Venlafaxine (as Venlafaxine hydrochloride) 75 mg Majoven XL
75mg capsules | 28 capsule P £22.08 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Majoven XL
150mg capsules | 28 capsule P £36.81 DT = £3.90
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Politid XL 75mg
capsules | 28 capsule P £23.41 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Politid XL
150mg capsules | 28 capsule P £39.03 DT = £3.90
▶ Tonpular XL (Wockhardt UK Ltd)
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Tonpular XL
75mg capsules | 28 capsule P £7.00 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Tonpular XL
150mg capsules | 28 capsule P £12.00 DT = £3.90
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venaxx XL
75mg capsules | 28 capsule P £10.40 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venaxx XL
150mg capsules | 28 capsule P £17.40 DT = £3.90
▶ Vencarm XL (Aspire Pharma Ltd)
Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Vencarm XL
37.5mg capsules | 28 capsule P £3.30 DT = £5.25
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Vencarm XL
75mg capsules | 28 capsule P £2.59 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Vencarm XL
150mg capsules | 28 capsule P £3.89 DT = £3.90
Venlafaxine (as Venlafaxine hydrochloride) 225 mg Vencarm XL
225mg capsules | 28 capsule P £9.90 DT = £47.11
▶ Venlablue XL (Creo Pharma Ltd)
Venlafaxine (as Venlafaxine hydrochloride) 37.5 mg Venlablue XL
37.5mg capsules | 28 capsule P £5.25 DT = £5.25
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlablue XL
75mg capsules | 28 capsule P £6.95 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venlablue XL
150mg capsules | 28 capsule P £9.95 DT = £3.90
▶ Venlasov XL (Sovereign Medical Ltd)
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venlasov XL
75mg capsules | 28 capsule P £2.45 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venlasov XL
150mg capsules | 28 capsule P £3.75 DT = £3.90
▶ Vensir XL (Morningside Healthcare Ltd)
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Vensir XL 75mg
capsules | 28 capsule P £2.60 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Vensir XL
150mg capsules | 28 capsule P £3.90 DT = £3.90
Venlafaxine (as Venlafaxine hydrochloride) 225 mg Vensir XL
225mg capsules | 28 capsule P £21.90 DT = £47.11
Venlafaxine (as Venlafaxine hydrochloride) 75 mg Venzip XL
75mg capsules | 28 capsule P £22.08 DT = £2.60
Venlafaxine (as Venlafaxine hydrochloride) 150 mg Venzip XL
150mg capsules | 28 capsule P £36.81 DT = £3.90
ANTIDEPRESSANTS › SEROTONIN UPTAKE
Depressive illness (particularly where sedation is
▶ Adult: Initially 150 mg daily in divided doses, dose to
be taken after food, alternatively initially 150 mg once
daily, dose to be taken at bedtime, increased if
necessary to 300 mg daily; increased if necessary to
600 mg daily in divided doses, higher dose for use in
▶ Elderly: Initially 100 mg daily in divided doses, dose to
be taken after food, alternatively initially 100 mg once
daily, dose to be taken at bedtime, increased if
necessary to 300 mg daily; increased if necessary to
600 mg daily in divided doses, higher dose for use in
▶ Adult: 75 mg daily, increased if necessary to 300 mg
l CONTRA-INDICATIONS Arrhythmias . during the manic
phase of bipolar disorder. heart block . immediate recovery
period after myocardial infarction
CAUTIONS, FURTHER INFORMATION Treatment should be
stopped if the patient enters a manic phase.
Elderly patients are particularly susceptible to many of
the side-effects of tricyclic antidepressants; low initial
doses should be used, with close monitoring, particularly
for psychiatric and cardiac side-effects.
l INTERACTIONS → Appendix 1: trazodone
l SIDE-EFFECTS Aggression . agranulocytosis . alertness
prolongation . seizure . serotonin syndrome . SIADH . skin
effective dose (every 2–3 days). Consider using a lower
starting dose in elderly patients.
Overdose The tricyclic-related antidepressant drugs may
be associated with a lower risk of cardiotoxicity in
Tricyclic and related antidepressants cause dry mouth,
coma of varying degree, hypotension, hypothermia,
hyperreflexia, extensor plantar responses, convulsions,
respiratory failure, cardiac conduction defects, and
arrhythmias. Dilated pupils and urinary retention also
occur. For details on the management of poisoning see
Tricyclic and related antidepressants under Emergency
treatment of poisoning p. 1359.
l PREGNANCY Avoid during first trimester—limited
information available. Monitor infant for signs of
withdrawal if used until delivery.
l BREAST FEEDING The amount secreted into breast milk is
l HEPATIC IMPAIRMENT Manufacturer advises caution,
particularly in severe impairment (increased risk of sideeffects).
l RENAL IMPAIRMENT Use with caution in severe
l TREATMENT CESSATION Withdrawal effects may occur
within 5 days of stopping treatment with antidepressant
drugs; they are usually mild and self-limiting, but in some
cases may be severe. The risk of withdrawal symptoms is
370 Mental health disorders BNF 78
increased if the antidepressant is stopped suddenly after
regular administration for 8 weeks or more. 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). If possible tricyclic and related antidepressants
l PRESCRIBING AND DISPENSING INFORMATION Limited
quantities of tricyclic antidepressants should be prescribed
at any one time because their cardiovascular and
epileptogenic effects are dangerous in overdosage.
