Prescribing Newsletter

Total Page:16

File Type:pdf, Size:1020Kb

Prescribing Newsletter Prescribing Newsletter Produced by Herefordshire CCG Medicines Optimisation Team December 2013 Newer Oral Anticoagulants (NOACs) STOP PRESS! Key Points: 1. Adherence: not suitable for patients with poor adherence. Urgent Calls Community pharmacists will target patients prescribed anti- The festive season coagulants for the New Medicines Service (NMS) and workload is upon us which makes annual Medicines Use Review (MUR). it even more important to ensure 2. Patient information & alert cards: vital for all patients, effective communication between including advice on bleeding risk and action to take in the health professionals to avoid patient safety incidents. event of bleeding. Obtain from pharmaceutical companies. 3. Check renal function: dose reduction may be required. Practices are asked to review 4. Monitoring: baseline and annual (minimum) U&Es. systems to ensure front line staff are aware of the need for prompt Annual review by GP and pharmacist to reinforce connection to prescribers to solve importance of adherence to treatment and check for ADRs. medicines queries to reduce Rivaroxaban in DVT Treatment delays for patients and carers save Patients experiencing DVT now have a new treatment option in time for both clinical and admin line with NICE TA261: staff. Rivaroxaban 15mg BD x 21 days, followed by 20mg OD Examples include alternatives to Guidelines for the safe use of rivaroxaban in DVT are available out of stock medicines, palliative on the intranet. care queries, medicine overuse GPs suspecting a DVT diagnosis will be likely to offer oral concerns and medicine queries rivaroxaban instead of LMWH injections (enoxaparin) for most from hospital staff relating to patients. Treatment will be limited to a maximum of 7 days until admission and discharge. diagnosis is confirmed. Pharmacies are asked to consider Contractors are requested to stocking small quantities of 15mg tablets (new 14 tablet pack document any occurrences as now available) to ensure there is no delay in starting treatment. incident reports. NOACs for Stroke Prevention in AF Prescribing guidelines for anticoagulants in AF have been updated to include apixaban in line with NICE TA275. The patient FAQs have also been updated accordingly. Both documents may be found on the intranet. Dose regimens for Oral Anticoagulants: Standard Dosing Regimen Other eg AF (non- TKR THR DVT / PE valve valvular) replacement Warfarin OD as per INR 110mg stat 110mg stat then 220mg* 150mg* Dabigatran then 220mg* not licensed not licensed OD for 27-34 BD OD x 9 days days 15mg BD x 21 10mg OD 10mg OD Rivaroxaban 20mg* OD days then not licensed for 2 weeks for 5 weeks 20mg* OD 2.5mg BD x 2.5mg BD for Apixaban 5mg* BD not licensed not licensed 10-14 days 32-38 days *NB dose reductions for age and / or risk factors eg renal function check BNF/SmPC The information contained in this newsletter is issued on the understanding that it is the best available from the resources at our disposal at the time of issue. Comments, suggestions, contributions welcome! Medicines Optimisation Team [email protected] DOSULEPIN PRESCRIBING Reducing dosulepin prescribing has been included as a national prescribing indicator in Wales since April 2011 and as a Regional West Midlands indicator for the first time in 2013/4. There is significant variation in the level of prescribing and Herefordshire GPs prescribe significantly more dosulepin than other areas in the West Midlands. See graph below for local prescribing data. In 2011 200 deaths related to tricyclic antidepressants were reported, 49 with dosulepin. 20% of fatal dosulepin overdose cases are unintentional (MHRA). Alternatives to Dosulepin Review Points Depression and anxiety: SSRIs are first line choice Don’t switch to or initiate dosulepin for new and are anxiolytic in long term use. Consider trial of patients beta-blockers for somatic symptoms of anxiety Only re-start dosulepin where previous use Other Sedative Anti-depressants include has been under the care of a consultant mirtazapine and alternative sedative TCAs eg Review existing patients to assess their clomipramine, trazodone: both sedative but less ongoing need and suitability for dosulepin – cardiotoxic than dosulepin Consider reduction in dose, change