ANTIDEPRESSANT DRUGS MEDICATION

MEDICATION Generic Name: Fluvoxamine maleate

Generic Name: Fluoxetine Brand Name: Luvox
Brand Name: Prozac DRUG CLASSIFICATION
DRUG CLASSIFICATION Therapeutic Class: Antidepressant
Therapeutic Class: Antidepressant Pharmacologic Class: SSRI
Pharmacologic Class: SSRI INDICATION
INDICATION  Obsessive compulsive disorder (OCD)
 Depression, obsessive-compulsive disorder (OCD) MECHANISM OF ACTION
 Depression in elderly patients Unknown. Selectively inhibits the presynaptic neuronal uptake of serotonin, which may
 Maintenance therapy for depression in stabilized patients improve OCD
 Depression caused by bipolar disorder SIDE EFFECTS/ADVERSE REACTIONS
MECHANISM OF ACTION CNS: headache, asthenia, somnolence, insomnia, nervousness, dizziness, tremor,
Unknown. Thought to be linked to drug’s inhibition of CNDS neuronal uptake of serotonin anxiety, hypertonia, agitation, depression, CNS stimulation
SIDE EFFECTS/ADVERSE REACTIONS CV: palpitations, vasodilation
CNS: nervousness, somnolence, anxiety, insomnia, headache, drowsiness, fatigue,tremor, EENT: amblyopia
dizziness, asthenia, fever, suicidal behavior GI: nausea, diarrhea, constipation, dyspepsia, anorexia, vomiting, flatulence,
CV: palpitations, hot flashes dysphagia, dry mouth, taste perversion
EENT: nasal congestion, pharyngitis, sinusitis GU: abnormal ejaculation, urinary frequency, impotence, anorgasmia, urine
GI: nausea, diarrhea, dry mouth anorexia, dyspepsia, constipation, abdominal pain, vomiting, retention
flatulence, increased appetite Respi: upper respiratory tract infection, dyspnea, yawning
GU: sexual dysfunction Skin: sweating
Meta: weight loss Other: tooth disorder, flulike syndrome, chills, decreased libido
Musculo: muscle pain NURSING RESPONSIBILITIES
Respi: upper respiratory tract infection, cough, respiratory distress  Record mood changes. Monitor patient for suicidal tendencies
Skin: rash, pruritus, diaphoresis  Drug isn’t approved for depression in the U.S. Don’t use for the treatment of
Other: flulike syndrome major depressive disorders in children younger than age 18
NURSING RESPONSIBILITIES  Patient’s shouldn’t stop drug without first consulting prescriber; abruptly
 Use antihistamines or topical corticosteroids to treat rashes or pruritus stopping drug may cause withdrawal syndrome, including headache, muscle
 Record mood changes. Watch for suicidal tendencies ache, and flulike symptoms
 Tell patient to avoid taking drug in the afternoon whenever possible  Warn patient to avoid hazardous activities until CNS effects of drug are
because fluoxetine commonly causes nervousness and insomnia known
 Drug may cause dizziness or drowsiness. Warn patient to avoid  Tell patient to notify prescriber about planned, suspected, or known
driving and other hazardous activities that require alertness and good pregnancy
psychomotor coordination until effects of drug are known  Tell patient who develops rash, hives, or a related allergic reaction to notify
CONTRAINDICATIONS AND CAUSES prescriber
 Contraindicated in patients hypersensitive to drug and in those taking MAO  Tell patient drug can be taken with or without food
inhibitors within 14 days of starting therapy  Inform patient that several weeks of therapy may be needed to obtain full
 Use cautiously in patients at high risk for suicide and in those with history of therapeutic effect
diabetes mellitus; seizures; mania; or hepatic, renal, or CV disease CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or to other phenyl
piperazine antidepressants, in those receiving pimozide or thioridazine
therapy, and within 2 weeks of MAO inhibitor
 Use cautiously in patients with hepatic dysfunction, other conditions that
may affect hemodynamic responses or metabolism, or history of mania or
 seizures
 Generic Name: Sertralin
MEDICATION Brand Name: Zoloft
Generic Name: Paroxetine DRUG CLASSIFICATION
Brand Name: Paxil Therapeutic Class: Antidepressant
DRUG CLASSIFICATION Pharmacologic Class: SSRI
Therapeutic Class: Antidepressant INDICATION