Driving and skilled tasks Drowsiness may affect the
performance of skilled tasks (e.g. driving).
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
CAUTIONARY AND ADVISORY LABELS 2, 21
▶ Trazodone hydrochloride (Non-proprietary)
Trazodone hydrochloride 10 mg per 1 ml Trazodone 50mg/5ml
oral solution sugar free sugar-free | 120 ml P £37.09–£180.00 DT
Trazodone hydrochloride 20 mg per 1 ml Trazodone 100mg/5ml
oral solution sugar free sugar-free | 120 ml P £155.00–£195.60
CAUTIONARY AND ADVISORY LABELS 2, 21
▶ Trazodone hydrochloride (Non-proprietary)
Trazodone hydrochloride 150 mg Trazodone 150mg tablets | 28 tablet P £34.00 DT = £4.69
Trazodone hydrochloride 150 mg Molipaxin 150mg tablets | 28 tablet P £16.08 DT = £4.69
CAUTIONARY AND ADVISORY LABELS 2, 21
▶ Trazodone hydrochloride (Non-proprietary)
Trazodone hydrochloride 50 mg Trazodone 50mg capsules | 84 capsule P £35.00 DT = £5.22
Trazodone hydrochloride 100 mg Trazodone 100mg capsules | 56 capsule P £41.00 DT = £5.69
Trazodone hydrochloride 50 mg Molipaxin 50mg capsules | 84 capsule P £23.92 DT = £5.22
Trazodone hydrochloride 100 mg Molipaxin 100mg capsules |
56 capsule P £28.14 DT = £5.69
Depressive illness (particularly where sedation is
▶ Adult: Initially 30–40 mg daily in divided doses,
alternatively initially 30–40 mg once daily, dose to be
taken at bedtime, increase dose gradually as necessary;
▶ Elderly: Initially 30 mg daily in divided doses,
alternatively initially 30 mg once daily, dose to be
taken at bedtime, increase dose gradually as necessary;
CAUTIONS, FURTHER INFORMATION Treatment should be
stopped if the patient enters a manic phase.
Elderly patients are particularly susceptible to many of
the side-effects of tricyclic antidepressants; low initial
doses should be used, with close monitoring, particularly
for psychiatric and cardiac side-effects.
l INTERACTIONS → Appendix 1: mianserin
l SIDE-EFFECTS Agranulocytosis . arthritis . bone marrow
dysfunction . suicidal tendencies .tremor. withdrawal
effective dose (every 2–3 days). Consider using a lower
starting dose in elderly patients.
Overdose The tricyclic-related antidepressant drugs may
be associated with a lower risk of cardiotoxicity in
Tricyclic and related antidepressants cause dry mouth,
coma of varying degree, hypotension, hypothermia,
hyperreflexia, extensor plantar responses, convulsions,
respiratory failure, cardiac conduction defects, and
arrhythmias. Dilated pupils and urinary retention also
occur. For details on the management of poisoning see
Tricyclic and related antidepressants under Emergency
treatment of poisoning p. 1359.
l BREAST FEEDING The amount secreted into breast milk is
l HEPATIC IMPAIRMENT Manufacturer advises caution; avoid
Dose adjustments Caution in renal impairment.
l MONITORING REQUIREMENTS A full blood count is
recommended every 4 weeks during the first 3 months of
treatment; clinical monitoring should continue
subsequently and treatment should be stopped and a full
blood count obtained if fever, sore throat, stomatitis, or
other signs of infection develop.
l TREATMENT CESSATION Withdrawal effects may occur
within 5 days of stopping treatment with antidepressant
drugs; they are usually mild and self-limiting, but in some
cases may be severe. The risk of withdrawal symptoms is
increased if the antidepressant is stopped suddenly after
regular administration for 8 weeks or more. 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). If possible tricyclic and related antidepressants
l PRESCRIBING AND DISPENSING INFORMATION Limited
quantities of tricyclic antidepressants should be prescribed
at any one time because their cardiovascular and
epileptogenic effects are dangerous in overdosage.
Driving and skilled tasks Drowsiness may affect the
performance of skilled tasks (e.g. driving).