or stop. Hypnotics: use short term eg zopiclone or sedating Max fax use is recommended to be reviewed antihistamine eg promethazine after 6-12 months. Neuropathic Pain: see Herefordshire guidelines and consider amitriptyline or nortriptyline (also unlicensed Review quantities prescribed for those but quoted in BNF & NICE CG173), gabapentin etc requiring ongoing prescription and assess Discontinuation risk of self harm and falls etc SSRIs remain first line choice in moderate Discontinue dosulepin slowly where possible, over one month if long term continuous use. Discontinuation depression and anxiety. Warn patients re symptoms can include insomnia, anxiety, GI symptoms transient side effects eg GI, anxiety. Consider short term hypnotic or benzodiazepine if Licensed Indication: “…treatment of symptoms of agitated depressive illness especially where an anti-anxiety Do not co-prescribe SSRIs and other effect is required”. antidepressants with tricyclics (TCA) eg NICE CG90: “Do not switch to, or start, dosulepin amitriptyline, dosulepin, nortriptyline [risk of because evidence supporting its tolerability relative to serotonin syndrome] other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose” TCA contra-indications / cautions MHRA Advice restricts initiation of treatment for C/I: Immediate post MI, arrhythmias & heart patients who have not previously received dosulepin to block; manic phase BAD specialists and provides advice on safe quantities, Cautions: cardiovascular disease, storage and potential drug interactions. hyperthyroidism (risk of arrhythmia), epilepsy, diabetes, dementia, BPH, chronic constipation, Dosulepin Audit glaucoma, urinary retention A Cardiff audit reviewed 845 patients. 255 (30%) 700 Dosulepin Prescribing stopped treatment with no 600 (by volume, ADQ per 1000 patients) alternative prescribed and 412 (49%) switched to an 500 QE Mar 13 QE Sep 13 alternative. Local audits in 400 Aspiration 2013 showed some patients initiated in the last 300 2 years for indications 200 such as insomnia, depression, bereavement, 100 anxiety plus bruxism & patients 1000 per ADQ 0 related maxillofacial conditions. Kington A local audit template is Colwall Cradley Nunwell Weobley Belmont Mortimer Pendeen Greyfriars Kingstone Cantilupe Fownhope available as is prescribing Street King Much Birch Much Alton Street Alton Quay House Quay St.Katherines The Marches The Golden Valley Golden support to help with Sarum House Ledbury Market Ledbury Moorfield House Moorfield reviews in practices. Wargrave House Westfield Surgery Westfield Medicines Optimisation Newsletter produced by Herefordshire CCG December 2013 .
Recommended publications
  • Dosulepin Prescribing
    SAFETY BULLETIN: DOSULEPIN PRESCRIBING In December 2007, the Medicines and Healthcare Regulatory Agency (MHRA) issued safety advice around prescribing of dosulepin, related to the narrow margin between therapeutic doses and potentially fatal doses. Nevertheless, dosulepin continues to be prescribed widely. Over eight years after the safety advice was published, prescribing of dosulepin in the Dorset area remains high. In the South West area, Dorset CCG was the highest prescriber of dosulepin for the 2015/16 financial year (3.238% of all antidepressant items). Of the 209 CCGs in the UK, Dorset is the fourteenth highest prescriber of dosulepin, and well above the national average of 2.111%. The following points summarise the reasons that dosulepin is not recommended for prescribing nationally, and in Dorset: Dosulepin has a small margin of safety between the (maximum) therapeutic dose and potentially fatal doses. The NICE guideline on depression in adults recommends that dosulepin should not be prescribed for adults with depression because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose. Dosulepin has also been used ‘off label’ in other indications such as fibromyalgia and neuropathic pain. However the evidence for use in in this way is weak, and is not recommended. The lethal dose of dosulepin is relatively low and can be potentiated by alcohol and other CNS depressants. Dosulepin overdose is associated with high mortality and can occur rapidly, even before hospital treatment can be received. Onset of toxicity occurs within 4-6 hours. Every year, up to 200 people in England and Wales fatally overdose with dosulepin.
