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Classification Antidepressant
Dosage/route The usual adult dose is 100-200 mg daily. The maximum dose is 300 mg daily.
Indication Adults: Depression of varying etiology and symtomatology; Obssessivecompulsive syndromes; phobias and panic attacks
Contraindication Hypersensitivity to clomipramine or excipients, crosssensitivity to tricyclic antidepressants of the dibenzazepine group.
Adverse reaction Very common: drowsiness, fatigue, restlessness, tremor, myoclonus, increase appetite, dry mouth, sweating, constipation, visual disturbances
Nursing Consideration -Monitor patient with history of CVD (including previous MI, stroke, tachycardia, or conduction abnormalities. -monitor BP, pulse every 4hrs; if systolic BP drops 20mmHg hold drug, notify physician. -monitor blood studies. -assess mental status.
Desipramine
Norpramine
The usual dose of doxepin is 75 to 300 mg daily administered at bedtime or in three divided doses. Doses greater than 300 mg daily are not more effective.
For depression
Hypersensitivity to drug Recovery phase of myocardial infarction (MI) MAO inhibitor use within past 14 days
CNS: sedation, weakness, anxiety, restlessness, insomnia, delusions, confusion, agitation, hallucinations, disorientation, extrapyramidal reactions, EEG changes, CV: hypotension, hypertension, tachycardia,
vision, dry eyes, laryngitis Drowsiness, dizziness, confusion, headache, dry mouth, constipation, blurring of vision, hypotension, tachycardia, rashes. Topical: Burning, stinging, scaling, oedema and dryness. Drowsiness, tremor, dry mouth and constipation. For Depression Hypersensitivity; mania, glaucoma, neonates (topical); lactation.
-Assess patients condition before therapy and regularly thereafter to monitor drug effectiveness. -assess baseline mental status and monitor throughout therapy -monitor VS regularly -determine alcohol consumption
Postural hypotension,
Depressive illness, especially where sllep disturbance, anxiety or agitation is a presenting symptom.
Surmontil
Nardil
The usual starting dose for adults is 50 to 75 mg per day, split into equal, smaller doses (for example, 25 mg three times daily). Doses are gradually increased every 2 to 3 weeks.
Concurrent use of monoamine oxidase inhibitors (MAOIs), an interval of at least 15 days should separate both treatments. Narrow angle glaucoma. Risk of urinary retention.
oedema; dizziness, headache, drowsiness, sleep disturbances, fatigue; rash; decreased sexual ability; constipation, wt gain, xerostomia; urinary retention; leukopenia; hepatitis, jaundice; weakness, tremor; blurred vision.
Uncontrolled hypertension; cerebrovascular disease; CHF; phaeochromocyto ma; history of hepatic disease or abnormal LFTs; severe renal impairment or renal disease.
Postural hypotension, oedema; dizziness, headache, drowsiness, sleep disturbances, fatigue; rash; decreased sexual ability; constipation, wt gain, xerostomia; urinary retention; leukopenia; hepatitis, jaundice; weakness, tremor; blurred vision.
Phenezine
Luvox, Luvox CR
Pamelor, Aventyl
The usual starting dose for adults is 50 mg daily given as a single dose at bedtime. The dose may be increased in 50 mg increments every 4-7 days to For Depression. achieve the desired response. The maximum dose is 300 mg/day.
Hypersensitivity. Not to be used with thioridazine, terfenadine, astemizole, cisapride, pimozide, aloestron, tizanidine. Lactation
Headache, asthenia, tremor, palpitations, nausea, diarrhoea, constipation, anorexia, vomiting, flatulence, somnolence, insomnia, dry mouth, nervousness, dizziness, tremor, anxiety, agitation, decreased libido, depression, CNS stimulation
Mania, recent MI, arrhythmias (particularly heart block); severe liver disease; children <6 yr.
The usual dose of nortriptyline in adults is 25 mg given 3 to 4 times daily. In children, doses usually are 30 to
Tachycardia, slows conduction and prolongation of PR interval, lowers seizure threshold, peripheral neuropathy, dry mouth, constipation, urinary hesitancy, confusion and blurred vision, nausea, sweating, hypersensitivity reactions.
