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg |
bupropion ( Wellbutrin ® / Zyban ®
)
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Class: Aminoketone |
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Dosing (Adults): Depression: Immediate release: 100 mg 3 times/day; begin at 100 mg twice daily; may increase to a maximum dose of 450 mg/day Sustained release: Initial: 150 mg/day in the morning; may increase to 150 mg twice daily by day 4 if tolerated; target dose: 300 mg/day given as 150 mg twice daily; maximum dose: 400 mg/day given as 200 mg twice daily Extended release: Initial: 150 mg/day in the morning; may increase as early as day 4 of dosing to 300 mg/day; maximum dose: 450 mg/day Smoking cessation (Zyban®): Initiate with 150 mg once daily for 3 days; increase to 150 mg twice daily; treatment should continue for 7-12 weeks Elderly: Depression: 50-100 mg/day, increase by 50-100 mg every 3-4 days as tolerated; there is evidence that the elderly respond at 150 mg/day in divided doses, but some may require a higher dose Dosing adjustment/comments in renal impairment: Effect of renal disease on bupropion's pharmacokinetics has not been studied; elimination of the major metabolites of bupropion may be affected by reduced renal function. Patients with renal failure should receive a reduced dosage initially and be closely monitored. Dosing adjustment in hepatic impairment: Mild to moderate hepatic impairment: Use with caution and/or reduced dose/frequency. Severe hepatic cirrhosis: Use with extreme caution; maximum dose: Wellbutrin®: 75 mg/day Wellbutrin SR®: 100 mg/day or 150 mg every other day Wellbutrin XL™: 150 mg every other day Zyban®: 150 mg every other day Supplied: Tablet, as hydrochloride (Wellbutrin®): 75 mg, 100 mg Tablet, extended release, as hydrochloride (Wellbutrin XL™): 150 mg, 300 mg Tablet, sustained release, as hydrochloride: 100 mg, 150 mg [equivalent to Wellbutrin® SR], 150 mg [equivalent to Zyban®] Wellbutrin® SR: 100 mg, 150 mg, 200 mg Zyban®: 150 mg |
citalopram (Celexa ®):
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Class: Selective serotonin reuptake inhibitor (SSRI) |
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Adults: Depression: Initial: 20 mg/day, generally with an increase to 40 mg/day; doses of more than 40 mg are not usually necessary. Should a dose increase be necessary, it should occur in 20 mg increments at intervals of no less than 1 week. Maximum dose: 60 mg/day; reduce dosage in elderly or those with hepatic impairment. Supplied Solution, oral: 10 mg/5 mL (240 mL) [alcohol free, sugar free; peppermint flavor] Tablet: 10 mg, 20 mg, 40 mg |
desipramine (Norpramin ®):
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Class: Tricyclic - Secondary Amine |
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Dosing Adolescents: Depression: Initial: 25-50 mg/day; gradually increase to 100 mg/day in single or divided doses (maximum: 150 mg/day) Adults: Depression: Initial: 75 mg/day in divided doses; increase gradually to 150-200 mg/day in divided or single dose (maximum: 300 mg/day) Cocaine withdrawal (unlabeled use): 50-200 mg/day in divided or single dose Elderly: Depression: Initial dose: 10-25 mg/day; increase by 10-25 mg every 3 days for inpatients and every week for outpatients if tolerated; usual maintenance dose: 75-100 mg/day, but doses up to 150 mg/day may be necessary Monitor blood pressure and pulse rate prior to and during initial therapy evaluate mental status; monitor weight; ECG in older adults and those patients with cardiac disease; blood levels are useful for therapeutic monitoring. Supplied Tablet, as hydrochloride: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg |
doxepin (Sinequan ®):
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Class: Tricyclic - Tertiary Amine |
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Dosing: Oral (entire daily dose may be given at bedtime): Depression or anxiety: Adolescents: Initial: 25-50 mg/day in single or divided doses; gradually increase to 100 mg/day Adults: Initial: 25-150 mg/day at bedtime or in 2-3 divided doses; may gradually increase up to 300 mg/day; single dose should not exceed 150 mg; select patients may respond to 25-50 mg/day Elderly: Use a lower dose and adjust gradually Chronic urticaria, angioedema, nocturnal pruritus: Adults and Elderly: 10-30 mg/day Dosing adjustment in hepatic impairment: Use a lower dose and adjust gradually Supplied Capsule, as hydrochloride: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg Solution, oral concentrate, as hydrochloride (Sinequan®): 10 mg/mL (120 mL) |
