l TREATMENT CESSATION The dose should preferably be
reduced gradually over about 4 weeks, or longer if
withdrawal symptoms emerge (6 months in patients who
have been on long-term maintenance treatment).
l DIRECTIONS FOR ADMINISTRATION Cipramil ® oral drops
should be mixed with water, orange juice, or apple juice
l PATIENT AND CARER ADVICE Counselling on
administration of oral drops is advised.
Driving and skilled tasks Patients should be advised of the
effects of citalopram on driving and skilled tasks.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Alcohol
▶ Citalopram (Non-proprietary)
Citalopram (as Citalopram hydrochloride) 40 mg per
1 ml Citalopram 40mg/ml oral drops sugar free sugar-free | 15 ml P £14.09 DT = £5.21
Citalopram (as Citalopram hydrochloride) 40 mg per
1 ml Cipramil 40mg/ml drops sugar-free | 15 ml P £10.08 DT =
▶ Citalopram (Non-proprietary)
Citalopram (as Citalopram hydrobromide) 10 mg Citalopram
10mg tablets | 28 tablet P £6.00 DT = £0.89
Citalopram (as Citalopram hydrobromide) 20 mg Citalopram
20mg tablets | 28 tablet P £9.00 DT = £0.88
Citalopram (as Citalopram hydrobromide) 40 mg Citalopram
40mg tablets | 28 tablet P £15.12 DT = £0.96
Citalopram (as Citalopram hydrobromide) 20 mg Cipramil 20mg
tablets | 28 tablet P £8.95 DT = £0.88
364 Mental health disorders BNF 78
l DRUG ACTION Escitalopram is the active enantiomer of
Depressive illness | Generalised anxiety disorder |
▶ Adult: 10 mg once daily; increased if necessary up to
▶ Elderly: Initially 5 mg once daily; maximum 10 mg per
▶ Adult: Initially 5 mg once daily for 7 days, then
increased to 10 mg daily; maximum 20 mg per day
▶ Elderly: Initially 2.5 mg once daily; maximum 10 mg
▶ Adult: Initially 10 mg once daily for 2–4 weeks, dose to
be adjusted after 2-4 weeks of treatment; usual dose
l CONTRA-INDICATIONS QT-interval prolongation
l CAUTIONS Susceptibility to QT-interval prolongation
l INTERACTIONS → Appendix 1: SSRIs
▶ Common or very common Sinusitis
l BREAST FEEDING Present in breast milk; avoid.
Dose adjustments Manufacturer advises initially 5 mg once
daily for 2 weeks in mild to moderate impairment,
thereafter increased to 10 mg once daily according to
response; titrate dose with extra caution in severe
l RENAL IMPAIRMENT Caution if eGFR less than
l TREATMENT CESSATION The dose should preferably be
reduced gradually over about 4 weeks, or longer if
withdrawal symptoms emerge (6 months in patients who
have been on long-term maintenance treatment).
l DIRECTIONS FOR ADMINISTRATION Oral drops can be
mixed with water, orange juice, or apple juice before
l PATIENT AND CARER ADVICE Counselling on
administration of oral drops advised.