Nortriptyline
Wellbutrin
50 mg once daily or in divided doses. It is advisable to begin at a low dose and increase the dose slowly.
Antidepressant
Bupropion
Given in one, two or three daily doses. For immediaterelease tablets, no single dose should exceed 150 mg and each dose should be separated by 6 hours.
For depression
Serzone
Hypersensitivity to phenylpiperazine antidepressants. Active liver disease or elevated baseline serum transaminase concentrations. Previous history of hepatocellular injury with nefazodone use. Concurrent use or within 14 days of discontinuing treatment with MAOI.
Nausea, dry mouth, insomnia, somnolence, agitation, constipation, asthenia, dizziness, lightheadedness, orthostatic hypotension, confusion, blurred vision, abnormal vision, eye pain, sinus bradycardia, bronchitis, syndrome of inappropriate secretion of antidiuretic hormone, impotence. Blurred Vision, Dry
Hypersensitivity
Mouth, Hypotension, Dizziness/Lighthea dedness, Drowsiness, Nervousness, Nausea/Vomiting. Symptoms of depression in patients with or without history of mania. ObsessiveCompulsive disorders. Hypersensitivity to the drug or any ingredient in the formulation, in combination with MAOI or within 14 days of discontinuing a MAOI. Coadiminstration fluvoxamine with cisapride. Lithium should generally not be given to patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, and to patients receiving diuretics, since the risk of lithium toxicity is Nausea, loose stools, dyspepsia, tremor, dizziness, insomnia, somnolence, dry mouth, increased sweating and male sexual dysfunction.
Lithium Toxicity
Eskalith CR
50mg/day once daily. May be increased to 200 mg/day over a period of 2 wks by 50mg increments.
Tegretol
Antimanic
Oral forms: Epilepsy. Acute mania; maintenance for bipolar affective disorders.
Dizziness, drowsiness, ataxia; dry mouth, abdominal pain, nausea, vomiting, anorexia; leucopenia, proteinuria, renal failure, heart failure and hyponatraemia.
-assess for seizures: character, location, duration, intensity, frequency, presence of aura. -assess for trigeminal neuralgia. -check for water retention, with decreased osmolality and concentration of Na+ plama, esp. in elderly patients with cardiac disease.
Anticonvulsants
Treatment of generalized epilepsy particularly w/ absence, myoclonic, tonicclonic, atonic & mixed patterns of seizures; & partial epilepsy particularly w/ Initially 10-15 simple or complex, mg/kg daily. secondary Dosage should be generalized, increased by 5-10 specific syndromes.
Hypersensitivity to Na valproate or valproic acid, porphyria. Acute & chronic hepatitis, history of severe hepatitis esp drugrelated.
Hemorrhage, bruising, hyperammonemia, nausea, vomiting, increased appetite, thrombocytopenia, anemia, bone marrow suppression, pancreatitis. GI irritation.
Valproic A Nimotop
mg/kg/wk. Maintenance: Adult 20-30 mg/kg. Childn 30 mg/kg/day. Elderly Should be determined by seizure control. Monitor patients when receiving daily doses >50 mg/kg. IV infusion: initially, !mg for 2hrs. dose may increase after 2hrs to 2mg if no marked reduction in BP.
Prophylaxis and treatment of ischaemic neurological deficits caused by cerebral vasospasm following subarchnoid hemorrhage of aneurismal origin.
Sick sinus syndrome, 2nd or 3rd degree heart block, hypotension less than 90 mm Hg systolic, hypersensitivity.
Peripheral oedema, hypotension, palpitations, tachycardia, flushing, dizziness, headache, nausea, increased micturition frequency, lethargy, eye pain, mental depression, visual disturbances, gingival hyperplasia, myalgia, tremor. Constipation, dizziness, nausea. Rarely, vertigo, headache, hypotension, erythromelalgia, paresthesia, neuropathy; bradycardiac arrhythmias, CHF, dyspnea, raised prolactin levels, single cases of galactorrhea. Extrapyramidal symptoms, tardive
-assess potential for interactions with other pharmacological agents and herbal products patient may be taking. -monitor I and O ratios and daily weight. -assess for signs of CHF. -assess therapeutic effectiveness.
Nimodipine
Isoptin
Contraindicated in patients with the sick sinus syndrome, preexisting second or third degree atrioventricular block or marked bradycardia.