    [Show full text]
  • Dose Equivalents of Antidepressants Evidence-Based Recommendations
    Journal of Affective Disorders 180 (2015) 179–184 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research report Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials Yu Hayasaka a,n, Marianna Purgato b, Laura R Magni c, Yusuke Ogawa a, Nozomi Takeshima a, Andrea Cipriani b,d, Corrado Barbui b, Stefan Leucht e, Toshi A Furukawa a a Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo- ku, Kyoto 606-8501, Japan b Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico “G.B.Rossi”, Pzz.le L.A. Scuro, 10, Verona 37134, Italy c Psychiatric Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy d Department of Psychiatry, University of Oxford, Oxford, UK e Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany article info abstract Article history: Background: Dose equivalence of antidepressants is critically important for clinical practice and for Received 4 February 2015 research. There are several methods to define and calculate dose equivalence but for antidepressants, Received in revised form only daily defined dose and consensus methods have been applied to date. The purpose of the present 10 March 2015 study is to examine dose equivalence of antidepressants by a less arbitrary and more systematic method. Accepted 12 March 2015 Methods: We used data from all randomized, double-blind, flexible-dose trials comparing fluoxetine or Available online 31 March 2015 paroxetine as standard drugs with any other active antidepressants as monotherapy in the acute phase Keywords: treatment of unipolar depression.
    [Show full text]
  • Appendix A: Potentially Inappropriate Prescriptions (Pips) for Older People (Modified from ‘STOPP/START 2’ O’Mahony Et Al 2014)
    Appendix A: Potentially Inappropriate Prescriptions (PIPs) for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014) Consider holding (or deprescribing - consult with patient): 1. Any drug prescribed without an evidence-based clinical indication 2. Any drug prescribed beyond the recommended duration, where well-defined 3. Any duplicate drug class (optimise monotherapy) Avoid hazardous combinations e.g.: 1. The Triple Whammy: NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015) 2. Sick Day Rules drugs: Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015) 3. Anticholinergic Burden (ACB): Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB: Amantadine Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine Baclofen Carbamazepine Disopyramide Loperamide Oxcarbazepine Pethidine
    [Show full text]
  • Efficacy of Dosulepin in Tension Type Headache and Midfacial Pain a Randomised Controlled Study
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 3 Ser.4 (March. 2020), PP 10-14 www.iosrjournals.org Efficacy of Dosulepin in Tension Type Headache and Midfacial Pain a Randomised Controlled Study Corresponding Author: XXXXX Abstract Introduction: Patients presenting with pain in the facial region are commonly reffered to Otorhinolaryngologist. Due to the various causative factors causing pain in the facial region, the proper diagnosis and more importantly the skill to rule out the sinogenic pain plays an important role in management. Tension type headache and midfacial pain are often misdiagnosed and treated wrongly and thus add to the morbidity of patients. Of all the medications that are used for the treatment, most provide minimal, short term relief with side effects on prolong use. Dosulepin a Tricyclic Antidepressant helps in relieving pain with minimal side effects as compared to other Tricyclic Antidepressants. Aims and Objective: To study the efficacy of dosulepin in patients attending outpatient Department of otorhinolaryngology of Silchar Medical College and Hospital Methods: 130 patients attending outpatient Department of ENT and Head and Neck Surgery of Silchar Medical College & Hospital, from September 2017 to August 2018 with complaints of headache diagnosed as tension type headache and midfacial pain were evaluated. Neurological and radiographic examinations were performed prior to therapy and local cause of pain in the facial region were ruled out. Together with this we also performed psychic evaluation for those patients who could not be withdrawn from current medication and then to start them on our current medication.
    [Show full text]
  • Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW
    Cambridgeshire and Peterborough Joint Prescribing Group MEDICINE REVIEW Name of Medicine / Trimipramine (Surmontil®) Class (generic and brand) Licensed indication(s) Treatment of depressive illness, especially where sleep disturbance, anxiety or agitation are presenting symptoms. Sleep disturbance is controlled within 24 hours and true antidepressant action follows within 7 to 10 days. Licensed dose(s) Adults: For depression 50-75 mg/day initially increasing to 150-300 mg/day in divided doses or one dose at night. The maintenance dose is 75-150 mg/day. Elderly: 10-25 mg three times a day initially. The initial dose should be increased with caution under close supervision. Half the normal maintenance dose may be sufficient to produce a satisfactory clinical response. Children: Not recommended. Purpose of Document To review information currently available on this class of medicines, give guidance on potential use and assign a prescribing classification http://www.cambsphn.nhs.uk/CJPG/CurrentDrugClassificationTable.aspx Annual cost (FP10) 10mg three times daily: £6,991 25mg three times daily: £7,819 150mg daily: £7,410 300mg daily: £14,820 Alternative Treatment Options within Class Tricyclic Annual Cost CPCCG Formulary Classification Antidepressant (FP10) Amitriptyline (75mg) Formulary £36 Lofepramine (140mg) Formulary £146 Imipramine (75mg) Non-formulary £37 Clomipramine (75mg) Non-formulary £63 Trimipramine (75mg). TBC £7,819 Nortriptyline (75mg) Not Recommended (pain) £276 Doxepin (150mg) TBC £6,006 Dosulepin (75mg) Not Recommended (NICE DO NOT DO) £19 Dosages are based on possible maintenance dose and are not equivalent between medications Recommendation It is recommended to Cambridgeshire and Peterborough CCG JPG members and through them to local NHS organisations that the arrangements for use of trimipramine are in line with restrictions agreed locally for drugs designated as NOT RECOMMENDED:.
