SSRI starting dose?

[SmallBird]

I am wondering what people think about starting at a particularly low dose for the first few days of treatment (Say 10mg of fluoxetine). I can't find good data to support this practice. What do most of you see and do? I think I've probably done both (which is to say, started at 10mg for a few days and then gone to 20mg vs just starting at 20mg).

 

[Jester25]

Depends on what you are treating. For anxiety disorders you want to start at a lower dose as they can initially make the anxiety worse. For depression, you can start at a higher dose. This is especially true for activating SSRIs like Prozac.

 

[OldPsychDoc]

Depends on WHO you are treating. Older pts, the med-naive, particularly somatic/prone to side effects...start low.

 

[Jester25]

Depends on WHO you are treating. Older pts, the med-naive, particularly somatic/prone to side effects...start low.

Yup.

 

[Leo Aquarius]

Lower the dose for any hepatic disorders that compromise phase II processing.

Also, be mindful of P450 interactions. Are there other meds on board that act as inducers or inhibitors? Dose accordingly.

 

[notdeadyet]

Unless in acute crisis, start low and go slow. Many good reasons to do this and no bad ones.

 

[nitemagi]

Anxiety disorders, start low (sometimes even 5mg prozac), aim high (60-80).

 

[MacDonaldTriad]

When Prozac first came out, they didn’t have scored 10mg pills and 20 was the only starting dose. In the hospital, we would have the nurses dissolve the 20 mg pills into those plastic cranberry juice cups with the tin foil lids. The patients would drink half of it, and we put the other half in the fridge for the next day. In rounds we called it "Cranzac". We even wrote orders saying all of this. I miss the old days when there were hardly any rules to break. Could you imagine a pharmacy review seeing this now days?

 

[vistaril]

I am wondering what people think about starting at a particularly low dose for the first few days of treatment (Say 10mg of fluoxetine). I can't find good data to support this practice. What do most of you see and do? I think I've probably done both (which is to say, started at 10mg for a few days and then gone to 20mg vs just starting at 20mg).

I don't think it much matters....it's not brain surgery either way. Regarding prozac in particular, I generally start at 20mg daily.

 

[slappy]

Depends on what you are treating. For anxiety disorders you want to start at a lower dose as they can initially make the anxiety worse. For depression, you can start at a higher dose. This is especially true for activating SSRIs like Prozac.

This is how I've been taught and how I use it. It seems to be a pretty good rule of thumb.

 

[OldPsychDoc]

When Prozac first came out, they didn’t have scored 10mg pills and 20 was the only starting dose. In the hospital, we would have the nurses dissolve the 20 mg pills into those plastic cranberry juice cups with the tin foil lids. The patients would drink half of it, and we put the other half in the fridge for the next day. In rounds we called it "Cranzac". We even wrote orders saying all of this. I miss the old days when there were hardly any rules to break. Could you imagine a pharmacy review seeing this now days?

Can you imagine trying to put this in through Epic (or your EMR nemesis of choice)?

Also--need to pass this on: http://www.gomerblog.com/2014/07/electronic-health-record/