BNF for Children 2011-2012

BNFC 2011–2012 4.3.3 Selective serotonin re-uptake inhibitors 187also reported) and hypersensitivity reactions includingrash (consider discontinuation—may be sign of impendingserious systemic reaction, possibly associated withvasculitis), urticaria, angioedema, anaphylaxis, arthralgia,myalgia and photosensitivity; other side-effectsinclude dry mouth, nervousness, anxiety, headache,insomnia, tremor, dizziness, asthenia, hallucinations,drowsiness, convulsions (see Cautions above), galactorrhoea,sexual dysfunction, urinary retention, sweating,hypomania or mania (see Cautions above), movementdisorders and dyskinesias, visual disturbances, hyponatraemia(see Hyponatraemia and AntidepressantTherapy, p. 184), and bleeding disorders includingecchymoses and purpura. Suicidal behaviour has beenlinked with antidepressants, see p. 184. Angle-closureglaucoma may very rarely be precipitated by treatmentwith SSRIs.CITALOPRAMCautions see notes aboveContra-indications see notes aboveHepatic impairment use doses at lower end of rangeRenal impairment no information available for estimatedglomerular filtration rate less than 20 mL/minute/1.73 m 2Pregnancy see notes aboveBreast-feeding present in milk—avoidSide-effects see notes above; also hepatitis, palpitation,tachycardia, oedema, bradycardia, posturalhypotension, coughing, yawning, confusion, impairedconcentration, aggression, malaise, amnesia,migraine, paraesthesia, abnormal dreams, euphoria,mydriasis, taste disturbance, increased salivation,rhinitis, tinnitus, polyuria, micturition disorders, andpruritusLicensed use not licensed for use in childrenIndication and doseMajor depression (but see Depressive Illness inChildren and Adolescents, above). By mouth as tabletsChild 12–18 years initially 10 mg once daily,increased if necessary to 20 mg once daily over 2–4 weeks; max. 60 mg once daily. By mouth as oral dropsChild 12–18 years initially 8 mg once dailyincreased if necessary to 16 mg once daily over 2–4 weeks; max. 48 mg once dailyCitalopram (Non-proprietary) ATablets, citalopram (as hydrobromide) 10 mg, netprice 28-tab pack = £1.03; 20 mg, 28-tab pack = £1.30;40 mg, 28-tab pack = £1.37. Counselling, drivingOral drops, citalopram (as hydrochloride) 40 mg/mL,net price 15-mL pack = £17.92. Counselling, driving,administrationNote 4 drops (8 mg) can be considered equivalent in therapeuticeffect to 10-mg tabletMix with water, orange juice, or apple juice before takingCipramil c (Lundbeck) ATablets, f/c, citalopram (as hydrobromide) 10 mg, netprice 28-tab pack = £5.38; 20 mg (scored), 28-tab pack= £8.95; 40 mg, 28-tab pack = £15.12. Counselling,drivingOral drops, sugar-free, citalopram (as hydrochloride)40 mg/mL, net price 15-mL pack = £10.08. Counselling,driving, administrationNote 4 drops (8 mg) can be considered equivalent in therapeuticeffect to 10-mg tabletMix with water, orange juice, or apple juice before takingFLUOXETINECautions see notes aboveContra-indications see notes aboveHepatic impairment reduce dose or increase doseintervalPregnancy see notes aboveBreast-feeding present in breast milk, avoidSide-effects see notes above; also vasodilatation,postural hypotension, pharyngitis, dyspnoea, chills,taste disturbance, sleep disturbances, euphoria, confusion,yawning, impaired concentration, changes inblood sugar, alopecia, urinary frequency; rarelypulmonary inflammation and fibrosis; very rarelyhepatitis, toxic epidermal necrolysis, and neurolepticmalignant syndrome-like eventIndication and doseMajor depression. By mouthChild 8–18 years 10 mg once daily increasedafter 1–2 weeks if necessary, max. 20 mg oncedailyLong duration of action Consider the long half-life offluoxetine when adjusting dosage (or in overdosage)Fluoxetine (Non-proprietary) ACapsules, fluoxetine (as hydrochloride) 20 mg, netprice 30-cap pack = £1.90; 60 mg, 30-cap pack =£54.43. Counselling, drivingBrands include Oxactin cLiquid, fluoxetine (as hydrochloride) 20 mg/5 mL, netprice 70 mL = £5.04. Counselling, drivingBrands include Prozep cProzac c (Lilly) ACapsules, fluoxetine (as hydrochloride) 20 mg(green/yellow), net price 30-cap pack = £1.50.Counselling, drivingLiquid, fluoxetine (as hydrochloride) 20 mg/5 mL, netprice 70 mL = £11.12. Counselling, drivingFLUVOXAMINE MALEATECautions see notes aboveContra-indications see notes aboveHepatic impairment start with low doseRenal impairment start with low dosePregnancy see notes aboveBreast-feeding present in milk—avoidSide-effects see notes above; palpitation, tachycardia,malaise; less commonly postural hypotension, confusion,ataxia; rarely abnormal liver function (usuallysymptomatic—discontinue treatment); also reportedparaesthesia, taste disturbance, neuroleptic malignantsyndrome-like eventIndication and doseObsessive-compulsive disorder. By mouthChild 8–18 years initially 25 mg dailyincreased if necessary in steps of 25 mg every4 Central nervous system