-assess fluid volume status: I-O ratio and record. -monitor BP and pulse. Monitor ALT, AST, bilirubin daily -monitor cardiac output.
Calcium Antagonists
Isoptin tab Adult 40-80 mg tid-qid. Max: 480 mg daily. Childn >6 yr 40-120 mg bidtid, up to 360 mg
Verapamil
Haldol
dyskinesia, neuroleptic malignant syndrome, other CNS effects, GI symptoms, endocrine effects, CV effects. Hypersensitivity reactions.
Antipsychotics Haloperidol
Prolixin
Adult As a neuroleptic agent: acute paranoia 5-10 mg IM to be repeated hourly until sufficient symptom control is achieved. Max: 60 mg/day.
status before drug therapy and reassess regularly thereafter. -monitor for possible adverse reactions. -monitor VS during initial treatment. -assess for constipation and urinary retention daily.
Hypersensitivity; comatose or severely depressed states; blood dyscrasias; liver disease; bone marrow depression; phaeochromocyto ma;
Tardive dyskinesia, sedation, mental confusion; hypotension; hyperprolactinaemi a leading to galactorrhoea and amenorrhoea in women; loss of libido, impotence and sterility in males.
Fluphenazine
Antipsychotics
Leponex
Adult: PO Mania; Psychoses; Schizophrenia Initial: 2.5-10 mg/day in 2-3 divided doses. Maintenance: 1-5 mg/day. Adjunct
History of bone marrow disorders including agranulocytosis, circulatory collapse, alcoholic or toxic psychosis,
Drowsiness, dizziness, headache; nausea, vomiting, constipation; anxiety, confusion, fatigue, transient
-assess mental status. -check for swallowing of oral medication. -Monitor I-O ratio, palpate bladder if low urinary output
in severe anxiety or behavioral disturbances 1 mg twice daily, up to 2 mg twice daily if needed. 12.5mg once to twice a day on the 1st day, 25 or 50mg on the 2nd day, followed by stepwise dosage increases up to 300-450 mg per day in divided doses.
fever, hypersalivation.
occurs. -assess for constipation, urinary retention daily, if these occur, increase bulk, water in diet.
Clozaphine
Antipsychotics
Zyprexa
Oral: acute and maintenance treatment of schizophrenia and other psychoses where positive symptoms and negative symptoms are prominent.
Tablet: initially 510 mg once a day. Antipsychotics Olanzadine Treatment of acute and chronic psychoses, including schizophrenia. Manic episodes associated with bipolar disorder. Hypersensitivity
Headache, dizziness, somnolence, agitation, postural hypotension. Tntramuscular injection site discomfort, postural hypotension, bradycardia with or without hypotension or syncope, tachycardia.
-assess mental status, orientation, mood, behavior, presence of hallucinations and type before initial administration and every mouth. -monitor swallowing of oral medication. -assess dizziness, faintness, palpitations, tachycardia on rising. -assess for neuroleptic malignant syndrome. -assess other medications patient is taking for effectiveness and interactions. -assess results of laboratory tests, therapeutic
Seroquel
Headache, asthenia, abdominal pain, back pain, fever, chest pain, postural and orthostatic hypotension, hypertension,
Antipsychotics
Quetiapine
Zeldox
Antipsychotics
Ziprazidone
25 mg twice daily on day 1, increase to 50 mg twice daily on day 2, 100 mg twice daily on day 3 and 150 mg Capsule: twice daily on Management of day 4. schizophrenia and other psychotic disorders and maintenance of clinical improvement and prevention of Capsule: 40mg relapse during twice daily. continuation Dosage may be therapy. adjusted up to maximum of 80mg twice daily. Injection: 10-20 mg intramuscularly up to maximum of 40mg/day.
effectiveness. -assess mental status for depression and suicidal ideation. -assess swallowing of oral medication. -monitor weight. -assess mental status before initial administration. -check swallowing of oral administration. -monitor inputoutput ratio. -assess dizziness, faintness, palpitations, tachycardia on rising. -monitor BP standing and laying.
Known QT-interval prolongation; acute myocardial infarction; uncompensated heart failure, cardiac arrhythmias requiring treatment with class I and III antiarrhythmic drugs.