V. Atypical Antidepressants

Brand Name:
Generic Name:
Classification: ATYPICAL ANTIDEPRESSANTS
Recommended Dosage, Route, and Frequency:
Antidepressant
Adult: PO Start at 50 mg b.i.d. or t.i.d., may increase on third day to 100 mg t.i.d. Maintenance doses
300 mg/d as single dose at bedtime
Geriatric: PO 25 mg h.s., may increase q3–7d to 50–150 mg/d in divided doses (max: 300 mg/d)
Drug Action: ADME, Onset, Peak, Duration
Potentiates the effects of serotonin and norepinephrine in the CNS. Has significant anticholinergic
properties. Also has antianxiety effect related to sedative properties. Therapeutic Effects:
Antidepressant and antianxiety action.
Absorption:Well absorbed following oral administration.
Distribution:Widely distributed; enters breast milk
Metabolism and Excretion: Extensively metabolized by the liver.
Drug-Drug and Drug-Food Interactions:
Drug: May decrease response to ANTIHYPERTENSIVES; CNS

DEPRESSANTS, alcohol, HYPNOTICS, BARBITURATES, SEDATIVES potentiate CNS depression; may
increase hypoprothrombinemic effect of ORAL ANTICOAGULANTS; ethchlorvynol, transient delirium;
with levodopa, SYMPATHOMIMETICS (e.g., epinephrine, norepinephrine), possibility of sympathetic
hyperactivity with hypertension and hyperpyrexia; with MAO INHIBITORS, possibility of severe reactions:
toxic psychosis, cardiovascular instability; methylphenidate increases plasma TCA levels; thyroid drugs
may increase possibility of arrhythmias; cimetidine may increase plasma TCA levels.
Herbal: Ginkgo may decrease seizure threshold, St. John's wort may cause serotonin syndrome.
Indications:
Treatment of various types of depression. Unlabeled Use: Anxiety, insomnia, neuropathic and chronic
pain syndromes.
Contraindications:
Hypersensitivity to other tricyclic compounds; acute recovery period after MI. Safety during
pregnancy (category C), lactation, or children <16 y of age is not established.
Side Effects: By system
CNS: fatigue EENT: blurred vision, dry eyes, dry mouth GI: constipation, increased appetite, weight gain
Derm: rash
Adverse Reaction: By system
CNS: NEUROLEPTIC MALIGNANT SYNDROME, fatigue, sedation, extrapyramidal reactions, tardive

dyskinesia. EENT: blurred vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI:
constipation, increased appetite, weight gain, paralytic ileus. GU: testicular swelling, urinary retention.
Derm: photosensitivity, rash. Endo: gynecomastia, sexual dysfunction. Hemat: blood dyscrasias. Misc:
fever.
Nursing Responsibilities: (ADPIE Format)

Assessment
● Monitor mental status (orientation, mood, behavior) frequently ● Observe for onset of extrapyramidal
side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions;
pseudoparkinsonism—mask facies, rigidity, tremors, drooling, shuffling gait, dysphagia, pill-rolling
motions of hands). ● Monitor for development of neuroleptic malignant syndrome (fever, respiratory
distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe
muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms
occur
Potential Nursing Diagnoses
Ineffective coping (Indications)
Chronic pain (Indications) Risk for injury (Side Effects)
Implementation
● Dose increases should be made at bedtime because of sedation. Dosage titration is a slow process;
may take weeks to months. May give entire dose (if 300 mg) at bedtime, when dose is stabilized. ●
Taper amoxapine to avoid withdrawal effects. ● PO: Administer medication with or immediately after a
meal to minimize gastric irritation.
Patient/Family Teaching
● Inform patient of the possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient
to report these symptoms immediately. ● Orthostatic hypotension, sedation, and confusion are
common during early therapy, especially in geriatric patients. Protect patient from falls and advise
patient to make position changes slowly.
Evaluation/Desired Outcomes
● Increased sense of well-being. ● Renewed interest in surroundings. ● Increased appetite. ● Improved
energy level. ● Improved sleep. ● Decreased anxiety. Initial response may be noted in 4– 7 days in some
patients. Most patients respond within 2 wk.

V. Atypical Antidepressants

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V. Atypical Antidepressants

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Brand Name:

Classification: ATYPICAL ANTIDEPRESSANTS

Recommended Dosage, Route, and Frequency:

Absorption:Well absorbed following oral administration.

Distribution:Widely distributed; enters breast milk

Metabolism and Excretion: Extensively metabolized by the liver.

Drug-Drug and Drug-Food Interactions:

Drug: May decrease response to ANTIHYPERTENSIVES; CNS

Side Effects: By system

Adverse Reaction: By system

CNS: NEUROLEPTIC MALIGNANT SYNDROME, fatigue, sedation, extrapyramidal reactions, tardive

Nursing Responsibilities: (ADPIE Format)

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