Lancashire and South Cumbria
Formulary
 
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4 Central nervous system
04-03-03 Selective serotonin re-uptake inhibitors

Citalopram
Formulary

Tablets (as hydrobromide) 10mg, 20mg
Oral drops (as hydrochloride) 40mg/mL (2mg/drop)

8mg oral drops is equivalent to 10mg tablet.


Lower incidence of drug interactions than some other SSRI’s.

First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions.

Link  MHRA: Citalopram and escitalopram: QT interval prolongation
Link  MHRA: Citalopram: suspected drug interaction with cocaine; prescribers should consider enquiring about illicit drug use
Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

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Escitalopram
Formulary

Tablets 5mg, 10mg, 20mg

Generalised Anxiety Disorder,
Major depressive illness.

In depression, escitalopram is only licensed for major depressive episodes.

Available for consultant initiation in generalised anxiety disorder but only after sertraline has been tried.

Link  LSCMMG: Citalopram and escitalopram: QT interval prolongation
Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

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Fluoxetine
Formulary

Capsules 20mg,
Dispersible tablets 20mg (for patients unable to swallow standard capsules),
Liquid 20mg/5mL

First line for children and adolescents.
Higher propensity for drug interactions.

Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

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Paroxetine
Formulary

Tablets 20mg, 30mg

Higher risk of discontinuation reactions.
Higher propensity for drug interactions.

Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

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Sertraline
Formulary

Tablets 50mg, 100mg

NICE advises: First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions

LSCFT: Depressive illness, obsessive compulsive disorder (under specialist supervision in children), post traumatic stress disorder, panic disorder, social anxiety disorder. NICE recommend first line for generalised anxiety disorder (unlicensed).
Lower incidence of drug interactions than some other SSRI’s.

Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery

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Vortioxetine Brintellix®
Formulary

Tablets 5mg, 10mg, 20mg

Major depressive episodes.

Third line use one in line with NICE TA367.

Link  MHRA: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery
Link  NICE TA367: Vortioxetine for treating major depressive episodes

Green View adult BNF  View SPC online  View childrens BNF