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Antidepressants in Renal insufficiency or Hepatic Disease

Antidepressant Therapy

Adjustments in Chronic Kidney Disease and Hepatic Dysfunction


Antidepressant Adjustments in Chronic Kidney Disease and Hepatic Dysfunction

Background


The purpose of this program is to provide dosing recommendations for a particular antidepressant for a patient with renal or hepatic insufficiency.  Most of these drugs are hepatically metabolized and may require dosage adjustments in some cases.  Dosage changes based on renal function, regardless of the severity, are relatively uncommon.

Using the program:
Select an antidepressant from the list and press 'Display Info' in order to generate a report for that particular drug.  Information generated includes:

  • Dosage in renal impairment
  • Hepatic Dosing
  • Half-life
  • Initial dosage and range
  • Link to prescribing information
  • Individual receptor actions (5-HT, NE, M1, etc.)
  • Dosing comments

Make a Selection

 
 
 



depression



Treatment failures or inadequate response top of page

Clinical result -  Action taken

  • Most patients are started on an SSRI --> if inadequate response consider maximizing the dose after confirming compliance with therapy.  If the patient had an adverse effect specific to that drug, consider changing to an alternative SSRI or move to one of the other classes such as a dual reuptake inhibitor.
  • If the patient has an inadequate response after maximizing the dose, consider the addition of a second agent or switching to a non-SSRI antidepressant.
  • If the patient responds to therapy, maintain current regimen and reevaluate the patient at each visit.
  • [Refractory patients] If the patient fails to respond to single or dual therapy at maximal doses while attempting changes within some of the classes, consider adding an atypical antipsychotic (2nd generation) drug such as aripiprasole, brexipiprazole, olanzepine or quetiapine for refractory patients.

Switching or discontinuing agents top of page

> https://globalrph.com/drugs/antidepressant-discontinuation-syndrome/

 


References top of page

 

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Antidepressants in Renal insufficiency or Hepatic Disease