Antidepressants and other psychiatric medications in cancer care
Carboplatin & Paclitaxel (CP)
CP: Carboplatin & Paclitaxel
Regimen
| Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Forde et al. 2022 (CheckMate 816) | 2017-2019 | Phase 3 (C) | 1a. CP & Nivolumab 1b. CVb & Nivolumab 1c. DC & Nivolumab |
Inferior EFS |
Note: there were additional comparator options depending on histology; see the respective histology-specific pages for more details. This study was conducted in the United States. The reason for the study was that an unanswered question at the time was whether adding an immune checkpoint inhibitor would improve outcomes.
Biomarker eligibility criteria
- CheckMate 816: No sensitizing EGFR or ALK mutations
Chemotherapy
- Carboplatin (Paraplatin) AUC 5 or 6 IV once on day 1
- Paclitaxel (Taxol) 175 or 200 mg/m2 IV once on day 1
21-day cycle for 3 cycles
Subsequent treatment
References
- CheckMate 816: Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, Felip E, Broderick SR, Brahmer JR, Swanson SJ, Kerr K, Wang C, Ciuleanu TE, Saylors GB, Tanaka F, Ito H, Chen KN, Liberman M, Vokes EE, Taube JM, Dorange C, Cai J, Fiore J, Jarkowski A, Balli D, Sausen M, Pandya D, Calvet CY, Girard N; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985. Epub 2022 Apr 11. link to original article contains dosing details in manuscript PubMed NCT02998528
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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 QTc prolongation |
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 | Anxiety
Depression |
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 | Anxiety
Depression |
50 mg | 150-200 mg | 26 hours | Weak 2D6 inhibition
Inhibits platelet function |
Nausea |
| Venlafaxine (Effexor XR) | SNRI | Anxiety
Depression |
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 | Activating
Depression |
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 | Anxiety
Depression 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 | Anxiety
Depression 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 | Anxiety
Depression 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 | Anxiety
Insomnia Pain control |
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
Anxiety Insomnia |
2.5-5 mg | 10 mg | 21-54 hours | QTc prolongation | Sedation
Weight gain |
| Quetiapine (Seroquel) | Antipsychotic | Agitation
Anxiety Insomnia Nausea |
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.