Pharmacology

Question 1

Typical fluoxetine dose

Answer 1

20-80 mg daily

Question 2

Typical fluvoxamine dose for OCD

Answer 2

150-300 mg daily

Question 3

Typical sertraline dose for OCD

Answer 3

100-300 mg daily, even up to 400 mg

Question 4

Typical paroxetine dose for OCD

Answer 4

20-80 mg daily

Question 5

Typical citalopram dose for OCD

Answer 5

20-80 mg daily (exceeds Health Canada Guidelines)

Question 6

EKG monitoring guidelines for citalopram / escitalopram for OCD

Answer 6

Monitor EKG, If QT-interval >440msec (in men) or >470msec (in women), but <500msec – reduce dose or switch to a lower risk drug (citalopram & escitalopram contra-indicated)
• If QT-interval >500msec – STOP citalopram/escitalopram and consider cardiology referral

Question 7

Typical escitalopram dose for OCD

Answer 7

10-50 mg daily (exceeds Health Canada Guidelines)

Question 8

Typical venlafaxine dose for OCD

Answer 8

225-375 mg daily; even up to 450 mg can be used

Question 9

First line medication for OCD

Answer 9

SSRIs

Question 10

Second line medications for OCD

Answer 10

Venlafaxine, clomipramine

Question 11

Adjunct treatment for OCD

Answer 11

Risperidone, olanzapine, aripiprazole, quetiapine, haloperidol (only for poor insight, tics, schizotypal personality)

Question 12

2nd line adjuncts for OCD

Answer 12

topiramate, memantine, riluzole

Question 13

What if there is incomplete improvement after a medication trial?

Answer 13

Consider CBT.