Version October 2024
| Generic drug name | Trade name (United States) | Usual starting dose (mg)* | Low starting dose (mg)* | Usual daily dose (mg) | Available oral doses (mg) | Mean half-life, hours (active metabolites)¶ |
| Selective serotonin reuptake inhibitors (SSRIs) | ||||||
| Citalopram | Celexa | 20 | 10 | 20 to 40Δ◊ | 10, 20, 40, L | 35; prolonged in hepatic impairment and older adults |
| Escitalopram | Lexapro | 10 | 5 to 10 | 10 to 20 | 5, 10, 20, L | 27 to 32; prolonged in hepatic impairment and older adults |
| Fluoxetine | Prozac | 20 | 5 to 10 | 20 to 60Δ | 10, 20, 40, 60, L | 120 (223); prolonged in severe hepatic impairment |
| Fluoxetine weekly | Prozac Weekly | 90 | NA | 90 | ||
| Fluvoxamine | Luvox | 50 | 25 | 50 to 300Δ | 25, 50, 100 100, 150 (controlled release) | 15; prolonged in older adults |
| Paroxetine | Paxil | 20 | 5 to 10 | 20 to 60Δ | 10, 20, 30, 40, L | 21 |
| Paroxetine CR | Paxil CR | 25 | 25 to 62.5 | 12.5, 25, 37.5 | 15 to 20 | |
| Sertraline | Zoloft | 50 | 12.5 to 25 | 50 to 200Δ | 25, 50, 100, L | 26 (66) |
| Serotonin-norepinephrine reuptake inhibitors (SNRIs) | ||||||
| Desvenlafaxine | Khedezla, Pristiq | 50 | 25 | 50 to 100 | 25, 50, 100 | 11; prolonged in severe renal and hepatic impairment |
| Duloxetine | Cymbalta, Irenka | 30 | 20 | 60 to 120 | 20, 30, 40, 60 | 12; prolonged in older female patients |
| Venlafaxine | Effexor | 37.5 | 25 | 75 to 375 | 25, 37.5, 50, 75, 100 | 5 (11); prolonged in severe renal and hepatic impairment |
| Venlafaxine XR | Effexor XR | 37.5 | 75 to 225 | 37.5, 75, 150, 225 | ||
CR: controlled release; L: liquid; NA: not applicable; XR: extended release.
* Lower starting doses are recommended for older adult patients and patients with panic disorder, significant anxiety, or hepatic disease.
¶ Mean half-lives of active metabolites are given in parentheses.
Δ Dose varies with diagnosis. Refer to text for specific guidelines.
◊ Maximum recommended dose of citalopram is 20 mg for patients >60 years of age, with significant hepatic insufficiency, or taking interacting medications that can increase citalopram levels. Refer to topic review of pharmacology of SSRI antidepressants for more information. Specific interactions of citalopram and other medications may be determined using the drug interactions program included within UpToDate.Do you want to add Medilib to your home screen?