Pharmacologic Class: SSRI  Depression
INDICATION  Obsessive-compulsive disorder
 Depression  Panic disorder
 Obsessive-compulsive disorder (OCD)  Posttraumatic stress disorder
 Panic disorder  Social anxiety disorder
 Social anxiety disorder MECHANISM OF ACTION
 Generalized anxiety disorder Unknown. Thought to be linked to drug’s inhibition of CNS neuronal uptake of
 Posttraumatic stress disorder serotonin
MECHANISM OF ACTION SIDE EFFECTS/ADVERSE REACTIONS
Unknown. Thought to be linked to drug’s inhibition of CNS neuronal uptake of serotonin CNS: headache, suicidal behavior, tremor, dizziness, insomnia, somnolence,
SIDE EFFECTS/ADVERSE REACTIONS paresthesia, hypesthesia, fatigue, nervousness, anxiety agitation, hypertonia,
CNS: somnolence, dizziness, insomnia, tremor, nervousness, anxiety, paresthesia, confusion, twitching, confusion
headache, agitation, asthenia, suicidal behavior CV: palpitations, chest pain, hot flashes
CV: palpitations, vasodilation, orthostatic hypotension GI: dry mouth, nausea, diarrhea, loose stools, dyspepsia, vomiting, constipation,
EENT: lump or tightness in throat thirst, flatulence, anorexia, abdominal pain, increased appetite
GI: dry mouth, nausea, constipation, diarrhea, flatulence, vomiting, dyspepsia, dysgeusia, GU: male sexual dysfunction
increased or decreased appetite, abdominal pain Musculo: myalgia
GU: ejaculatory disturbances, sexual dysfunction, urinary frequency, other urinary disorders Skin: rash, pruritus, diaphoresis
Musculo: myopathy, myalgia, myasthenia NURSING RESPONSIBILITIES
Skin: rash, pruritus, diaphoresis  Give sertraline once daily, either in morning or evening, with or without food
Other: yawning, decreased libido  Make dosage adjustments at intervals of no less than 1 week
NURSING RESPONSIBILITIES  Record mood changes. Monitor patient for suicidal tendencies and allow only a
 Patients taking drug may be at increased risk for developing suicidal minimum supply of drug
behavior, but this hasn’t been definitively attributed to use of the drug  Don’t use the oral concentrate dropper, which is made of rubber, in a patient with
 if signs and symptoms of psychosis occur or increase, expect prescriber to latex allergy
reduce dosage. Record mood changes. Monitor patient for suicidal  Advise patient to use caution when performing hazardous tasks that require
tendencies, and allow only a minimum supply of drug alertness
 Tell patient that drug may be taken with or without food, usually in morning  Instruct patient to avoid stopping the medication abruptly
 Tell patient not to break, crush, or chew controlled-release tablets CONTRAINDICATIONS AND CAUSES
 Warn patient to avoid activities that require alertness and good coordination  Contraindicated in patient with a hypersensitivity to drug or its components
until effects of drug are known  Contraindicated in patients taking pimozide or MAO inhibitors or within 14 days
 Instruct patient not to stop taking medication abruptly of MAO inhibitor therapy
CONTRAINDICATIONS AND CAUSES  Use cautiously in patients at risk for suicide and in those with seizure disorders,
 Contraindicated in patients hypersensitive to drug, within 14 days of MAO major affective disorder, or diseases or conditions that affect metabolism or
inhibitor therapy, and in those thioridazine hemodynamic responses
 Contraindicated in children and adolescents under age 18 with major depressive  Use in third trimester of pregnancy may cause neonatal complications at
disorder birth. Consider the risk versus benefit of treatment during this time
 Use cautiously in patients with history of seizure disorders or mania and in those
with other severe, systemic illness
 If signs or symptoms of psychosis occur or increase, expect prescriber to reduce
dosage. Record mood changes. Monitor patient for suicidal tendencies, and allow
only a minimum supply of drug
 Monitor patient for complaints of sexual dysfunction. In men, they include
anorgasmy, erectile difficulties, delayed ejaculation or orgasm, or impotence; in
women, they include anorgasmy or difficulty with orgasm
