Remeron less sedating at higher doses Xxx broadcast chat

07-Apr-2020 17:12

Anxiety and insomnia are common problems in the institutionalized elderly.

If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls.

Psychotropic medications, including side effects and recommendations on use in the elderly, are briefly reviewed in the following sections.

OBRA requirements for the prescribing of antidepressant drugs are limited.

Furthermore, selective serotonin reuptake inhibitors (SSRIs), nortriptyline (Pamelor) and trazodone (Desyrel) are being prescribed significantly more often, and amitriptyline (Elavil) and doxepin (Sinequan) are being used less often.8The prescribing patterns for anxiolytic and sedative-hypnotic drugs are less consistent.

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Paroxetine (Paxil), which has no active metabolite, also has a considerably shorter half-life (24 hours) than fluoxetine.1213Most SSRIs are associated with significant drug interactions.

In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia.

Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful.

Fluoxetine, paroxetine and, to a lesser extent, sertraline inhibit the metabolism of warfarin (Coumadin), cisapride (Propulsid), benzodiazepines, quinidine, tricyclic antidepressants, theophylline and some statins.12 In patients at risk for these interactions, citalopram (Celexa), a new SSRI now available in the United States, may offer an advantage.

Studies have shown that compared with other SSRIs, citalopram has less of an inhibitory effect on the cytochrome P450 system.14 Citalopram is as effective as fluoxetine and sertraline in the treatment of depression.14Trazodone and nefazodone (Serzone) are also recommended for use in the elderly.

Paroxetine (Paxil), which has no active metabolite, also has a considerably shorter half-life (24 hours) than fluoxetine.1213Most SSRIs are associated with significant drug interactions.In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia.Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful.Fluoxetine, paroxetine and, to a lesser extent, sertraline inhibit the metabolism of warfarin (Coumadin), cisapride (Propulsid), benzodiazepines, quinidine, tricyclic antidepressants, theophylline and some statins.12 In patients at risk for these interactions, citalopram (Celexa), a new SSRI now available in the United States, may offer an advantage.Studies have shown that compared with other SSRIs, citalopram has less of an inhibitory effect on the cytochrome P450 system.14 Citalopram is as effective as fluoxetine and sertraline in the treatment of depression.14Trazodone and nefazodone (Serzone) are also recommended for use in the elderly.Survey procedures and interpretive guidelines for skilled nursing facilities and intermediate care facilities. According to the OBRA strategy, the long-term care facility, rather than the prescribing physician, is accountable for monitoring drug use.8 Some consider that this approach better reflects the realities of nursing home practice, in that the prescribing physician only visits the facility occasionally.8 Regardless of where final responsibility lies, physicians need to be aware of the HCFA interpretive guidelines for the fulfillment of OBRA requirements.