Drug | Anticholinergic | Drowsiness | Insomnia/ agitation | Orthostatic hypotension | QTc prolongation* | Gastrointestinal toxicity | Weight gain | Sexual dysfunction |
Selective serotonin reuptake inhibitors¶ | ||||||||
Citalopram | 0 | 0 | 1+ | 1+ | 3+Δ | 1+¶ | 1+ | 3+ |
Escitalopram | 0 | 0 | 1+ | 1+ | 2+ | 1+¶ | 1+ | 3+ |
Fluoxetine | 0 | 0 | 2+ | 1+ | 1+ | 1+¶ | 0 | 3+ |
Fluvoxamine | 0 | 1+ | 1+ | 1+ | 1+ | 1+¶ | 1+ | 3+ |
Paroxetine | 1+ | 1+ | 1+ | 2+ | 0 to 1+ | 1+¶ | 2+ | 4+ |
Sertraline | 0 | 0 | 2+ | 1+ | 1 to 2+ | 2+¶◊ | 1+ | 3+ |
Atypical agents | ||||||||
Agomelatine§ (not available in United States) | 0 | 1+ | 1+ | 0 | 0 | 1+ | 0 | 0 to 1+ |
Bupropion | 0 | 0 | 2+ (immediate release) 1+ (sustained release) | 0 | 0 to 1+¥ | 1+ | 0 | 0 |
Mirtazapine | 1+ | 4+ | 0 | 0 | 1+ | 0 | 4+ | 1+ |
Serotonin-norepinephrine reuptake inhibitors¶‡ | ||||||||
Desvenlafaxine† | 0 | 0 | 1+ | 0 | 0 | 2+ | Unknown | 1+ |
Duloxetine | 0 | 0 | 1+ | 0 | 0 | 2+¶ | 0 to 1+ | 1+ |
Levomilnacipran† | 0** | 0 | 0 to 1+ | 0 to 1+ | 0 | 2+¶ | 0 | 1+ |
Milnacipran† | 0 | 1+ | 0 | 0 | 0 | 2+¶ | 0 | 1+ |
Venlafaxine† | 0 | 1+ | 1+ | 0 | 0 to 1+¥ | 2+ | 0 to 1+ | 3+ |
Serotonin modulators | ||||||||
Nefazodone¶¶ | 1+ | 2+ | 0 | 1+ | 0 | 2+ | 0 | 0 |
Trazodone | 0 | 4+ | 0 | 1+ (hypnotic dose) 3+ (antidepressant dose) | 1 to 2+ | 1+ (hypnotic dose) 3+ (antidepressant dose) | 0 (hypnotic dose) 1+ (antidepressant dose) | 1+ΔΔ |
Vilazodone | 0 | 0 | 2+ | 0 | 0 | 4+◊◊ | 0 | 1+ |
Vortioxetine | 0 | 0 | 0 | 0 | 0 | 3+ | 0 | 1+ |
Tricyclic and tetracyclic antidepressants | ||||||||
Amitriptyline | 4+ | 4+ | 0 | 3+ | 1 to 2+ | 1+§§ | 4+ | 3 to 4+ |
Amoxapine | 2+ | 2+ | 2+ | 2+ | 1+ | 0§§ | 2+ | ND |
Clomipramine | 4+ | 4+ | 1+ | 2+ | 3+ | 1+§§ | 4+ | 4+ |
Desipramine | 1+ | 2+ | 1+ | 2+ | 1 to 2+ | 0§§ | 1+ | ND |
Doxepin | 3+ | 3+ | 0 | 2+ | 3+ | 0§§ | 4+ | 3+ |
Imipramine | 3+ | 3+ | 1+ | 4+ | 3+ | 1+§§ | 4+ | 3+ |
Maprotiline | 2+ | 3+ | 0 | 2+ | 1+ | 0§§ | 2+ | ND |
Nortriptyline | 2+ | 2+ | 0 | 1+ | 1 to 2+ | 0§§ | 1+ | ND |
Protriptyline | 2+ | 1+ | 1+ | 2+ | 1+ | 1+§§ | 1+ | 3 to 4+ |
Trimipramine | 4+ | 4+ | 1+ | 3+ | 1+ | 0§§ | 4+ | ND |
Monoamine oxidase inhibitors | ||||||||
Isocarboxazid | 1+ | 1+ | 2+ | 2+ | 0 | 1+ | 1+ | 4+ |
Phenelzine | 1+ | 2+ | 1+ | 3+ | 0 | 1+ | 2+ | 4+ |
Selegiline | 1+ | 0 | 1+ | 1+ | 0 | 0 | 0 | 0 |
Tranylcypromine | 1+ | 1+ | 2+ | 2+ | 0 | 1+ | 1+ | 4+ |
SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitors.
* Relative mean QTc prolongation at therapeutic doses; arrhythmogenic potential can be significantly increased in overdose (eg, for cyclic antidepressants, bupropion, citalopram, duloxetine, venlafaxine, and some others). QTc prolongation classifications are based upon US Food and Drug Administration guidance.[6] The use of other classification criteria may lead to some agents being classified differently by other sources. Refer to UpToDate topics on acquired long QT syndrome and acute antidepressant poisonings.
¶ All SSRIs and SNRIs can cause transient nausea and gastrointestinal discomfort when starting therapy or increasing dose.
Δ Based upon reports of dose-related QTc prolongation and arrhythmia, the maximum recommended dose of citalopram is 40 mg/day in most patients; for patients at increased risk of elevated serum concentrations (eg, age >60 years, significant hepatic impairment, receiving interacting medications), the maximum daily dose is 20 mg.
◊ Sertraline is associated with higher rates of diarrhea.
§ Agomelatine may be hepatotoxic and is contraindicated in any degree of liver impairment. Transaminase monitoring is required.
¥ Evidence of an association with QTc prolongation and arrhythmias is limited to overdose; available data on QTc effects of bupropion and venlafaxine at therapeutic doses are reassuring.
‡ SNRIs do not have significant anticholinergic effects. However, SNRIs can produce anticholinergic-like effects (which appear to be mediated by noradrenergic stimulation) such as dry mouth and constipation, and they should be used with caution in narrow angle glaucoma. Levomilnacipran is associated with urinary hesitancy.
† May cause persistent dose-related increases in blood pressure (primarily diastolic) and heart rate. Monitor blood pressure regularly.
** Levomilnacipran can cause dose-dependent urinary hesitancy.
¶¶ Caution: can cause liver failure; transaminase monitoring is required. Withdrawn from market due to hepatotoxicity in many countries.
ΔΔ Trazodone is associated rarely with priapism, which is considered a medical emergency. Refer to UpToDate topic on serotonin modulators.
◊◊ Gastrointestinal effects include nausea, vomiting, and diarrhea.
§§ Gastrointestinal forms of anticholinergic side effects include: dry mouth, constipation, epigastric distress, decreased esophagogastric tone. Refer to "Anticholinergic" data column for frequency rankings.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