Driving and skilled tasks Patients should be counselled
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Escitalopram (as Escitalopram oxalate) 20 mg per 1 ml Cipralex
20mg/ml oral drops sugar-free | 15 ml P £20.16 DT = £20.16
▶ Escitalopram (Non-proprietary)
Escitalopram (as Escitalopram oxalate) 5 mg Escitalopram 5mg
tablets | 28 tablet P £8.97 DT = £0.91
Escitalopram (as Escitalopram oxalate) 10 mg Escitalopram 10mg
tablets | 28 tablet P £14.91 DT = £1.13
Escitalopram (as Escitalopram oxalate) 20 mg Escitalopram 20mg
tablets | 28 tablet P £25.20 DT = £1.47
Escitalopram (as Escitalopram oxalate) 5 mg Cipralex 5mg tablets
| 28 tablet P £8.97 DT = £0.91
Escitalopram (as Escitalopram oxalate) 10 mg Cipralex 10mg
tablets | 28 tablet P £14.91 DT = £1.13
Escitalopram (as Escitalopram oxalate) 20 mg Cipralex 20mg
tablets | 28 tablet P £25.20 DT = £1.47
▶ Adult: Initially 20 mg daily, dose is increased after
3–4 weeks if necessary, and at appropriate intervals
thereafter, daily dose may be administered as a single
or divided dose; maximum 60 mg per day
▶ Elderly: Initially 20 mg daily, dose is increased after
3–4 weeks if necessary, and at appropriate intervals
thereafter, daily dose may be administered as a single
or divided dose, usual maximum dose is 40 mg daily but
doses up to 60 mg daily can be used
▶ Adult: 60 mg daily, daily dose may be administered as a
▶ Elderly: Up to 40 mg daily, daily dose may be
administered as a single or divided dose, usual
maximum dose is 40 mg daily but doses up to 60 mg
▶ Adult: 20 mg daily, increased if necessary up to 60 mg
daily, daily dose may be administered as a single or
divided dose, dose to be increased gradually, review
treatment if inadequate response after 10 weeks;
▶ Elderly: 20 mg daily, increased if necessary up to 40 mg
daily, daily dose may be administered as a single or
divided dose, dose to be increased gradually, review
treatment if inadequate response after 10 weeks, usual
maximum dose is 40 mg daily but doses up to 60 mg
Menopausal symptoms, particularly hot flushes, in women
with breast cancer (except those taking tamoxifen)
▶ Consider the long half-life of fluoxetine when adjusting
l UNLICENSED USE g Fluoxetine is used for menopausal
symptoms, ibut it is not licensed for this indication.
l INTERACTIONS → Appendix 1: SSRIs
disorders . serum sickness . speech disorder. vasculitis
▶ Frequency not known Bone fracture
l BREAST FEEDING Present in milk—avoid.
Dose adjustments Manufacturer advises dose reduction or
l DIRECTIONS FOR ADMINISTRATION Dispersible tablets can
be dispersed in water for administration or swallowed
l PATIENT AND CARER ADVICE Patients and carers should be
counselled on the administration of dispersible tablets.
Driving and skilled tasks Patients should be counselled
about the effects on driving and skilled tasks.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
▶ Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 10 mg Fluoxetine 10mg
tablets | 30 tablet P £44.00 DT = £44.00
CAUTIONARY AND ADVISORY LABELS 10
Fluoxetine (as Fluoxetine hydrochloride) 20 mg Olena 20mg
dispersible tablets sugar-free | 28 tablet P £3.44 DT = £3.44
▶ Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 ml Fluoxetine
20mg/5ml oral solution | 70 ml P £12.75 DT = £2.93
Fluoxetine 20mg/5ml oral solution sugar free sugar-free | 70 ml P £12.95 DT = £12.95
▶ Prozac (Eli Lilly and Company Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 ml Prozac
20mg/5ml liquid | 70 ml P £11.12 DT = £2.93
▶ Prozep (Chemidex Pharma Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 ml Prozep
20mg/5ml oral solution sugar-free | 70 ml P £12.95 DT = £12.95
▶ Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 10 mg Fluoxetine 10mg
capsules | 30 capsule P £57.34 DT = £44.68
Fluoxetine (as Fluoxetine hydrochloride) 20 mg Fluoxetine 20mg
capsules | 30 capsule P £2.51 DT = £0.93
Fluoxetine (as Fluoxetine hydrochloride) 30 mg Fluoxetine 30mg
capsules | 30 capsule P £1.80 DT = £1.80
Fluoxetine (as Fluoxetine hydrochloride) 40 mg Fluoxetine 40mg
capsules | 30 capsule P £1.80 DT = £1.80
Fluoxetine (as Fluoxetine hydrochloride) 60 mg Fluoxetine 60mg
capsules | 30 capsule P £54.36 DT = £6.53
▶ Oxactin (Discovery Pharmaceuticals)
Fluoxetine (as Fluoxetine hydrochloride) 20 mg Oxactin 20mg
capsules | 30 capsule P £0.72 DT = £0.93
▶ Prozac (Eli Lilly and Company Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 20 mg Prozac 20mg
capsules | 30 capsule P £1.50 DT = £0.93
Fluvoxamine maleate 23-Jul-2018
▶ Adult: Initially 50–100 mg daily, dose to be taken in the
evening, dose to be increased gradually, increased if
necessary up to 300 mg daily, doses over 150 mg daily
are given in divided doses; maintenance 100 mg daily
▶ Adult: Initially 50 mg daily, dose to be taken in the
evening, dose is increased gradually if necessary after
several weeks, increased if necessary up to 300 mg
daily; maintenance 100–300 mg daily, doses over
150 mg daily are given in divided doses, if no
improvement in obsessive-compulsive disorder within
10 weeks, treatment should be reconsidered
l INTERACTIONS → Appendix 1: SSRIs
▶ Rare or very rare Hepatic function abnormal (discontinue)
▶ Frequency not known Bone fracture . glaucoma . neuroleptic malignant-like syndrome . withdrawal
l BREAST FEEDING Present in milk—avoid.