duloxetine (Cymbalta ® )
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Class: Norephinephrine / serotonin reuptake inhibitor |
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Dosing (Adults): Depression: Treatment of major depressive disorder: Initial: 40-60 mg/day; dose may be divided (ie, 20 or 30 mg twice daily) or given as a single daily dose of 60 mg; maximum dose: 60 mg/day Diabetic neuropathy:: 60 mg orally once daily. Lower initial doses may be considered in patients where tolerability is a concern and/or renal impairment is present. Management of chronic pain syndromes (unlabeled use): 60 mg once daily Management of stress incontinence (unlabeled use): 40 mg twice daily Elderly: Treatment of major depressive disorder: Initial dose: 20 mg 1-2 times/day; increase to 40-60 mg/day as a single daily dose or in divided doses Renal dosing: [CRCL 30-50 ml/min]: Lower initial doses may be considered with titration guided by response and tolerability. [< 30 ml/min]: Not recommended. Supplied:: 20 mg, 30 mg, 60 mg capsule. |
escitalopram (Lexapro ® ) :
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Class: Selective serotonin reuptake inhibitor (SSRI) |
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Mechanism of Action The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT). Dosing: Oral: Adults: Depression, GAD: Initial: 10 mg/day; dose may be increased to 20 mg/day after at least 1 week Elderly: 10 mg/day; bioavailability and half-life are increased by 50% in the elderly Dosage adjustment in renal impairment: Mild to moderate impairment: No dosage adjustment needed. Severe impairment: Clcr<20 mL/minute: Use caution. Dosage adjustment in hepatic impairment: 10 mg/day Supplied: Solution, oral: 1 mg/mL (240 mL) Tablet: 5 mg, 10 mg, 20 mg |
fluoxetine (Prozac® ) :
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Class: Selective serotonin reuptake inhibitor (SSRI) |
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Dosing (Adults): Depression, OCD, PMDD, bulimia:
Initially, 20mg orally every morning - may increase after several weeks
by 20 mg/day increments. Usual effective dose: 20-40mg/day. Maximum:
80mg/day. Obsessive compulsive disorder (OCD): 40-80 mg/day. PMDD: 20 mg/day continuously, or 20 mg/day starting 14 days prior to menstruation and through first full day of menses (repeat with each cycle). Panic disorder: Initially, 10 mg/day. After 1 week, increase to 20 mg/day. May increase after several weeks. Doses >60 mg/day have not been evaluated. [Supplied: 10, 20 mg, 40mg capsule. Long-acting delayed release capsule: 90 mg] |
fluvoxamine (Luvox ®):
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ClClass: Selective serotonin reuptake inhibitor (SSRI) |
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Dosing (Adults): OCD: Initially, 50 mg orally at bedtime, usual effective: 100-300 mg/day divided into 2 doses. Maximum: 300mg/day. Elderly: Reduce dose, titrate slowly Dosage adjustment in hepatic impairment: Reduce dose, titrate slowly Supplied Tablet: 25 mg, 50 mg, 100 mg |
imipramine (Tofranil ®):
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Class: cyclic - Tertiary Amine |
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(Adults): Initially, 25 mg orally at
bedtime, increase gradually to usual effective dose 50-300 mg/day. Dosing Oral: Children: Enuresis: >/= 6 years: Initial: 25 mg at bedtime, if inadequate response still seen after 1 week of therapy, increase by 25 mg/day; dose should not exceed 2.5 mg/kg/day or 50 mg at bedtime if 6-12 years of age or 75 mg at bedtime if >/= 12 years of age Adolescents: Depression: Initial: 30-40 mg/day; increase gradually; maximum: 100 mg/day in single or divided doses Adults: Depression: Initial: 25 mg 3-4 times/day, increase dose gradually, total dose may be given at bedtime; maximum: 300 mg/day Elderly: Initial: 10-25 mg at bedtime; increase by 10-25 mg every 3 days for inpatients and weekly for outpatients if tolerated; average daily dose to achieve a therapeutic concentration: 100 mg/day; range: 50-150 mg/day Supplied Capsule, as pamoate (Tofranil-PM®): 75 mg, 100 mg, 125 mg, 150 mg Tablet, as hydrochloride (Tofranil®): 10 mg, 25 mg, 50 mg [generic tablets may contain sodium benzoate] |