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
CAUTIONARY AND ADVISORY LABELS 2, 25
▶ Mianserin hydrochloride (Non-proprietary)
Mianserin hydrochloride 10 mg Mianserin 10mg tablets | 28 tablet P £14.75 DT = £13.58
Mianserin hydrochloride 30 mg Mianserin 30mg tablets | 28 tablet P £33.45 DT = £30.82
l DRUG ACTION Mirtazapine is a presynaptic alpha2-
adrenoreceptor antagonist which increases central
noradrenergic and serotonergic neurotransmission.
▶ Adult: Initially 15–30 mg daily for 2–4 weeks, dose to
be taken at bedtime, then adjusted according to
response to up to 45 mg once daily, alternatively up to
45 mg daily in 2 divided doses
of urinary retention . hypotension . psychoses (may
aggravate psychotic symptoms). susceptibility to angleclosure glaucoma
l INTERACTIONS → Appendix 1: mirtazapine
discontinuation). myalgia . nausea . oedema . postural
hypotension . sleep disorders .tremor. vomiting . weight
▶ Uncommon Hallucination . mania . movement disorders . oral disorders . syncope
▶ Rare or very rare Aggression . pancreatitis
▶ Frequency not known Agranulocytosis . arrhythmias . bone
(SCARs). SIADH . skin reactions . sudden death . suicidal
tendencies .thrombocytopenia . urinary retention . withdrawal syndrome
l PREGNANCY Use with caution—limited experience;
monitor neonate for withdrawal effects.
l BREAST FEEDING Present in milk; use only if potential
l HEPATIC IMPAIRMENT Manufacturer advises caution (risk
of increased plasma concentration, no information
available in severe impairment).
l RENAL IMPAIRMENT Clearance reduced by 30% if eGFR
less than 40 mL/minute/1.73 m2
if eGFR less than 10 mL/minute/1.73 m2
l TREATMENT CESSATION 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
l DIRECTIONS FOR ADMINISTRATION Orodispersible tablet
(Zispin SolTab ®) should be placed on the tongue, allowed
l PATIENT AND CARER ADVICE Counselling on
administration of orodispersible tablet advised.
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 immediately if blood dyscrasia suspected.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule, oral
CAUTIONARY AND ADVISORY LABELS 2, 25
▶ Mirtazapine (Non-proprietary)
Mirtazapine 15 mg Mirtazapine 15mg tablets | 28 tablet P £4.60 DT = £1.23
Mirtazapine 30 mg Mirtazapine 30mg tablets | 28 tablet P £4.50 DT = £1.07
Mirtazapine 45 mg Mirtazapine 45mg tablets | 28 tablet P £4.95 DT = £1.36
CAUTIONARY AND ADVISORY LABELS 2
▶ Mirtazapine (Non-proprietary)
Mirtazapine 15 mg per 1 ml Mirtazapine 15mg/ml oral solution
sugar free sugar-free | 66 ml P £49.51 DT = £49.51
CAUTIONARY AND ADVISORY LABELS 2
EXCIPIENTS: May contain Aspartame
▶ Mirtazapine (Non-proprietary)
Mirtazapine 15 mg Mirtazapine 15mg orodispersible tablets | 30 tablet P £19.19 DT = £1.83
Mirtazapine 30 mg Mirtazapine 30mg orodispersible tablets | 30 tablet P £19.19 DT = £2.00
Mirtazapine 45 mg Mirtazapine 45mg orodispersible tablets |
▶ Zispin SolTab (Merck Sharp & Dohme Ltd)
Mirtazapine 15 mg Zispin SolTab 15mg orodispersible tablets | 30 tablet P £15.06 DT = £1.83
Mirtazapine 30 mg Zispin SolTab 30mg orodispersible tablets | 30 tablet P £15.06 DT = £2.00
Mirtazapine 45 mg Zispin SolTab 45mg orodispersible tablets | 30 tablet P £15.06 DT = £2.07
Amitriptyline hydrochloride 28-May-2018
Abdominal pain or discomfort (in patients who have not
responded to laxatives, loperamide, or antispasmodics)
▶ Adult: Initially 5–10 mg daily, to be taken at night;
increased in steps of 10 mg at least every 2 weeks as
required; maximum 30 mg per day
Major depressive disorder [not recommended—increased
▶ Adult: Initially 50 mg daily in 2 divided doses, then
increased in steps of 25 mg once daily on alternate days
if required, maximum 150 mg daily in 2 divided doses
▶ Elderly: Initially 10–25 mg daily, increased if necessary
up to 100–150 mg daily in 2 divided doses, dose
increases dependent on individual patient response
and tolerability—doses above 100 mg should be used
Major depressive disorder in patients with cardiovascular
disease [not recommended—increased risk of fatality in
▶ Adult: Initially 10–25 mg daily, increased if necessary
up to 100–150 mg daily in 2 divided doses, dose
increases dependent on individual patient response
and tolerability—doses above 100 mg should be used