 Tell patient that drug may be taken with or without food, usually in morning
MEDICATION
 Generic Name: Citaprolam
Brand Name: Celexa
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: SSRI
INDICATION
 Depression
MECHANISM OF ACTION
A selective serotonin reuptake inhibitor whose action is presumed to be linked to
potentiation of serotogenic activity in the CNS resulting from inhibition of
neuronal reuptake of serotonin
SIDE EFFECTS/ADVERSE REACTIONS
CNS: tremor, somnolence, insomnia, anxiety, agitation, dizziness, paresthesia,
migraine, impaired concentration, amnesia, depression, apathy, suicide attempt,
confusion, fatigue, fever
CV: tachycardia, orthostatic hypotension, hypotension
EENT: rhinitis, sinusitis, abnormal accommodation
GI: dry mouth, nausea, diarrhea, anorexia, dyspepsia, vomiting, abdominal pain,
taste perversion, increased saliva, flatulence, increased appetite
GU: dysmenorrhea, amenorrhea, ejaculation disorder, impotence, anorgasmia,
polyuria
Meta: decreased or increased weight
Musculo: arthralgia, myalgia
Respi: upper respiratory tract infection, coughing
Skin: rash, pruritus, increased sweating
Other: yawning, decreased libido
NURSING RESPONSIBILITIES
 Although drug hasn’t been shown to impair psychomotor performance, any
psychoactive drug has the potential to impair judgment, thinking, or motor
skills
 The possibility of a suicide attempt is inherent in depression and may persist
until significant remission occurs. Closely supervise high-risk patients at
start of drug therapy. Reduce risk of overdose by limiting amount of drug
available per refill
 At least 14 days should elapse between MAO inhibitor therapy and
citalopram
 Tell patient that drug may be taken in the morning or evening without regard
to meals. If drowsiness occurs, he should take drug in evening
 Advise patient not to stop medication abruptly
 Instruct patient to exercise caution when driving or operating hazardous
machinery; drug may impair judgment, thinking, and motor skills
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or its inactive
components, within 14 days of MAO inhibitor therapy, and in patients
taking pimozide
 Use cautiously in patients with history of mania, seizures, suicidal
thoughts, or hepatic or renal impairment
 Safety and effectiveness of drug haven’t been established in children
Generic Name: Escitalopram
Brand Name: Lexapro
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: SSRI
INDICATION
 Treatment and maintenance therapy for patients with major
depressive disorder
MECHANISM OF ACTION
Antidepressant action thought to be linked to potentiation of serotogenic activity in the CNS
resulting from inhibition of neuronal reuptake of serotonin. Drug is the S-enantiomer of the
racemic compound citalopram and is thought to be the active component
SIDE EFFECTS/ADVERSE REACTIONS
CNS: fever, insomnia, dizziness, somnolence, paresthesia, light-headedness, migraine, tremor,
vertigo, abnormal dreams, irritability, impaired concentration, fatigue, lethargy, suicidal
behavior
CV: palpitations, hypertension, flushing, chest pain
EENT: rhinitis, sinusitis, blurred vision, tinnitus, earache
GI: nausea, diarrhea, constipation, indigestion, abdominal pain, vomiting, increased or
decreased appetite, dry mouth, flatulence, heartburn, cramps, gastroesophageal reflux
GU: ejaculation disorder, impotence, anorgasmia, menstrual cramps, UTI, urinary frequency
Meta: weight gain or loss
Musculo: arthralgia, myalgia, muscle cramps, pain in arms or legs
Respi: bronchitis, cough
Skin: rash, increased sweating
Other: decreased libido, yawning, flulike symptoms
NURSING RESPONSIBILITIES
 Evaluate patient for history of drug abuse and observe for sign of misuse or abuse
 Periodically reassess patient to determine need for maintenance treatment
and appropriate dosing
 Inform patient that symptoms should improve gradually over several weeks,
rather than immediately
 Tell patient that although improvement may occur within 1-4 weeks, he
should continue drug as prescribed
