Agent | Initial daily dose | Suggested dose titration based upon response | Maintenance daily dose range | Selected characteristics*¶ |
Selective serotonin reuptake inhibitors (SSRIs)* | ||||
Fluoxetine | Children: 5 to 10 mg Adolescents: 10 mg | After 7 days increase daily dose to 20 mg; then after 4 and 8 weeks increase daily dose by 20 mg, if needed | 10 to 80 mg |
|
Fluvoxamine | 25 to 50 mg at bedtime | Increase daily dose by 25 mg (child) or 25 to 50 mg (adolescent) after a minimum of 7 days, if needed | 50 to 300 mg |
|
Sertraline | 12.5 to 25 mg | Increase daily dose by 12.5 mg (child) or 25 to 50 mg (adolescent) after a minimum of 7 days, if needed | 50 to 200 mg |
|
Escitalopram | 10 mg | Increase daily dose by 5 to 10 mg after a minimum of 14 days, if needed | 10 to 20 mg |
|
Paroxetine | 5 to 10 mg | Increase daily dose by 5 mg (child) or 10 mg (adolescent) after a minimum of 7 days, if needed | 10 to 60 mg |
|
Serotonin norepinephrine reuptake inhibitor (SNRI)* | ||||
Venlafaxine extended-release (ER) | 37.5 mg | Increase daily dose by 37.5 mg (child) or 75 mg (adolescent) after a minimum of 7 days, if needed | 75 to 225 mg |
|
Duloxetine | 30 mg | Increase daily dose by 30 mg after a minimum of 14 days, if needed | 30 to 60 mg Some patients may benefit from a higher daily dose, increased by 30 mg increments every 2 to 4 weeks, to maximum of 120 mg per day |
|
Tricyclic antidepressants (TCA) | ||||
Clomipramine | Children ≥10 years old and adolescents: 25 mg | Increase daily dose by 25 mg after a minimum of 7 days, if needed; give in divided doses with meals and bedtime | 25 to 250 mg (2 to 6Δ mg/kg per day); doses >2.5 mg/kg per day should be used cautiouslyΔ | Applies to clomipramine and imipramine:
|
Imipramine | 10 to 25 mg | Increase daily dose by 25 mg after a minimum of 7 days, if needed; give in divided doses with meals and bedtime | 10 to 300 mg (2 to 6Δ mg/kg per day); doses >2.5 mg/kg per day should be used cautiouslyΔ | |
Benzodiazepines | ||||
Clonazepam | 0.25 to 0.5 mg | 1 to 6 mg | Applies to clonazepam and lorazepam:
| |
Lorazepam | 0.25 to 0.5 mg | 0.25 to 8 mg |
CYP: cytochrome P450 drug metabolizing enzymes; ECG: electrocardiogram; GAD: generalized anxiety disorder.
* Common generally mild adverse effects of SSRIs and SNRIs seen in children treated for anxiety disorders may include headache, anorexia, vomiting, sleep disturbance and somnolence.
¶ This table notes when agents are moderate or strong inhibitors of CYP isoenzymes; significant interactions can occasionally occur due to weak inhibition of CYP isoenzymes (eg, target drug is highly dependent on CYP metabolism and has a narrow therapeutic index). This table also notes major CYP isoenzymes involved in metabolism of these agents, but other CYP isoenzymes may also contribute. Accordingly, specific interactions should be checked using a drug interactions program such as the drug interactions program included with UpToDate.
Δ Dose-related ECG changes have been reported in children and close monitoring is necessary with larger doses. According to the product information approved in the United States, doses >2.5 mg/kg per day are not recommended in children.Do you want to add Medilib to your home screen?