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

TAM (Treatments and Medicines) NHS Highland
NHS Highland

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)

Therapy notes

  • off-label indication for Raynaud’s phenomenon.

Formulation and dosage details

Formulation:

Capsules 20mg

Dosage:

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

Formulation and dosage details

Formulation:

Liquid 20mg/5mL

Dosage:

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

SERTRALINE - (First line)

Therapy notes

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

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.

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.

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

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.

Formulation and dosage details

Formulation:

Tablets 20mg, 30mg

Dosage:

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

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