 Advise patient to consult health care provider before taking other
prescription or OTC drugs
 Tell patient that drug may be taken in the morning or evening without regard
to meals
 Encourage patient to avoid alcohol while taking drug
 Tell patient to notify health care provider if she’s pregnant or breast-feeding
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients taking MAO inhibitors or within 14 days of
MAO inhibitor therapy and in those hypersensitive to escitalopram,
citalopram, or any of its inactive ingredients
 Use cautiously in patients with a history of mania, seizure disorders, suicidal
thoughts, or renal or hepatic impairment
 Use cautiously in patients with diseases that produce altered metabolism or
hemodynamic responses
 Use with caution in elderly patients because they may have a greater
sensitivity to drug
 Drug appears in breastmilk. Patient should either stop breastfeeding or stop
taking drug
CYCLIC COMPOUNDS
MEDICATION
Generic Name: Imipramine
Brand Name: Tofranil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Trcicylic antidepressant
INDICATION
 Depression
 Childhood enuresis
MECHANISM OF ACTION
Unknown, a tricyclic antidepressant that increases norepinephrine, serotonin, or both in the
CNS by blocking their reuptake by the presynaptic neurons
SIDE EFFECTS/ADVERSE REACTIONS
CNS: CVA, drowsiness, dizziness, excitation, tremor, confusion, hallucinations,
anxiety, ataxia, paresthesia, nervousness, EEG changes, seizures, extrapyramidal
reactions
CV: orthostatic hypotension, tachycardia, ECG changes, hypertension, MI,
arrhythmias, heart block, precipitation of heart failure
EENT: blurred vision, tinnitus, mydriasis
GI: dry mouth, constipation, nausea, vomiting, anorexia, paralytic ileus, abdominal
cramps
GU: urine retention
Meta: hypoglycemia, hyperglycemia
Skin: rash, urticaria, photosensitivity reactions, pruritus, diaphoresis
Other: hypersensitivity reactions
NURSING RESPONSIBILITIES
 Monitor patient for nausea, headache, and malaise after abrupt withdrawal of
long-term therapy; these symptoms don’t indicate addiction
 Don’t withdraw drug abruptly
 Because of hypertensive episodes during surgery in patients receiving
tricyclic antidepressants, stop drug gradually several days before surgery
 If signs and symptoms f psychosis occur or increase, expect prescriber to
reduce dosage. Record mood changes. Monitor patient for suicidal
tendencies, and allow only a minimum supply of drug
 To prevent relapse in children receiving drug for enuresis, withdraw drug
gradually
 Tell patient to take full dose at bedtime whenever possible, but earn him of
possible morning dizziness upon standing up quickly
 Tell patient to avoid alcohol while taking this drug
 Warn patient to avoid hazardous activities that require alertness and good
coordination until effects of the drug are known. Drowsiness and dizziness usually
subside after a few weeks
 Warn patient not to stop drug suddenly
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and in those receiving MAO
inhibitors; also contraindicated during acute recovery phase of MI
 Use with extreme caution in patients at risk for suicide; in patients with history of
urine retention, angle-closure glaucoma, or seizure disorders; in patients with
increased intraocular pressure, CV disease, impaired hepatic function,
hyperthyroidism, or impaired renal function; and in patients receiving thyroid
drugs. Injectable form contains sulfites, which may cause allergic reactions in
hypersensitive patients
MEDICATION
Generic Name: Desipramine
Brand Name: Norpramin
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
INDICATION
 Depression
MECHANISM OF ACTION
Unknown. A tricyclic antidepressant that increases amount of norepinephrine,
serotonin or both in the CNS by blocking their uptake by the presynaptic neurons
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, dizziness, excitation, tremor, weakness, confusion, anxiety,
restlessness, agitation, headache, nervousness, EEG changes, seizures,
extrapyramidal reactions
CV: orthostatic hypotension, tachycardia, ECG changes, hypertension
