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C H A P T E R 2 1 Antidepressant agents

Drug therapy across the lifespan (continued)

BOX 21.1

for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate. OLDER ADULTS Older people may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) effects to increased sedation, dizziness and

even hallucinations. Doses of all of these drugs need to be reduced and the person monitored very closely for toxic effects. Safety measures should be provided if CNS effects do occur. People with hepatic or renal impairment should be monitored very closely while taking these drugs. Decreased doses may be needed. Because many older people also have renal or hepatic impairment, they need to be screened carefully.

TABLE 21.1

DRUGS IN FOCUS Tricyclic antidepressants

Common side effects

Sedation

Anticholinergic Hypotension Cardiovascular

Drug name

Usual dosage

Amines amitriptyline (Endep, Amitrip) clomipramine (Anafranil, Placil)

++++

++++

++++

++

75–150 mg/day PO 25–50 mg PO b.d or t.d.s. 75 mg (elderly 50–75 mg) daily in divided doses or as a single dose at bedtime, increased gradually as Adult initially

+++

+++

+++

+++

dosulepin

++ Central nervous

++++ See Medsafe report of prolongation of QT intervals www. medsafe.govt.nz/ profs/PUArticles/ December2013QT ProlongationAnd Antidepressants. htm

hydrochloride

system adverse effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep

necessary to 150 mg daily (elderly 75 mg may

disturbances, irritability, and paraesthesia; drowsiness

be sufficient); up to 225 mg daily in some circumstances (e.g. hospital use) Capsules are 25 mg

is associated with some of the tricyclic antidepressants ... not sedation www.nzf.org.nz/ nzf_2252.html? searchterm= dothiepin

dothiepin (Dothep)

++++

+++

+++

+++

25–60 mg PO t.d.s. Adult initially 75 mg (elderly 50–75 mg) daily in divided doses or as a single dose at bedtime, increased gradually as necessary to 150 mg daily (elderly 75 mg may be sufficient);

up to 225 mg daily in some circumstances (e.g. hospital use) Continued on following page