eiiiiF 236Sertraline 19-Mar-2018
lINDICATIONS AND DOSE
Obsessive-compulsive disorder
▶BY MOUTH
▶Child 6–11 years:Initially 25 mg daily for 1 week, then
increased to 50 mg daily, then increased in steps of
50 mg at intervals of at least 1 week if required;
maximum 200 mg per day
▶Child 12–17 years:Initially 50 mg daily, then increased in
steps of 50 mg at intervals of at least 1 week if required;
maximum 200 mg per day
Major depression
▶BY MOUTH
▶Child 12–17 years:Initially 50 mg once daily, then
increased in steps of 50 mg at intervals of at least
1 week if required; maximum 200 mg per daylUNLICENSED USENot licensed for use in children for
depression.
lINTERACTIONS→Appendix 1 : SSRIs
lSIDE-EFFECTS
▶Common or very commonChest pain.depression.
gastrointestinal disorders.increased risk of infection.
neuromuscular dysfunction.vasodilation
▶UncommonAlbuminuria.anaemia.back pain.breast pain
.burping.chills.cold sweat.cystitis.dizziness postural.
dysphagia.dyspnoea.ear pain.eye pain.haemorrhage.
hypertension.hypothyroidism.migraine.mood altered.
movement disorders.muscle complaints.muscle
weakness.oedema.oral disorders.osteoarthritis.
periorbital oedema.respiratory disorders.sensation
abnormal.skin reactions.speech disorder.suicide
attempt.thinking abnormal.thirst.urinary disorders
▶Rare or very rareBalanoposthitis.bone disorder.cardiac
disorder.coma.conversion disorder.diabetes mellitus.
drug dependence.drug tolerance decreased.dysphonia.
eye disorders.gait abnormal.genital discharge.glaucoma
.hair texture abnormal.hepatic disorders.hiccups.
hypercholesterolaemia.hypoglycaemia.injury.
lymphadenopathy.myocardial infarction.neoplasms.
oliguria.paranoia.peripheral ischaemia.psychotic
disorder.sleep walking.vision disorders.vulvovaginal
atrophy
▶Frequency not knownCerebrovascular insufficiency.
gynaecomastia.hyperglycaemia.leucopenia.neuroleptic
malignant syndrome.pancreatitis.severe cutaneous
adverse reactions (SCARs)
lBREAST FEEDINGNot known to be harmful but consider
discontinuing breast-feeding.
lHEPATIC IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsReduce dose or increase dose interval in
mild or moderate impairment.
lRENAL IMPAIRMENTUse with caution.
lTREATMENT CESSATIONThe 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).
lPRESCRIBING AND DISPENSING INFORMATIONThe RCPCH
and NPPG recommend that, when a liquid special of
sertraline is required, the following strength is used:
50 mg/ 5 mL.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Sertraline for OCD (obsessive
compulsive disorder) and depressionwww.medicinesforchildren.
org.uk/sertraline-for-ocd-obsessive-compulsive-disorder-and-
depression
Driving and skilled tasksPatients should be counselled on
the effects on driving and skilled tasks.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Tablet
▶Sertraline (Non-proprietary)
Sertraline (as Sertraline hydrochloride) 50 mgSertraline 50 mg
tablets| 28 tabletP£ 19. 25 DT = £ 0. 67
Sertraline (as Sertraline hydrochloride) 100 mgSertraline 100 mg
tablets| 28 tabletP£ 29. 09 DT = £ 0. 91
▶Lustral(Pfizer Ltd)
Sertraline (as Sertraline hydrochloride) 50 mgLustral 50 mg
tablets| 28 tabletP£ 17. 82 DT = £ 0. 67
Sertraline (as Sertraline hydrochloride) 100 mgLustral 100 mg
tablets| 28 tabletP£ 29. 16 DT = £ 0. 91ANTIDEPRESSANTS›TRICYCLIC
ANTIDEPRESSANTSAmitriptyline hydrochloride
lINDICATIONS AND DOSE
Neuropathic pain
▶BY MOUTH
▶Child 2–11 years:Initially 200 – 500 micrograms/kg once
daily (max. per dose 10 mg), dose to be taken at night,
increased if necessary; maximum 1 mg/kg twice daily
on specialist advice
▶Child 12–17 years:Initially 10 mg once daily, increased if
necessary to 75 mg once daily, dose to be taken at
night, dose to be increased gradually, higher doses to
be given on specialist advicelUNLICENSED USENot licensed for use in neuropathic pain.
lCONTRA-INDICATIONSArrhythmias.during manic phase
of bipolar disorder.heart block
lCAUTIONSCardiovascular disease.chronic constipation.
diabetes.epilepsy.history of bipolar disorder.history of
psychosis.hyperthyroidism (risk of arrhythmias).patients
with a significant risk of suicide.phaeochromocytoma
(risk of arrhythmias).susceptibility to angle-closure
glaucoma.urinary retention
CAUTIONS, FURTHER INFORMATIONTreatment should be
stopped if the patient enters a manic phase.
lINTERACTIONS→Appendix 1 : tricyclic antidepressants
lSIDE-EFFECTS
▶Common or very commonAnticholinergic syndrome.
drowsiness.QT interval prolongation
▶Frequency not knownAgranulocytosis.alopecia.anxiety.
appetite abnormal.arrhythmias.asthenia.bone marrow
depression.breast enlargement.cardiac conduction
disorders.coma.concentration impaired.confusion.
constipation.delirium.delusions.diarrhoea.dizziness.
dry mouth.dysarthria.eosinophilia.epigastric distress.
face oedema.galactorrhoea.gynaecomastia.
hallucination.headache.hepatic disorders.hyperhidrosis
.hyperpyrexia.hypertension.hyponatraemia.
hypotension.leucopenia.mood altered.movement
disorders.mydriasis.myocardial infarction.nausea.
neuroleptic malignant syndrome.oral disorders.
palpitations.paralytic ileus.peripheral neuropathy.
photosensitivity reaction.seizure.sensation abnormal.
sexual dysfunction.SIADH.skin reactions.sleep
disorders.stroke.sudden cardiac death.suicidal
tendencies.syncope.taste altered.testicular swelling.
thrombocytopenia.tinnitus.tremor.urinary disorders.
urinary tract dilation.vision disorders.vomiting.weight
changes.withdrawal syndrome
Overdose Overdosage with amitriptyline is associated
with a relatively high rate of fatality. Symptoms of
overdosage may include dry mouth, coma of varying
degree, hypotension, hypothermia, hyperreflexia, extensor238 Mental health disorders BNFC 2018 – 2019
Nervous system4