EENT: blurred vision, tinnitus, mydriasis
GI: dry mouth, constipation, nausea, vomiting, anorexia, paralytic ileus
GU: urine retention
Meta: hypoglycemia, hyperglycemia
Skin: rash, urticaria, photosensitivity reactions, diaphoresis
Other: hypersensitivity reactions, sudden death in children
NURSING RESPONSIBILITIES
 Monitor patient for nausea, headache, and malaise after abrupt withdrawal of
long-term therapy; these symptoms don’t indicate addiction
 Don’t withdraw drug abruptly
 If signs and symptoms of psychosis occur or increase, expect prescriber to
reduce dosage. Record mood changes. Monitor patient for suicidal
tendencies, and allow only a minimum supply of drug
 Advise patient to take full dose at bedtime, whenever possible
 Warn patient to avoid hazardous activities that require alertness and good
coordination until effects of drug are known. Drowsiness and dizziness
usually subside after a few weeks
 Tell patient to call prescriber if ever sore throat occurs. Blood counts may
need to be avoided
 Tell patient to avoid alcohol during drug therapy because it may antagonize
effects of desipramine
 Warn patient to not stop drug abruptly
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug, in those who have taken
MAO inhibitors within 14 days
 Contraindicated in patients during acute recovery phase after MI
 Use with extreme caution in patients with CV disease; on those with history
of urine retention, glaucoma, seizure disorders, or thyroid disease; and in
those taking thyroid drug
 Avoid use in children
 Generic Name: Amitriptyline
Brand Name: Elavil Generic Name: Nortriptyline
DRUG CLASSIFICATION Brand Name: Pamelor
Therapeutic Class: Antidepressant DRUG CLASSIFICATION
Pharmacologic Class: Tricyclic antidepressant Therapeutic Class: Antidepressant
INDICATION Pharmacologic Class: Tricyclic antidepressant
 Depression (outpatients) INDICATION
 Depression (hospitalized patients)  Depression
 Postherpetic neuralgia  Postherpetic neuralgia
 Prevention of chronic headache MECHANISM OF ACTION
 Prevention of chronic headache Unknown. Increases the amount of norepinephrine, serotonin, or both in the CNS by blocking
 Prevention of migraine reuptake by the presynaptic neurons
 Fibromyalgia SIDE EFFECTS/ADVERSE REACTIONS
MECHANISM OF ACTION CNS: drowsiness, dizziness, seizures, stroke, tremor, weakness, confusion, headache,
Unknown. A tricyclic antidepressant that increases the amount of norepinephrine, nervousness, EEG changes, extrapyramidal syndrome, insomnia, nightmares, hallucinations,
serotonin, or both in the CNS by blocking their reuptake by the presynaptic paresthesia, ataxia, agitation
neurons CV: tachycardia, heart block, MI, ECG changes, hypotension,
SIDE EFFECTS/ADVERSE REACTIONS EENT: blurred vision, tinnitus, mydriasis,
CNS: stroke, seizures, coma, ataxia, tremor, peripheral neuropathy, anxiety, GI: constipation, dry mouth, nausea, vomiting, anorexia, paralytic ileus
insomnia, restlessness, drowsiness, dizziness, GU: urine retention
CV: orthostatic hypotension, tachycardiaEENT: blurred vision, tinnitus, Hema: agranulocytosis, thrombocytopenia, bone marrow depression, eosinophilia
mydriasis, increased intraocular pressure Meta: hypoglycemia, hyperglycemia,
GI: dry mouth, nausea, vomiting, anorexia, epigastric pain, diarrhea, constipation, Skin: rash, urticaria, photosensitivity reactions, diaphoresis
paralytic ileus Other: hypersensitivity reactions
GU: urine retention, altered libido, impotence NURSING RESPONSIBILITIES
Hema: agranulocytosis, thrombocytopenia, leukopenia, eosinophilia  Monitor patient for nausea, headache, and malaise after abrupt withdrawal of
Meta: hypoglycemia, hyperglycemia long-term therapy; these symptoms don’t indicate addiction
Skin: rash, urticaria, photosensitivity reactions, diaphoresis  If signs and symptoms of psychosis occur or increase, expect to reduce
Other: hypersensitivity reactions dosage. Record mood changes. Monitor patient for suicidal tendencies and
NURSING RESPONSIBILITIES allow him only a minimum supply of drug
