Third line only |
Mirtazapine |
Mirtazapine can very rarley cause blood disorders - Patients should be advised to report any fever, sore throat, stomatitis or other |
signs of infection during treatment. Blood count should be performed and the drug stopped immediatley if blood dyscrasia |
suspected. Can also increase appetite and weight gain, and cause anti-cholinergic side effects such as dry mouth and postural |
hypotension. Nausea, vomiting, dizziness, agitation, anxiety, and headache are most common features of withdrawal if treatment |
stopped abruptly or if dose reduced markedly; dose should be reduced over several weeks. |
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GREEN Mirtazapine |
tablets 15mg, 30mg, 45mg |
orodispersable tablets 15mg, 30mg, 45mg (only for those with swallowing difficulties) |
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Venlafaxine |
Take into account the toxicity in overdose for people at serious risk of suicide and be aware that venlafaxine is associated with a |
greater risk of death in overdose. |
When prescribing antidepressants other than an SSRI take into account the increased likelihood of the patient stopping treatment |
because of side effects and the need to increase the dose gradually with venlafaxine, duloxetine and tricyclic antidepressants. |
Treatment with venlafaxine should be initiated under specialist supervision/recommendation when used at 300mg/day or above. It |
is contra-indicated in patients with an identified very high risk of serious cardiac ventricular arrythmia (e.g. those with a significant |
left ventricular dysfunction, NYHA Class III/IV), or those with uncontrolled hypertension. Venlafaxine should be used with caution in |
patients with established cardiac disease that may increase the risk of ventricular arrhythmias (e.g. recent myocardial infarction). |
Regular measurement of blood pressure is recommeded for patients receiving venlafaxine. |
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GREEN Venlafaxine |
tablets/capsules m/r 75mg, 150mg, 225mg, 300mg, 375mg |
tablets 37.5mg, 75mg |
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Vortioxetine |
Vortioxetine is recommended as an option for the treatment of major depression episodes in adults by NICE TA367 |
Where the condition has responded inadequately to 2 antidepressants within the current episode. |
GREEN Vortioxetine (Brintellix®) |
tablets 5mg, 10mg, 20mg |
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Duloxetine for depression - prescribe by brand name only |
When prescribing antidepressants other than an SSRI take into account the increased likelihood of the patient stopping treatment |
because of side effects and the need to increase the dose gradually venlafaxine, duloxetine and tricyclic antidepressants. Consider |
the specific cautions, contra-indications and monitoring requirements for duloxetine. Regular measurement of blood pressure is |
recommended for patients receiving duloxetine. |
AMBER Duloxetine (Cymbalta®) capsules 30mg, 60mg |
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L-Tryptophan |
For initiation by a consultant psychiatrist only, in treatment resistant depression. Please see shared care guideline here |
SHARED CARE L-Tryptophan tablets 500mg |
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Other specialists interventions initiated by specialist mental health teams only: |
MAOIs phenelzine - AMBER with ongoing specialist review |
Antidepressants with lithium augmentation - AMBER with ongoing specialist review |
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Other antidepressants which may be initiated by LCFT are as follows: |
AMBER Mianserin |
(LCFT) tablets 10mg, 30mg |
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AMBER Moclobemide |
(LCFT) tablets 150mg, 300mg |
|
AMBER Reboxetine |
(LCFT) tablets 4mg |
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Treatment of diabetic neuropathic pain with duloxetine - prescribe by brand name only. |
Duloxetine is to be prescribed for diabetic neuropathic pain when the use of tricyclic antidepressants are inappropriate, not |
tolerated or ineffective. Withdraw other antidepressants before initiating duloxetine. Prescribe by brand name only. Treatment |
should be reviewed after two weeks to assess tolerability, and then after two months to assess response – additional response |
after this time is unlikely. |
GREEN Duloxetine (Cymbalta®) capsules 30mg, 60mg |
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Agomelatine (BLACK traffic Light) |
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Agomelatine should only be initiated and prescribing continued by a consultant psychiatrist from Lancashire Care Trust, for those |
patients who had tried other antidepressant treatments, including where possible the NICE recommended options for the |
management of treatment refractory depression. GPs should not be asked to pick up prescribing of agomelatine. All requests |
should be directed through the Pharmacy Dept of Lancashire Care Foundation Trust initially for authorisation. Patients must be |
monitored for symptoms suggesting hepatic dysfunction. Liver function tests must be performed in all patients: at initiation of |
treatment, and then after six weeks, twelve weeks and twenty four weeks. Thereafter liver function tests should be checked |
when clinically indicated. |
Click here for the Joint Formulary for Psychotropic Medication LCFT. |
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All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the |
public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service |
Email: info.elmmb@nhs.net |
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Copyright© 2016 East Lancashire Medicines Management Board |
All rights reserved. Disclaimer/Terms and conditions |