Hazzard's Geriatric Medicine and Gerontology, 8e >Behavioral Symptoms of Dementia and Psychoactive

Drug Therapy
Jeffrey B. Halter, Joseph G. Ouslander, Stephanie Studenski, Kevin P. High, Sanjay Asthana, Mark A. Supiano, Christine S. Ritchie, Kenneth Schmader+
TABLE 60-9ANTIDEPRESSANT ORAL DOSAGES AND SIDE EFFECTS

INITIAL DAILY DOSE (mg) MAX DAILY DOSE (mg) SIDE EFFECTS

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

GI distress, sexual dysfunction, slight weight

Citalopram 5–10 20 gain, QTc prolongation at doses >20 mg,
hyponatremia, SIADH

GI distress, sexual dysfunction, slight weight

Escitalopram 5 10
gain, hyponatremia, SIADH, insomnia, fatigue

GI distress, sexual dysfunction, slight weight

Fluoxetine 10 80 gain, abnormal dreams, hyponatremia, SIADH,
insomnia, fatigue

GI distress, sexual dysfunction, slight weight

Sertraline 25 200
gain, hyponatremia, SIADH, headache

Paroxetine 10 40 Anticholinergic effects may increase risk of

delirium, may cause withdrawal effects due to
Paroxetine CR 12.5 50 short half life, GI distress, hyponatremia, SIADH

SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS

GI distress, dry mouth, urinary hesitancy,

Duloxetine 30 120 headaches, fatigue, sedation, hyponatremia,
hepatitis

GI distress, minimal sedation, headaches, sexual

Venlafaxine XR 37.5 225
dysfunction, weight loss, withdrawal symptoms,
anxiety, dose-dependent hypertension,
Venlafaxine IR 25–50 375
hyponatremia, mild anticholinergic effects

Dizziness, dry mouth, insomnia, decreased

appetite, GI distress, dose-dependent
Desvenlafaxine 50 100
hypertension, elevated cholesterol and
triglycerides, hyponatremia

OTHER

Dry mouth, GI distress, dizziness, QT

prolongation, elevated cholesterol and
Mirtazapine 7.5 30–45
triglycerides, weight gain, increased appetite,
sedation

Bupropion XL 150 450

Mild anticholinergic effects, hypotension, high
Bupropion SR 100 150 BID sedation, slight sexual dysfunction, serotonin
syndrome, increased appetite, dry mouth
Bupropion IR 75 150 TID

PREFERRED TRICYCLIC ANTIDEPRESSANTS

 Therapeutic window 50–150 ng/mL;
Nortriptyline 10–25 75–150 anticholinergic effects, hypotension, sedation,
sexual dysfunction, slight weight gain

Therapeutic window 150–300 ng/mL; mild

anticholinergic effects, hypotension, slight GI
Desipramine 10–25 50–150
distress, sedation, sexual dysfunction, slight
weight gain

Maximum recommended dosage for patients greater than 60 years of age. BID, twice daily; CR, controlled release; GI distress, gastrointestinal distress (eg, nausea, vomiting, diarrhea, constipation); IR, immediate
release; SIADH, syndrome of inappropriate secretion of antidiuretic hormone; TID, three times a day.

Date of download: 12/29/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.