 Drug may increase the risk of suicidal thoughts and behavior in children,  Drug may increase the risk of suicidal thinking and behavior in children,
adolescents, and young adults with major depressive disorder. Don’t use in adolescents, and young adults with major depressive disorder or other
children younger than age 12 psychiatric disorder
 If signs and symptoms of psychosis occur or increase, expect prescriber to  advise
reduce dosage. Record mood changes. Monitor patient for suicidal CONTRAINDICATIONS AND CAUSES
tendencies and allow only minimum supply of drug  Contraindicated in patients hypersensitive to drug and during acute recovery
 Watch for nausea, headache, and malaise after abrupt withdrawal of long- phase of MI; also contraindicated within 14 days of MAO inhibitor
term therapy; these symptoms don’t indicate addiction  Use with extreme caution in patients with glaucoma, suicidal tendency,
 Advise families and caregivers to closely observe patient for increased history of urine retention or seizures, CV disease, or hyperthyroidism and in
suicidal thinking and behavior those receiving thyroid drugs
 Warn patient to avoid activities that require alertness and good psychomotor
coordination until CNS effects of drug re known. Drowsiness and dizziness
usually subside after a few weeks
 Inform patient that dry mouth may be relieved with sugarless hard candy or
gum. Saliva substitutes may be useful
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and in those who have
received a MAO inhibitor within the past 14 days
 Contraindicated during acute recovery phase of MI
 Use cautiously in patients with history of seizures, urine retention, angle-
closure glaucoma, or increased intraocular pressure; diabetes, or impaired
liver function; and in those receiving thyroid drugs
 Use cautiously in elderly patients and in patients with suicidal ideation
 Generic Name: Doxepin
Brand Name: Silenor
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressant
INDICATION
 Depression; anxiety
MECHANISM OF ACTION
Unknown. Increases amount of norepinephrine, serotonin, or both in the CNS by blocking their
reuptake by the presynaptic neurons
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, dizziness, seizures, confusion, numbness, hallucinations, paresthesia, ataxia,
weakness, headache, extrapyramidal reactions
CV: orthostatic hypotension, tachycardia, ECG changes
EENT: blurred vision, tinnitus
GI: dry mouth, constipation, nausea, vomiting, anorexia
GU: urine retention
Meta: hypoglycemia, hyperglycemia
Skin: diaphoresis, rash, urticaria, photosensitivity reactions
Other: hypersensitivity reactions
NURSING RESPONSIBILITIES
 Don’t withdraw drug abruptly
 Monitor patient for nausea, headache, and malaise after abrupt withdrawal of long-
term therapy; these symptoms don’t indicate addiction
 If signs and symptoms of psychosis occur or increase, expect
prescriber to reduce dosage. Record mood changes. Monitor patient
for suicidal tendencies and allow a minimum supply of drug
 Drug may increase risk of suicidal thoughts and behavior in children,
adolescents, and young adults ages 18-2, especially during the first
few months of treatment, especially in those with major depressive
disorder
 Recommend use of sugarless hard candy or gum to relieve dry mouth
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug and in those with
glaucoma or tendency toward urine retention; also contraindicated in
those who have received a MAO inhibitor within past 14 days and
during acute recovery phase of an MI
 Doxepin isn’t approved for use in children younger than age 12
Generic Name: Trimipramine
Brand Name: Surmontil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Tricyclic antidepressants
INDICATION
 Treatment of depression, often in conjunction with psychotherapy
MECHANISM OF ACTION
Potentiates the effect of serotonin and norepinephrine in the CNS. Has significant anticholinergic properties,
including sedation. Therapeutic Effects: Antidepressant action
SIDE EFFECTS/ADVERSE REACTIONS
CNS: lethargy, sedation.
