Difference between revisions of "Antidepressants and other psychiatric medications in cancer care"
m (spacing) |
(half-lives) |
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!Starting dose | !Starting dose | ||
!Target dose | !Target dose | ||
+ | !Half-life | ||
!Interactions | !Interactions | ||
!Side effects | !Side effects | ||
Line 17: | Line 18: | ||
|10 mg | |10 mg | ||
|20-40 mg | |20-40 mg | ||
+ | |35 hours | ||
|Mild 2D6 inhibition | |Mild 2D6 inhibition | ||
Platelet dysfunction | Platelet dysfunction | ||
Line 28: | Line 30: | ||
|5 mg | |5 mg | ||
|10-20 mg | |10-20 mg | ||
+ | |27-32 hours; 50% greater in elderly patients | ||
|Mild 2D6 inhibition | |Mild 2D6 inhibition | ||
Platelet dysfunction | Platelet dysfunction | ||
Line 39: | Line 42: | ||
|10 mg | |10 mg | ||
|20-60 mg | |20-60 mg | ||
+ | |4-6 days (fluoxetine); 9.3 days (norfluoxetine) | ||
|CYP450 2D6 inhibition | |CYP450 2D6 inhibition | ||
Very long half-life and multiple drug interactions | Very long half-life and multiple drug interactions | ||
Line 50: | Line 54: | ||
|50 mg | |50 mg | ||
|150-200 mg | |150-200 mg | ||
+ | |26 hours | ||
|Weak 2D6 inhibition | |Weak 2D6 inhibition | ||
Inhibits platelet function | Inhibits platelet function | ||
Line 60: | Line 65: | ||
|37.5 mg | |37.5 mg | ||
|150 mg | |150 mg | ||
+ | |5 hours (parent drug); 11 hours (active metabolite) | ||
|2D6 inhibition | |2D6 inhibition | ||
Reduces platelet function | Reduces platelet function | ||
Line 73: | Line 79: | ||
XR: 150 mg | XR: 150 mg | ||
|150-300 mg | |150-300 mg | ||
+ | |21 hours | ||
|Strong 2D6 inhibition | |Strong 2D6 inhibition | ||
|Seizure risk (Black box) | |Seizure risk (Black box) | ||
Line 84: | Line 91: | ||
|7.5 mg | |7.5 mg | ||
|30-40 mg | |30-40 mg | ||
+ | |20-40 hours | ||
|Neutropenia reported | |Neutropenia reported | ||
2D6 substrate | 2D6 substrate | ||
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|25-50 mg | |25-50 mg | ||
|50-100 mg | |50-100 mg | ||
+ | |3-6 hours (first phase); 5-9 hours (second phase) | ||
|3A4 substrate | |3A4 substrate | ||
|Sedation | |Sedation | ||
Line 107: | Line 116: | ||
|10-25 mg | |10-25 mg | ||
|Check blood levels and EKG | |Check blood levels and EKG | ||
+ | |12-27 hours | ||
|Strong 2D6 inhibition | |Strong 2D6 inhibition | ||
Rare agranulocytosis | Rare agranulocytosis | ||
Line 119: | Line 129: | ||
|10-25 mg | |10-25 mg | ||
|Check blood levels and EKG | |Check blood levels and EKG | ||
+ | |11-25 hours | ||
|Strong 2D6 inhibition | |Strong 2D6 inhibition | ||
Rare agranulocytosis | Rare agranulocytosis | ||
Line 131: | Line 142: | ||
|10-25 mg | |10-25 mg | ||
|Check blood levels and EKG | |Check blood levels and EKG | ||
+ | |18-44 hours | ||
|Strong 2D6 inhibition | |Strong 2D6 inhibition | ||
Rare agranulocytosis | Rare agranulocytosis | ||
Line 142: | Line 154: | ||
|100 mg | |100 mg | ||
|Large range from 300-3600 mg | |Large range from 300-3600 mg | ||
+ | |5-7 hours | ||
|Renal excreted (i.e. not metabolized) | |Renal excreted (i.e. not metabolized) | ||
|Sedation | |Sedation | ||
Line 150: | Line 163: | ||
|25 mg | |25 mg | ||
|200 mg (for psych) | |200 mg (for psych) | ||
+ | |14 hours with enzyme-inducing anticonvulsants (EIA); 59 hours with valproic acid (VPA); 28 hours with EIA & VPA | ||
|No weight gain | |No weight gain | ||
Other anti-seizure medications can double blood levels of lamotrigine | Other anti-seizure medications can double blood levels of lamotrigine | ||
Line 160: | Line 174: | ||
|5 mg | |5 mg | ||
|15-20 mg | |15-20 mg | ||
+ | |75 hours (CYP2D6 extensive metabolizers); 146 hours CYP2D6 poor metabolizers) | ||
|QTc prolongation may be less than other atypicals | |QTc prolongation may be less than other atypicals | ||
No CYP450 inhibition | No CYP450 inhibition | ||
Line 173: | Line 188: | ||
|2.5-5 mg | |2.5-5 mg | ||
|10 mg | |10 mg | ||
+ | |21-54 hours | ||
|QTc prolongation | |QTc prolongation | ||
|Sedation | |Sedation | ||
Line 185: | Line 201: | ||
