Dosulepin For safety reasons, do not switch to, or start, dosulepin as evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose. NICE. Oct. 2009. Due to its risk dosulepin should not be continued in anyone at high risk of suicide.  For exisiting patients who have not responded to treatment switch to an alternative  For exisiting patients that have responded to treatment, explain risks, only continue if it is in the patient’s best interests and the patient’s choice. Document the discussion in the patient’s notes

Alternatives for neuropathic pain Alternatives for depression

Local guidelines for the management of neuropathic pain suggest Local guidelines for the treatment of depression in adults suggest options for alternative pharmacological treatments. options for alternative pharmacological treatments.

Alternative tricyclic antidepressants (TCA): include amitriptyline, If a SSRI has not been tried, 1st and 2nd line: options include sertraline, nd rd imipramine and lofepramine. If there has been no response to a TCA, 2 citalopram, fluoxetine or mirtazapine. 3 line: options are fluvoxamine, line options include gabapentin and carbamazepine paroxetine or venlafaxine. If a TCA is needed, consider lofepramine.

Two minute presentation How to switch or stop

All antidepressants have the potential to cause withdrawal phenomena. When taken continuously for 6 weeks or longer, dosulepin should not be stopped abruptly unless a serious adverse event has occurred..

Suggested withdrawal regimen: EMIS search Current 150mg/day

A search for patients issued with dosulepin in the previous three months Week 1 100mg/day has been created. It should be copied into your practice search folder Week 2 50mg/day and re-run. This will give you a list of patients you need to review. Below Week 3 25mg/day is a screen shot of where the search is saved. Week 4 Stop Switching dosulepin to SSRI: cross taper.

Gradually reduce the dose to 25-50mg/day as above. Add SSRI at usual starting dose. Slowly withdraw the remaining dosulepin over 5-7 days.

Produced by: Seema Gadhia. Clinical Associate. Medicines Optimisation.. Aylesbury Vale and Chiltern Clinical Commissioning Groups Date: Jan-17 Ratified by: Medicines Management Joint Subcommittee Jan-17 Review date: Jan-19