Antidepressants and other psychiatric medications in cancer care
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Medication | Class | Indication | Starting dose | Target dose | Interactions | Side effects |
---|---|---|---|---|---|---|
Citalopram (Celexa) | SSRI | Anxiety
Depression |
10 mg | 20-40 mg | Mild 2D6 inhibition
Platelet dysfunction |
Nausea
fatigue |
Escitalopram (Lexapro) | SSRI | Anxiety
Depression |
5 mg | 10-20 mg | Mild 2D6 inhibition
Platelet dysfunction |
Nausea
fatigue |
Fluoxetine (Prozac) | SSRI | Depression
Anxiety |
10 mg | 20-60 mg | CYP450 2D6 inhibition
Very long half-life and multiple drug interactions |
Nausea
Sedation |
Sertraline (Zoloft) | SSRI | Depression
Anxiety |
50 mg | 150-200 mg | Weak 2D6 inhibition
Inhibits platelet function |
Nausea |
Venlafaxine (Effexor XR) | SNRI | Depression
Anxiety |
37.5 mg | 150 mg | 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 | Strong 2D6 inhibition | Seizure risk (Black box)
Anxiety |
Mirtazapine (Remeron) | Other antidepressant | Anxiety
Depression Insomnia |
7.5 mg | 30-40 mg | Neutropenia reported
2D6 substrate |
Weight gain
Sedation |
Trazodone (Desyrel) | Other antidepressant | Anxiety
Insomnia |
25-50 mg | 50-100 mg | 3A4 substrate | Sedation
Nausea |
Desipramine (Norpramin) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Imipramine (Tofranil) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Nortriptyline (Pamelor) | Tricyclic | Depression
Anxiety Insomnia Boost pain control |
10-25 mg | Check blood levels and EKG | Strong 2D6 inhibition
Rare agranulocytosis |
Anticholinergic symptoms |
Gabepentin (Neurontin) | Anti-seizure | Pain control
Anxiety Insomnia |
100 mg | Large range from 300-3600 mg | Renal excreted (i.e. not metabolized) | Sedation |
Lamotrigine (Lamictal) | Anti-seizure | Elevates mood | 25 mg | 200 mg (for psych) | 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 | 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 | QTc prolongation | Sedation
Weight gain |
Quetiapine (Seroquel) | Antipsychotic | Nausea
Anxiety Insomnia Agitation |
25-50 mg | 100-300 mg | 3A4 substrate, limited drug/drug interactions
QTc prolongation |
Sedation
Weight gain |
Zolpidem (Ambien) | Insomnia | Insomnia | 5 mg | 5-10 mg | Alcohol interaction
Hepatic metabolism |
Sedation
Dizziness Parasomnias |
Information adapted from a table created by Christine Wittmann, MD and Laurie Rosenblatt, MD. Used with permission.