TAM (Treatments and Medicines) NHS HighlandImportant: 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.
Other antidepressants (Formulary)
What's new / Latest updates
25/05/24 - Vortioxetine tablets 5mg, 10mg, 20mg SMC1158/16 added.
- 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.
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.
Important: Therapy notes
- MHRA advice: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021).
Important: Formulation and dosage details
Formulation:
Tablets 5mg, 10mg, 20mg (Restricted: Specialist recommendation only)
Dosage:
SMC1158/16: the treatment of major depressive episodes in adults.
SMC restriction: patients who have experienced an inadequate response (either due to lack of
adequate efficacy and/or safety concerns/intolerability) to two or more previous antidepressants.
- Any unused medication should be returned to pharmacy for destruction.