Selective serotonin re-uptake inhibitors (SSRIs) (Formulary)

MHRA advice: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021) (www.gov.uk).

  • For most patients fluoxetine or sertraline are the first choice SSRIs.
  • Sertraline is preferred in older people and those with a recent myocardial infarction or unstable angina.
  • Citalopram should not be initiated due to the potential risk of co-prescribing contra-indicated medicines.
  • Paroxetine is not recommended for initiation in new patients.

FLUOXETINE - (First line)

Important: Therapy notes

  • off-label indication for Reynaud’s phenomenon.

Important: Formulation and dosage details

Formulation:

Capsules 20mg

Dosage:

Depressive illness: 20mg once daily.
Refer to BNF for other indications.

Important: Formulation and dosage details

Formulation:

Liquid 20mg/5mL

Dosage:

Depressive illness: 20mg once daily.
Refer to BNF for other indications.

SERTRALINE - (First line)

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 50mg, 100mg

Dosage:

Depressive illness: initially 50mg daily, increased if necessary by increments of 50mg over several weeks to maximum 200mg daily; usual maintenance dose 50mg daily.
Refer to BNF for other indications.

CITALOPRAM

Important: Therapy notes



MHRA advice: Citalopram and escitalopram: QT interval prolongation (December 2014) (www.gov.uk).
MHRA advice: Citalopram: suspected drug interaction with cocaine; prescribers should consider enquiring about illicit drug use (July 2016) (www.gov.uk).

  • Citalopram should not be initiated due to the potential risk of co-prescribing contra-indicated medicines.
  • Citalopram is associated with dose-dependent QT interval prolongation; it is contra-indicated when co-prescribed with all other medicines that prolong the QT interval.

Important: Formulation and dosage details

Formulation:

Tablets 10mg, 20mg, 40mg

Dosage:

Depressive illness: 20mg once daily as a single dose in the morning or evening increased if necessary to maximum 40mg daily.
Older people, maximum 20mg daily.

Important: Formulation and dosage details

Formulation:

Oral drops 40mg/mL

Dosage:

Depressive illness: 16mg daily as a single dose in the morning or evening increased if necessary to maximum 32mg daily.
Older people maximum 16mg daily.
Refer to BNF for other indications.

Notes:

8mg (4 drops) oral drops may be considered to be equivalent in therapeutic effect to 10mg citalopram tablet. Mix with water, orange juice, or apple juice before taking.

PAROXETINE

Important: Therapy notes

  • There is no evidence that paroxetine doses higher than licensed doses are more effective.
  • Paroxetine is not recommended for initiation in new patients.

Important: Formulation and dosage details

Formulation:

Tablets 20mg, 30mg

Dosage:

Depressive illness: 20mg each morning.
Refer to BNF for other indications.

Important: Formulation and dosage details

Formulation:

Oral suspension 10mg/5mL

Dosage:

Depressive illness: 20mg each morning.
Refer to BNF for other indications.

Editorial Information

Document Id: F075