Selective Serotonin Reuptake Inhibitors Flashcards
What are the preferred SSRIs?
Fluoxetine and Citalopram
What is safe to use post MI?
Sertraline
What is the SSRI of choice in children?
Fluoxetine
What are some common adverse effects of SSRIs?
- GI symptoms
- Increased GI bleeding risk (co-prescribe a PPI if elderly or taking NSAIDs)
- Increased anxiety or agitation.
Which 2 SSRIs have a higher propensity for drug reactions?
Fluoxetine and Paroxetine
What drugs do SSRIs interact with?
- NSAIDs - higher risk of GI bleed
- Warfarin/Heparin - Avoid most SSRIs. Consider mirtazapine.
- Aspirin - avoid
- Triptans - avoid SSRIs
What can Citalopram increase?
QT interval - dose dependent
Who should Citalopram not be used in?
- Congenital long QT syndrome
- People who are taking other drugs that prolong the QT interval.
- Known QT interval prolongation.
What is the maximum dose of citalopram in adults?
40mg
If a patient is older than 65 years, what is the maximum dose of Citalopram they should be prescribed?
20mg
What is the maximum dose of Citalopram for someone with hepatic impairment?
20mg
What are some symptoms of Discontinuation Syndrome?
- Increased mood change
- Restlessness
- Difficulty sleeping
- Unsteadiness
- Sweating
- Gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
- Paraesthesia
Which SSRI has a higher incidence of discontinuation syndrome & why?
Paroxetine
It has a short half life
How should you stop an SSRI?
Why is fluoxetine different?
It should be gradually stopped over 4 weeks.
Fluoxetine has a long half life and so can just be stopped.
After starting an SSRI, when should you review the patient?
When may you want to review them sooner and when would you do this?
In 2 weeks.
If they are < 30 years or risk of suicide, review after 1 week
