Other antidepressants (Formulary)

  • Choice of therapy is influenced by side-effect profiles; mirtazapine is associated with weight gain and sedative effects whilst the use of venlafaxine is associated with cardiovascular side-effects and requires monitoring.
  • See Diabetes for the use of duloxetine in the treatment of painful diabetic neuropathy.

MIRTAZAPINE

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 15mg, 30mg, 45mg

Dosage:

Initially 15mg daily at bedtime increased according to response to 45mg daily as a single dose at bedtime or in 2 divided doses.

VENLAFAXINE

Important: Therapy notes

MHRA advice: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021) (www.gov.uk).
MHRA advice: Methylthioninium chloride (methylene blue): update on central nervous system (CNS) toxicity (December 2014) (www.gov.uk).

  • Screen all patients carefully for high blood pressure. Pre-existing hypertension should be controlled before initiation of treatment. Review blood pressure periodically, after initiation of treatment and after dose increases.

Important: Formulation and dosage details

Formulation:

Tablets 37.5mg, 75mg

Dosage:

Depressive illness: initially 75mg daily in 2 divided doses increased if necessary after several weeks to 150mg daily in 2 divided doses. In severely depressed or hospitalised patients, maximum 375mg daily. 
Refer to BNF for other indications.

Important: Formulation and dosage details

Formulation:

Modified release capsules 75mg, 150mg

Dosage:

75mg daily increased if necessary after at least 3 to 4 weeks to 150mg once daily; maximum 375mg once daily.
Refer to BNF for other indications.

Notes:

The immediate-release twice-daily tablets are the more cost-effective option and should be considered first choice unless once-daily dosing is an advantage for individual patients. 

Editorial Information

Document Id: F077