    [Show full text]
  • Detecting Depression and Anxiety in Older Adults
    Detecting Depression and Anxiety in Older Adults Dr Nick Woodthorpe Depression in Older Adults Introduction to Depression • 1 in 5 older people living in the community • 2 in 5 living in care homes Causes of Depression • Painful events • Past depression or family history • Personality • Physical illness • Medicines • Drugs and Alcohol • Loneliness Particular Issues in Depression • Physical symptoms, for example, thyroid problems, heart disease or arthritis. • Long-term illness • Confusion and memory problems • A new sense of loneliness/lack of purpose Depression - Symptoms • 2 weeks • No hypomania or mania • No psychoactive drugs • No organic mental disorder Depression - Symptoms • Feeling low or sad (they may not report this) • Loss of interest in life • Low energy and tired for no reason Depression - Symptoms • Change in appetite and weight • Restlessness or psychomotor retardation • Anxious • Avoidance • Irritable • Sleep disturbance • Loss of confidence and self-esteem Depression - Symptoms • Hopelessness and worthlessness • Poor concentration • Panicky • Loss of libido • Sense of guilt • Suicidal thoughts • Delusions or hallucinations Depression - Diagnostic Categories • Mild • Moderate • Severe with or without psychosis • Recurrent Anxiety in Later Life Everyone gets anxious sometimes Everyone gets anxious sometimes Fight or Flight Response Fight or Flight Response Causes of anxiety in later life • Painful events • Stress • Past experiences- upbringing/Childhood • Personality • Physical illness • Medicines • Diet - caffeine, excess
    [Show full text]
  • Still the Leading Antidepressant After 40 Years of Randomised Controlle
    BRITISH JOURNAL OF PSYCHIATRY "2001), 178, 129^144 REVIEW ARTICLE Amitriptyline vv.therest:stilltheleading METHOD Inclusion criteria antidepressant after 40 years of randomised All RCTs comparing amitriptyline with any y other tricyclic,heterocyclic or SSRI were in- controlled trials cluded. Crossover studies were excluded. Studies adopting any criteria to define CORRADO BARBUI and MATTHEW HOTOPF patients suffering from depression were included; a concurrent diagnosis of another psychiatric disorder was not considered an exclusion criterion. Trials in patients with depression with a concomitant medical ill- Background Tricyclic antidepressants Amitriptyline is one of the first `reference' ness were not included in this review. have similar efficacy and slightly lower tricyclic antidepressants TCAs). Over the past 40 years a number of newer tricyclics, tolerability than selective serotonin Search strategy heterocyclics and selective serotonin re- Relevant studies were located by searching reuptakeinhibitorsreuptake inhibitors SSRIs).However, uptake inhibitors SSRIs) have been intro- the Cochrane Collaboration Depression, there are no systematic reviews assessing duced Garattini et aletal,1998). Despite Anxiety and Neurosis Controlled Trials several large systematic reviews comparing amitriptyline, the reference tricyclic drug, Register CCDANCTR). This specialised tricyclics and SSRIs there is no clear agree- vv. other tricyclics and SSRIs directly. register is regularly updated by electronic ment over first-line treatment of depression Medline,Embase,PsycINFO,LILACS, SongSong et aletal,1993; Anderson & Tomenson, Aims ToreviewTo review the tolerability and Psyndex,CINAHL,SIGLE) and non-electro- 1995; Montgomery & Kasper,1995; efficacy of amitriptyline inthe nicnicliterature searches. The register was HotopfHotopf et aletal,1996; Canadian Coordinating management of depression. searched using the following terms: Office for Health Technology Assessment, AMITRIPTYLIN**AMITRIPTYLIN oror AMITRILAMITRIL oror ELA-ELA- 19971997aa).