EENT: blurred vision, dry eyes, dry mouth.
CV: arrhythmias, hypotension, ECG changes.
GI: constipation, hepatitis, paralytic ileus, increased appetite, weight gain.
GU: urinary retention, ↓ libido.
Meta: changes in blood glucose, gynecomastia.
Hema: blood dyscrasias.
Skin: photosensitivity
NURSING RESPONSIBILITIES
 Monitor BP and pulse before and during initial therapy. Notify health care professional of decreases in BP (10–20
mmHg) or sudden increase in pulse rate. Patients taking high doses or with a history of cardiovascular disease should
have ECG monitored before and periodically during therapy.
 Geriatric patients started on trimipramine may be at an increased risk for falls; start with low dose and monitor
closely.
 Monitor mental status and affect. Assess for suicidal tendencies, especially during early therapy. Restrict amount
of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yrs. After starting
therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4
wks, every 3 wks for next 4 wks, and on advice of health care professional thereafter. Assess for bipolar disorder;
onset may mimic depression and trimipramine is not approved for treatment of bipolar disorder.
 Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability
[tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI
symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs,
triptans).
CONTRAINDICATIONS AND CAUSES
 Tricyclic antidepressants; Recovery phase following MI; Concurrent use of MAO inhibitors or MAO-like drugs
(linezolid or methylene blue); Angle-closure glaucoma.
 Instruct patient to take medication as directed. Take missed doses as soon as possible unless almost time for next
dose. Advise patient that drug effects may not be noticed for at least 2 wk. Do not discontinue without consulting
health care professional. Abrupt discontinuation may cause nausea, vomiting, diarrhea, headache, trouble sleeping
with vivid dreams, and irritability. Instruct patient to read medication guide, Antidepressant Medicines,
Depression and other Serious Mental Illness, and Suicidal Thoughts or Actions prior to starting therapy and with
each Rx refill.
 May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness
until response to drug is known.
 Orthostatic hypotension, and sedation are common during early therapy, especially in geriatric patients. Protect
patient from falls and advise patient to make position changes slowly.
 Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy has been
discontinued.
 Advise patient, family, and caregivers to look for suicidality, especially during early therapy or dose changes.
Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new
or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability,
aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of
serotonin syndrome occur.
 Instruct patient to notify health care professional if urinary retention occurs or if dry mouth or
constipation persists. Sugarless candy or gum may diminish dry mouth, and an increase in fluid
intake or bulk may prevent constipation.
 Therapy for depression is usually prolonged and should be continued for at
least 3 mo to prevent relapse. Emphasize the importance of follow-up exams
to monitor effectiveness and side effects
 MEDICATION Generic Name: Amoxapine
Generic Name: Mirtazapine Brand Name: Asendin
DRUG CLASSIFICATION
Brand Name: Remeron
Therapeutic Class: Antidepressant
DRUG CLASSIFICATION Pharmacologic Class:
Therapeutic Class: Antidepressant INDICATION
Pharmacologic Class: Tetracyclic antidepressant  Treatment of various types of depression.
INDICATION  Unlabeled Uses: Anxiety, insomnia, neuropathic and chronic pain syndromes
 Depression MECHANISM OF ACTION
Potentiates the effects of serotonin and norepinephrine in the CNS. Has significant
MECHANISM OF ACTION
anticholinergic properties. Also has antianxiety effect related to sedative properties. Therapeutic
Thought to enhance central noradrenergic and serotonergic activity Effects: Antidepressant and antianxiety action
SIDE EFFECTS/ADVERSE REACTIONS SIDE EFFECTS/ADVERSE REACTIONS
CNS: somnolence, suicidal behavior, dizziness, asthenia, abnormal dreams, CNS: neuroleptic malignant syndrome, fatigue, sedation, extrapyramidal reactions, tardive
abnormal thinking, tremors, confusion dyskinesia.
