Medicines Knowledge Week 5 (Amitriptyline, Venlafaxine, Aripiprazole, Clozapine, Donepezil) Flashcards
Amitriptyline drug class
Tricyclic antidepressant (TCA)
Amitriptyline indications
- Major depression
- Adjuvant in pain management
- Migraine prophylaxis
Amitriptyline dosage range and timing
Depression: oral 25–75 mg daily, increasing by 25–50 mg every 2–3 days to 75–150 mg daily. Maximum 300 mg daily
> dose may be divided or given as single dose at night
Adjuvant in pain management, migraine prophylaxis: oral 10–25 mg at night initially; titrate up to a maximum night time dose of 75 mg in migraine and 150 mg in pain management.
Amitriptyline counselling
You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days
Try taking this medicine at night to reduce daytime drowsiness
These drugs may increase the effects of alcohol.
Amitriptyline monitoring
Monitor patients for increased suicidal thoughts which can occur soon after starting antidepressants
Monitor for adverse effects such as seizures and prolonged QT interval
Venlafaxine drug class
Serotonin and noradrenaline reuptake inhibitor (SNRI)
Venlafaxine indications
Major depression
Generalised anxiety disorder
Social phobia
Venlafaxine dosage range and timing
Adult, oral 75 mg once daily; if required, increase to 150 mg once daily.
Venlafaxine counselling
Take with food to minimise stomach upsets
Do not stop taking this medicine suddenly unless your doctor tells you to.
Do not open, crush or chew capsules, or put them in water.
Venlafaxine monitoring
Monitor patients for increased suicidal thoughts which can occur soon after starting antidepressants
Check BP before starting treatment then check regularly while using venlafaxine
Aripiprazole drug class
Antipsychotic
Aripiprazole indications
Schizophrenia
Bipolar disorder as monotherapy
Aripiprazole dosage range and timing
Schizophrenia: 10-15 mg once daily
Bipolar disorder: 15-30mg once daily
Aripiprazole counselling
Taking antipsychotic medicine regularly is important because stopping it or not taking it regularly is associted with high risk of relapse and suicide
Consider whether a regular injection may suit you better than taking tablets
This medicine may cause drowsiness and may increase the effects of alcohol, cannabis or sleeping tablets. Do not drive or operate machinery if you are affected.
Aripiprazole monitoring
Warn patients and carers of the possibility of impulse control disorders (bing eating, gambling, overspending) and monitor for such behaviours
Monitor weight, blood glucose, lipids, and blood pressure at baseline and regularly thereafter
Clozapine drug class
Antipsychotic
Clozapine indications
Schizophrenia in people unresponsive to, or intolerant of, other antipsychotics
Bipolar disorder
Clozapine dosage range and timing
Adult, oral 12.5 mg on the first day, increased to 25–50 mg on second day
- If well tolerated, increase in 25–50 mg increments to 300 mg daily within 2–3 weeks. Then increase in 50–100 mg increments at 4–7‑day intervals if required. Usual range is 200–600 mg daily (maximum of 900 mg daily).
> doses upto 300mg are usually given as a single dose in the evening
Clozapine counselling
This medicine may cause severe constipation; contact your doctor urgently if your bowel habits change and/or you have abdominal pain.
Your clozapine dose may need changing if you vary your caffeine intake (eg tea, coffee, cola drinks) or if you start or stop smoking tobacco
You will need to have regular blood tests and other checks while taking clozapine to help your doctor look out for serious side effects.
Clozapine Monitoring
- Monitor patients closely for constiaption and ensure effective management
- Monitor for adverse effects such as hypertension (measure blood pressure) and myoclonic jerks
Donepezil drug class
Anticholinesterases in alzheimers disease
Donepezil indication
Alzheimers disease
Donepezil dosage range and timing
Oral, initially 5 mg once daily for a minimum of 4 weeks. Increase to 10 mg once daily.
Donepezil counselling
Take the tablet every night just before you go to bed.
It does not matter if you take it before, with or after food.
This medicine may cause dizziness or drowsiness; if you are affected, avoid operating machinery.
Donepezil monitoring
Monitor for adverse effects such as seizures and hallucinations
Monitor for bradycardia in patients using drugs that can cause bradycardia, increases risk of bradycardia and hypotension.
Monitor for inappropriate sexual behaviours