    [Show full text]
  • Association of Selective Serotonin Reuptake Inhibitors with the Risk for Spontaneous Intracranial Hemorrhage
    Supplementary Online Content Renoux C, Vahey S, Dell’Aniello S, Boivin J-F. Association of selective serotonin reuptake inhibitors with the risk for spontaneous intracranial hemorrhage. JAMA Neurol. Published online December 5, 2016. doi:10.1001/jamaneurol.2016.4529 eMethods 1. List of Antidepressants for Cohort Entry eMethods 2. List of Antidepressants According to the Degree of Serotonin Reuptake Inhibition eMethods 3. Potential Confounding Variables Included in Multivariate Models eMethods 4. Sensitivity Analyses eFigure. Flowchart of Incident Antidepressant (AD) Cohort Definition and Case- Control Selection eTable 1. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 2. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of SSRIs Relative to TCAs eTable 3. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of SSRIs Relative to TCAs. eTable 4. Crude and Adjusted Rate Ratios of Intracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 5. Crude and Adjusted Rate Ratios of Subarachnoid Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak eTable 6. Crude and Adjusted Rate Ratios of Intracranial Extracerebral Hemorrhage Associated With Current Use of Antidepressants With Strong Degree of Inhibition of Serotonin Reuptake Relative to Weak This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 eMethods 1.
    [Show full text]
  • Package Leaflet: Information for the User
    Package leaflet: Information for the use Linezolid [MAH] 2 mg/ml solution for infusion Linezolid Read all of this leaflet carefully before you start using this medicine because it contains important information for you. - Keep this leaflet. You may need to read it again. - If you have any further questions, ask your doctor or nurse. - If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet 1. What Linezolid [MAH] is and what it is used for 2. What you need to know before you use Linezolid [MAH] 3. How to use Linezolid [MAH] 4. Possible side effects 5. How to store Linezolid [MAH] 6. Contents of the pack and other information 1. What Linezolid [MAH] is and what it is used for Linezolid [MAH] is an antibiotic of the oxazolidinones group that works by stopping the growth of certain bacteria (germs) that cause infections. It is used to treat pneumonia and some infections in the skin or under the skin. Your doctor will have decided if Linezolid [MAH] is suitable to treat your infection. 2. What you need to know before you use Linezolid [MAH] You should not be treated with Linezolid [MAH]: if you are allergic (hypersensitive) to linezolid or any of the other ingredients of this medicine if you are taking or have taken within the last 2 weeks any medicines known as monoamine oxidase inhibitors (MAOIs: for example phenelzine, isocarboxazid, selegiline, moclobemide). These medications may be used to treat depression or Parkinson’s disease; if you are breastfeeding.
    [Show full text]
  • Tcas Versus Placebo - New Studies in the Guideline Update
    TCAs versus placebo - new studies in the guideline update Comparisons Included in this Clinical Question Amitriptyline vs placebo Clomipramine vs placebo Dosulepin (dothiepin) vs placebo AMSTERDAM2003A LARSEN1989 FERGUSON1994B BAKISH1992B PECKNOLD1976B ITIL1993 BAKISH1992C RAMPELLO1991 MINDHAM1991 BREMNER1995 THOMPSON2001B CLAGHORN1983 CLAGHORN1983B FEIGHNER1979 GELENBERG1990 GEORGOTAS1982A GOLDBERG1980 HICKS1988 HOLLYMAN1988 HORMAZABAL1985 HOSCHL1989 KLIESER1988 LAAKMAN1995 LAPIERRE1991 LYDIARD1997 MYNORSWALLIS1995 MYNORSWALLIS1997 REIMHERR1990 RICKELS1982D RICKELS1985 RICKELS1991 ROFFMAN1982 ROWAN1982 SMITH1990 SPRING1992 STASSEN1993 WILCOX1994 16 Imipramine vs placebo BARGESCHAAPVELD2002 BEASLEY1991B BOYER1996A BYERLEY1988 CASSANO1986 CASSANO1996 CLAGHORN1996A COHN1984 COHN1985 COHN1990A COHN1992 COHN1996 DOMINGUEZ1981 DOMINGUEZ1985 DUNBAR1991 ELKIN1989 ENTSUAH1994 