mirtazapine (Remeron ®):
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Class: Tetracyclic |
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Dosing (Adults): Depression: Initially, 15 mg orally at bedtime. Usual effective dose: 15-45 mg/day. (Dose increases made no more frequently than every 1-2 weeks. ) Use: May be particularly helpful in depressed patients with insomnia due to its sedative properties. Mechanism of Action: Evidence gathered in preclinical studies suggests that mirtazapine enhances central noradrenergic and serotonergic activity. These studies have shown that mirtazapine acts as an antagonist at central presynaptic α2 adrenergic inhibitory autoreceptors and heteroreceptors, an action that is postulated to result in an increase in central noradrenergic and serotonergic activity. Mirtazapine is a potent antagonist of 5-HT2 and 5-HT3 receptors. Mirtazapine has no significant affinity for the 5-HT1A and 5-HT1B receptors. Mirtazapine is a potent antagonist of histamine (H1) receptors, a property that may explain its prominent sedative effects. Mirtazapine is a moderate peripheral α1 adrenergic antagonist, a property that may explain the occasional orthostatic hypotension reported in association with its use. Mirtazapine is a moderate antagonist at muscarinic receptors, a property that may explain the relatively low incidence of anticholinergic side effects associated with its use. Dosage adjustment in renal impairment: Clcr 11-39 mL/minute: 30% decreased clearance Clcr<10 mL/minute: 50% decreased clearance Dosage adjustment in hepatic impairment: Clearance decreased by 30% Supplied: 1: 15 mg, 30 mg, 45 mg tablet. Orally-disintegrating tablet: 15 mg, 30 mg, 45 mg. |
nefazodone (Serzone ®):
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Class: Phenylpiperazine |
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Dosing (Adults): Depression: Initially, 100mg orally twice daily. Usual effective dose: 150-300mg orally twice daily. Maximum: 600 mg/day. [Supplied: 50 mg, 100 mg, 150 mg, 200 mg, 250 mg tablet.] |
nortriptyline (Pamelor ®):
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Class: Tricyclic - Secondary Amine |
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Dosing (Ad (Adults): ------------------------------------------------------------ Depression: Adults: Initially, 25mg orally 1 to 4 times daily. Usual effective dose: 50-150 mg/day.. Elderly ( Note: Nortriptyline is one of the best tolerated TCAs in the elderly) Initial: 10-25 mg at bedtime. Dosage can be increased by 25 mg every 3 days for inpatients and weekly for outpatients if tolerated. Usual maintenance dose: 75 mg as a single bedtime dose or 2 divided doses; however, lower or higher doses may be required to stay within the therapeutic window Chronic urticaria, angioedema, nocturnal pruritus (unlabeled use): Adults: Oral: 75 mg/day Smoking cessation (unlabeled use): Adults: 25-75 mg/day beginning 10-14 days before "quit" day; continue therapy for >/= 12 weeks after "quit" day Dosing adjustment in hepatic impairment: Lower doses and slower titration dependent on individualization of dosage is recommended Supplied Capsule, as hydrochloride: 10 mg, 25 mg, 50 mg, 75 mg |
paroxetine (Paxil ®):
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Class: Selective serotonin reuptake inhibitor (SSRI) |
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Dosing (Adults): Depression: Initially, 20 mg orally every morning. Usual effective dose: 20-50 mg/day. Maximum: 50mg/day. (Controlled release tablet - Paxil CR): Initially, 25 mg once daily. Increase if needed by 12.5 mg/day increments at intervals of at least 1 week. Maximum dose: 62.5 mg/day. OCD / Panic attacks: Initially, 10-20mg/day. Increase if needed by 10 mg/day increments at intervals of at least 1 week. Usual effective dose: 10-60 mg/day. Recommended dose: 40 mg/day. Maximum: 60 mg/day. (Controlled release tablet - Paxil CR): Panic attacks: Initially,12.5 mg once daily. Increase if needed by 12.5 mg/day at intervals of at least 1 week. maximum dose: 75 mg/day. GAD: Initially, 20 mg once daily every morning. If dose is increased, adjust in increments of 10 mg/day at 1 week intervals. PMDD: (Controlled release tablet - Paxil CR): Initially, 12.5 mg once daily in the morning. May be increased to 25 mg/day. Dosing changes should occur at intervals of at least 1 week. May be given daily throughout the menstrual cycle or limited to the luteal phase. PTSD: Initially, 20 mg orally every morning. Usual effective dose: 20-50 mg/day. Maximum: 50mg/day. Supplied: 10 mg, 20 mg, 30 mg, 40 mg tablet. Controlled release tablet: 12.5 mg, 25 mg, 37.5 mg. |
