C H A P T E R 2 1
Antidepressant agents
319
BOX 21.1
Drug therapy across the lifespan (continued)
for adverse effects on the fetus and possible neurological
effects on the baby. Use should be reserved for situations
in which the benefits to the mother far outweigh the
potential risks to the neonate.
OLDER ADULTS
Older people may be more susceptible to the adverse
effects of these drugs, from unanticipated central nervous
system (CNS) effects to increased sedation, dizziness and
even hallucinations. Doses of all of these drugs need to be
reduced and the person monitored very closely for toxic
effects. Safety measures should be provided if CNS effects
do occur.
People with hepatic or renal impairment should
be monitored very closely while taking these drugs.
Decreased doses may be needed. Because many older
people also have renal or hepatic impairment, they need
to be screened carefully.
TABLE 21.1
DRUGS IN FOCUS Tricyclic antidepressants
Drug name
Common side effects
Usual dosage
Sedation
Anticholinergic Hypotension Cardiovascular
Amines
amitriptyline
(Endep, Amitrip)
++++
++++
++++
++
75–150 mg/day
PO
clomipramine
(Anafranil, Placil)
+++
+++
+++
+++
25–50 mg PO b.d
or t.d.s.
dosulepin
hydrochloride
++
Central nervous
system adverse
effects are
common,
particularly in the
elderly, and include
anxiety, dizziness,
agitation,
confusion, sleep
disturbances,
irritability, and
paraesthesia;
drowsiness
is associated
with some of
the tricyclic
antidepressants ...
not sedation
/
nzf_2252.html?
searchterm=
dothiepin
++++
See Medsafe report
of prolongation of
QT intervals www.
medsafe.govt.nz/
profs/PUArticles/
December2013QT
ProlongationAnd
Antidepressants.
htm
Adult initially
75 mg (elderly
50–75 mg) daily
in divided doses
or as a single
dose at bedtime,
increased
gradually as
necessary
to 150 mg
daily (elderly
75 mg may
be sufficient);
up to 225 mg
daily in some
circumstances
(e.g. hospital use)
Capsules are
25 mg
dothiepin (Dothep)
++++
+++
+++
+++
25–60 mg PO t.d.s.
Adult initially
75 mg (elderly
50–75 mg) daily
in divided doses
or as a single
dose at bedtime,
increased
gradually as
necessary to
150 mg daily
(elderly 75 mg
may be sufficient);
up to 225 mg
daily in some
circumstances
(e.g. hospital use)
Continued on following page