Dose adjustments Manufacturer advises low initial dose.
Dose adjustments Start with low dose.
l TREATMENT CESSATION The dose should preferably be
reduced gradually over about 4 weeks, or longer if
withdrawal symptoms emerge (6 months in patients who
have been on long-term maintenance treatment).
Driving and skilled tasks Patients should be counselled
about the effects on driving and skilled tasks.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
▶ Fluvoxamine maleate (Non-proprietary)
Fluvoxamine maleate 50 mg Fluvoxamine 50mg tablets | 60 tablet P £20.98 DT = £17.54
Fluvoxamine maleate 100 mg Fluvoxamine 100mg tablets | 30 tablet P £20.98 DT = £17.69
Fluvoxamine maleate 50 mg Faverin 50mg tablets |
60 tablet P £17.10 DT = £17.54
Fluvoxamine maleate 100 mg Faverin 100mg tablets | 30 tablet P £17.10 DT = £17.69
Major depression | Social anxiety disorder | Post-traumatic
stress disorder | Generalised anxiety disorder
▶ Adult: 20 mg daily, dose to be taken in the morning, no
evidence of greater efficacy at higher doses; maximum
▶ Elderly: 20 mg daily, dose to be taken in the morning,
no evidence of greater efficacy at higher doses;
▶ Adult: Initially 20 mg daily, dose to be taken in the
morning, increased in steps of 10 mg, dose to be
increased gradually, increased to 40 mg daily, no
evidence of greater efficacy at higher doses; maximum
▶ Elderly: Initially 20 mg daily, dose to be taken in the
morning, increased in steps of 10 mg, dose to be
increased gradually; maximum 40 mg per day
▶ Adult: Initially 10 mg daily, dose to be taken in the
morning, increased in steps of 10 mg, dose to be
increased gradually, increased to 40 mg daily, no
evidence of greater efficacy at higher doses; maximum
▶ Elderly: Initially 10 mg daily, dose to be taken in the
morning, increased in steps of 10 mg, dose to be
increased gradually; maximum 40 mg per day
Menopausal symptoms, particularly hot flushes, in women
with breast cancer (except those taking tamoxifen).
l UNLICENSED USE g Paroxetine is used for menopausal
symptoms, ibut it is not licensed for this indication.
l CAUTIONS Achlorhydria . high gastric pH
▶ Achlorhydria or high gastric pH Causes reduced absorption of
l INTERACTIONS → Appendix 1: SSRIs
366 Mental health disorders BNF 78
▶ Common or very common Vision blurred
▶ Uncommon Diabetic control impaired
▶ Rare or very rare Acute glaucoma . hepatic disorders . peripheral oedema
l PREGNANCY Increased risk of congenital malformations,
especially if used in the first trimester.
l BREAST FEEDING Present in milk but amount too small to
Dose adjustments Manufacturer advises dose at the lower
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