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Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey+
TABLE 68-9Adverse Drug Reactions and Monitoring Parameters Associated with Select New-Generation Antidepressants
Drug ADR(s) Monitoring Comments
Antidepressants from Each Pharmacologic Class
Common to all antidepressants
(US boxed warning) for all antidepressants;
Behavioral changes caregivers should be alerted to monitor for acute
Suicidality
changes in behavior (especially early in
Mental status treatment)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Common to all SSRIs
Most prominent on initial treatment; generally
Assess severity and impact on patient
Anxiety or nervousness subsides over time as antidepressant causes
functioning and quality of life
neurochemical adaptations
Among SSRI class: fluoxetine may be more
Insomnia Sleep patterns activating; fluvoxamine and paroxetine may be
more sedating
Nausea Frequency and severity
Autonomic function (eg, pulse, temperature); Criteria include mental status change, clonus,
Serotonin syndrome
neuromuscular function hyperthermia, diaphoresis, and tachycardia
Spontaneous self-reporting may be low; clinician
Assess severity and impact on patient
Sexual dysfunction should assess symptoms; reversible on drug
functioning and quality of life
discontinuation
SSRI-Specific
Caution use in “at-risk” patients (eg, electrolyte
Electrocardiogram; electrolytes (eg, potassium,
Citalopram (possibly escitalopram) QT interval prolongation disturbance); discontinue if QTc persistently
magnesium)
>500 milliseconds
Symptoms: dry mouth, constipation, urinary Paroxetine possesses relatively more
Paroxetine Anticholinergic effects
retention, mental status anticholinergic effects than other SSRIs
Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
Common to all SNRIs
Possibly less likely with duloxetine; may need to
Cardiovascular changes Increases in blood pressure; heart rate
lower/discontinue dose
Insomnia Sleep patterns Possibly less likely with duloxetine
Nausea Frequency and severity
Autonomic function (eg, pulse temperature); Criteria include mental status changes, clonus,
Serotonin syndrome
neuromuscular function hyperthermia, diaphoresis, and tachycardia
Spontaneous self-reporting may be low;
Assess severity and impact on patient
Sexual dysfunction clinicians should assess symptoms; reversible on
functioning and quality of life
drug discontinuation
SNRI-Specific
Elevations in total cholesterol, low-density
Desvenlafaxine Dose-related hyperlipidemia Lipid profile
lipoproteins, and triglycerides
Mixed Serotonergic Effects (Mixed 5-HT)
Nefazodone use is extremely limited in the
Nefazodone Liver toxicity Liver function tests
United States due to concerns about liver toxicity
May be more severe as compared with other
Trazodone Orthostatic hypotension Blood pressure, pulse
antidepressants; rate-limiting side effect
Patient report of sexual side effects, especially Patient should seek medical attention for
Priapism
painful erection prolonged erection (ie, >4 hours)
Autonomic function (eg, pulse temperature); Criteria include mental status changes, clonus,
Vilazodone Serotonin syndrome
neuromuscular function hyperthermia, diaphoresis, and tachycardia
Serotonin and α2-Adrenergic Antagonist
Frequently occurring and significant (>7%)
Mirtazapine Weight gain Body weight
weight gain among adults
Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)
See text for proper dosing, which can help
Bupropion Seizure activity Electroencephalogram decrease seizure risk; caution use in patients
with eating disorders or alcohol use disorders
Data from references 2, 39, 40, 46, 65.
Date of download: 03/17/19 from AccessPharmacy: accesspharmacy.mhmedical.com, Copyright © McGraw-Hill Education. All rights reserved.