sertraline (Zoloft ®):
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Class: Selective serotonin reuptake inhibitor (SSRI) |
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Dosing (Adults): Depression / OCD: Initially, 50 mg orally once daily. Usual effective dose: 50-200 mg/day. May increase daily dose, at intervals of not less than 1 week. Maximum: 200 mg/day. Panic attacks: Initially, 25mg orally once daily. Maximum: 200 mg/day. PMDD: Usual dose: 50 mg orally once daily throughout menstrual cycle or limited to the luteal phase of menstrual cycle. , depending on physician assessment. May titrate up to 100 - 150mg if poor response. Supplied: 25 mg, 50 mg, 100 mg tablet. Oral concentrate: 20 mg/ml (60 ml.) |
trazodone (Desyrel ®):
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ClasClass: Triazolopyridine |
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Oral: Therapeutic effects may take up to 6 weeks to occur; therapy is
normally maintained for 6-12 months after optimum response is reached to
prevent recurrence of depression. Dosing (Adults): Depression: Initial: 150 mg/day in 3 divided doses (may increase by 50 mg/day every 3-7 days); maximum: 600 mg/day. Dosing after meals may decrease lightheadedness and postural hypotension. Sedation/hypnotic (unlabeled use): 25-50 mg at bedtime (often in combination with daytime SSRIs); may increase up to 200 mg at bedtime. Dosing after meals may decrease lightheadedness and postural hypotension. Elderly: 25-50 mg at bedtime with 25-50 mg/day dose increase every 3 days for inpatients and weekly for outpatients, if tolerated; usual dose: 75-150 mg/day Supplied: 50 mg, 100 mg, 150 mg, 300 mg tablet. |
venlafaxine (Effexor ®)
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Class: Norephinephrine / serotonin reuptake inhibitor |
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Phenethylamine (Non-tricyclic). (Potent inhibitor of serotonin and
norepinephrine reuptake + weak inhibitor of dopamine reuptake. )
Dosing: Adults: Depression: Immediate-release tablets: 75 mg/day, administered in 2 or 3 divided doses, taken with food; dose may be increased in 75 mg/day increments at intervals of at least 4 days, up to 225-375 mg/day Extended-release capsules: 75 mg once daily taken with food; for some new patients, it may be desirable to start at 37.5 mg/day for 4-7 days before increasing to 75 mg once daily; dose may be increased by up to 75 mg/day increments every 4 days as tolerated, up to a maximum of 225 mg/day GAD, social anxiety disorder: Extended-release capsules: 75 mg once daily taken with food; for some new patients, it may be desirable to start at 37.5 mg/day for 4-7 days before increasing to 75 mg once daily; dose may be increased by up to 75 mg/day increments every 4 days as tolerated, up to a maximum of 225 mg/day Note: When discontinuing this medication after more than 1 week of treatment, it is generally recommended that the dose be tapered. If venlafaxine is used for 6 weeks or longer, the dose should be tapered over 2 weeks when discontinuing its use. Dosing adjustment in renal impairment: Clcr 10-70 mL/minute: Decrease dose by 25%; decrease total daily dose by 50% if dialysis patients; dialysis patients should receive dosing after completion of dialysis Dosing adjustment in moderate hepatic impairment: Reduce total daily dosage by 50% Administration Administer with food. Extended release capsule: Swallow capsule whole; do not crush or chew. Alternatively, contents may be sprinkled on a spoonful of applesauce and swallowed immediately without chewing; followed with a glass of water to ensure complete swallowing of the pellets. Supplied: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg tablet. 37.5 mg, 75 mg, 150 mg extended release capsule. |
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any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. |
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