ESCOBAR1980 FABRE1980 FABRE1992 FABRE1996 FEIGER1996A FEIGHNER1980 FEIGHNER1982 FEIGHNER1983A FEIGHNER1983B FEIGHNER1989 FEIGHNER1989A FEIGHNER1989B FEIGHNER1989C FEIGHNER1992B FEIGHNER1993 FONTAINE1994 GELENBERG2002 GERNER1980B HAYES1983 ITIL1983A KASPER1995B KELLAMS1979 LAIRD1993 LAPIERRE1987 LECRUBIER1997B LIPMAN1986 LYDIARD1989 MARCH1990 17 MARKOWITZ1985 MENDELS1986 MERIDETH1983 Nortriptyline vs placebo NANDI1976 GEORGOTAS1986A NORTON1984 KATZ1990 PEDERSEN2002 NAIR1995 PESELOW1989 WHITE1984A PESELOW1989B PHILIPP1999 QUITKIN1989 RICKELS1981 RICKELS1982A RICKELS1987 SCHWEIZER1994 SCHWEIZER1998 SHRIVASTAVA1992 SILVERSTONE1994 SMALL1981 UCHA1990 VERSIANI1989 VERSIANI1990
    [Show full text]
  • Print This Article
    International Journal of Advances in Medicine Kumar MS et al. Int J Adv Med. 2021 Oct;8(10):1551-1559 http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933 DOI: https://dx.doi.org/10.18203/2349-3933.ijam20213642 Original Research Article Effectiveness and tolerability of eight-week treatment with dosulepin hydrochloride in patients with major depressive disorder not responding to four consecutive weeks of treatment with single selective serotonin reuptake inhibitor M. Suresh Kumar1*, Amrit Pattojoshi2 1PSYMED Hospital, Harrington Road, Shenoy Nagar, Chennai, Tamil Nadu, India 2Dr. Amrit Pattojoshi's Clinic, Bhouma Nagar, Bhubaneswar, Odisha, India Received: 12 August 2021 Accepted: 23 August 2021 *Correspondence: Dr. M. Suresh Kumar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Though manageable, major depressive disorder remains an underdiagnosed and undertreated condition. The objective of this study was to assess the effectiveness and safety of 8 weeks of treatment with the tricyclic antidepressant dosulepin hydrochloride in patients with depressive episodes not responsive to 4 consecutive weeks of treatment with a single selective serotonin reuptake inhibitor (SSRI). Methods: Patients diagnosed with depressive episode without psychotic symptoms (by ICD-10 diagnostic criteria for research), mini-mental state examination score of ≥24, and not responsive to four weeks of treatment with SSRIs (<50% reduction in depressive symptoms) were enrolled. The main outcome measures were mean change in the Hamilton depression, Hamilton anxiety, and insomnia severity index scores at Week 8 compared to baseline.
    [Show full text]
  • Amitriptyline(BAN, Rinn)
    376 Antidepressants Amitriptyline (BAN, rINN) leading to paralytic ileus, urinary retention, blurred vi- • imipramine sion and disturbances in accommodation, increased in- • clomipramine Amitriptilina; Amitriptyliini; Amitriptylin; Amitriptylinum. 3- • protriptyline (10,11-Dihydro-5H-dibenzo[a,d]cyclohepten-5-ylidene)propyld- tra-ocular pressure, and hyperthermia. Tolerance is of- • trazodone imethylamine; 10,11-Dihydro-N,N-dimethyl-5H-dibenzo[a,d]cy- ten achieved if treatment is continued and adverse • desipramine cloheptene-Δ5, -propylamine. effects may be less troublesome if treatment is begun 1. Richelson E. Antimuscarinic and other receptor-blocking prop- Амитриптилин with small doses and then increased gradually, al- erties of antidepressants. Mayo Clin Proc 1983; 58: 40–6. C H N = 277.4. though this may delay the clinical response. 20 23 Effects on the blood. After a case report of agranulocytosis CAS — 50-48-6. Drowsiness may also be common, although a few linked with imipramine, review of the literature suggested that ATC — N06AA09. tricyclic antidepressants possess little or no sedative agranulocytosis associated with tricyclic antidepressant use was ATC Vet — QN06AA09. potential and may produce nervousness and insomnia. a rare idiosyncratic condition, resulting from a direct toxic effect rather than an allergic mechanism, and particularly affected the Other neurological adverse effects include headache, elderly from 4 to 8 weeks after beginning treatment.1 peripheral neuropathy, tremor, ataxia, epileptiform sei- Between 1963
    [Show full text]