|25-50 mg | |25-50 mg | ||
|100-300 mg | |100-300 mg | ||
+ | |6-7 hours | ||
|3A4 substrate, limited drug/drug interactions | |3A4 substrate, limited drug/drug interactions | ||
QTc prolongation | QTc prolongation | ||
Line 195: | Line 212: | ||
|5 mg | |5 mg | ||
|5-10 mg | |5-10 mg | ||
+ | |2.5-3.1 hours | ||
|Alcohol interaction | |Alcohol interaction | ||
Hepatic metabolism | Hepatic metabolism |
Revision as of 17:42, 10 July 2012
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Medication | Class | Indication | Starting dose | Target dose | Half-life | Interactions | Side effects |
---|---|---|---|---|---|---|---|
Citalopram (Celexa) | SSRI | Anxiety
Depression |
10 mg | 20-40 mg | 35 hours | Mild 2D6 inhibition
Platelet dysfunction |
Nausea
fatigue |
Escitalopram (Lexapro) | SSRI | Anxiety
Depression |
5 mg | 10-20 mg | 27-32 hours; 50% greater in elderly patients | Mild 2D6 inhibition
Platelet dysfunction |
Nausea
fatigue |
Fluoxetine (Prozac) | SSRI | Depression
Anxiety |
10 mg | 20-60 mg | 4-6 days (fluoxetine); 9.3 days (norfluoxetine) | CYP450 2D6 inhibition
Very long half-life and multiple drug interactions |
Nausea
Sedation |
Sertraline (Zoloft) | SSRI | Depression
Anxiety |
50 mg | 150-200 mg | 26 hours | Weak 2D6 inhibition
Inhibits platelet function |
Nausea |
Venlafaxine (Effexor XR) | SNRI | Depression
Anxiety |
37.5 mg | 150 mg | 5 hours (parent drug); 11 hours (active metabolite) | 2D6 inhibition
Reduces platelet function |
Hypertension
Nausea Flu-like withdrawal |
Bupropion (Wellbutrin/Zyban) | Other antidepressant | Depression
Activating |
SR: 50-75 mg
XR: 150 mg |
150-300 mg | 21 hours | Strong 2D6 inhibition | Seizure risk (Black box)
Anxiety |
Mirtazapine (Remeron) | Other antidepressant | Anxiety
Depression Insomnia |
7.5 mg | 30-40 mg | 20-40 hours | Neutropenia reported
2D6 substrate |
Weight gain
Sedation |
Trazodone (Desyrel) | Other antidepressant | Anxiety
Insomnia |
25-50 mg | 50-100 mg | 3-6 hours (first phase); 5-9 hours (second phase) | 3A4 substrate | Sedation
Nausea |
Desipramine (Norpramin) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | 12-27 hours | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Imipramine (Tofranil) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | 11-25 hours | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Nortriptyline (Pamelor) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | 18-44 hours | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Gabepentin (Neurontin) | Anti-seizure | Pain control
Anxiety Insomnia |
100 mg | Large range from 300-3600 mg | 5-7 hours | Renal excreted (i.e. not metabolized) | Sedation |
Lamotrigine (Lamictal) | Anti-seizure | Elevates mood | 25 mg | 200 mg (for psych) | 14 hours with enzyme-inducing anticonvulsants (EIA); 59 hours with valproic acid (VPA); 28 hours with EIA & VPA | No weight gain
Other anti-seizure medications can double blood levels of lamotrigine |
Stevens-Johnson with any change in dose (Black box) |
Aripiprazole (Abilify) | Antipsychotic | Agitation
Anxiety |
5 mg | 15-20 mg | 75 hours (CYP2D6 extensive metabolizers); 146 hours CYP2D6 poor metabolizers) | QTc prolongation may be less than other atypicals
No CYP450 inhibition Rare agranulocytosis |
Less weight gain
Extrapyramidal symptoms including akathisia and risk of tardive dyskinesia when mixed with prochlorperazine (Compazine) or metoclopramide (Reglan) |
Olanzapine (Zyprexa) | Antipsychotic | Agitation
Insomnia Anxiety |
2.5-5 mg | 10 mg | 21-54 hours | QTc prolongation | Sedation
Weight gain |
Quetiapine (Seroquel) | Antipsychotic | Nausea
Anxiety Insomnia Agitation |
25-50 mg | 100-300 mg | 6-7 hours | 3A4 substrate, limited drug/drug interactions
QTc prolongation |
Sedation
Weight gain |
Zolpidem (Ambien) | Insomnia | Insomnia | 5 mg | 5-10 mg | 2.5-3.1 hours | Alcohol interaction
Hepatic metabolism |
Sedation
Dizziness Parasomnias |
Information adapted from a table created by Christine Wittmann, MD and Laurie Rosenblatt, MD. Used with permission.