CV: edema, peripheral edema CV: arrhythmias, hypotension, ECG changes.
EENT: blurred vision, dry eyes, dry mouth.
GI: increased appetite, dry mouth, constipation, nausea
GI: constipation, increased appetite, weight gain, paralytic ileus.
GU: urinary frequency GU: testicular swelling, urinary retention
Meta: weight gain Hema: blood dyscrasias
Musculo: back pain, myalgia Skin: photosensitivity, rash. Endo: gynecomastia, sexual dysfunction
Respi: dyspnea Other: fever
Other: flulike syndrome NURSING RESPONSIBILITIES
 Monitor mental status (orientation, mood, behavior) frequently. Assess for suicidal
NURSING RESPONSIBILITIES
tendencies, especially during early therapy. Restrict amount of drug available to patient.
 Record mood changes. Watch for suicidal tendencies  Monitor BP and pulse before and during initial therapy. Notify physician or other health
 Drug may increase risk of suicidal thinking and behavior in children, care professional of decreases in BP (10–20 mmHg) or sudden increase in pulse rate.
adolescents, and young adults ages 18 to 24 with major depressive or other Patients taking high doses or with a history of cardiovascular disease should have ECG
psychiatric disorder monitored before and periodically during therapy.
 Advise families and caregivers to closely observe patient for increasing  Observe for onset of extrapyramidal side effects (akathisia—restlessness; dystonia—
muscle spasms and twisting motions; pseudoparkinsonism—mask facies, rigidity,
suicidal thinking and behavior
tremors, drooling, shuffling gait, dysphagia, pill-rolling motions of hands). Dose
 Instruct patient to take drug at bedtime. Caution patient not to perform reduction or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine
hazardous activities if he gets too sleepy may be used to control these symptoms.
 Instruct patient not to use alcohol or other CNS depressants while taking  Monitor for tardive dyskinesia (lip smacking or puckering, puffing of cheeks, rhythmic
drug chewing or worm-like movement of tongue and mouth, uncontrolled movements of
extremities). Notify health care professional immediately if these symptoms occur; they
 Stress importance of following prescriber’s orders
may be irreversible.
CONTRAINDICATIONS AND CAUSES  Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress,
 Contraindicated in patients hypersensitive to drug and within 14 days of MAO tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness,
inhibitor therapy severe muscle stiffness, loss of bladder control). Notify health care professional
 Mirtazapine isn’t approved for use in children immediately if these symptoms occur
 Use cautiously in patients with CV or cerebrovascular disease, seizure disorders,  Instruct patient to take medication as directed. Abrupt discontinuation may cause nausea,
headache, and malaise.
suicidal thoughts, hepatic or renal impairment, or history of mania or hypomania
 Inform patient of the possibility of extrapyramidal symptoms and tardive dyskinesia.
 Use cautiously in patients with condition that predispose them to Instruct patient to report these symptoms immediately.
hypotension, such as dehydration, hypovolemia, or antihypertensive  May cause drowsiness and blurred vision. Caution patient to avoid driving and other
therapy activities requiring alertness until response to drug is known.
 Give drug cautiously to elderly patients; decreased clearance has  Orthostatic hypotension, sedation, and confusion are common during early therapy,
occurred in this age group especially in geriatric patients. Protect patient from falls and advise patient to make
position changes slowly.
 Refer patient to nutritional or weight management program as appropriate.
 Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days
after therapy.
 Therapy for depression is usually prolonged. Emphasize the importance of follow-up
exams to monitor effectiveness and side effects and to improve coping skills.
 Treatment is not a cure since symptoms can recur after discontinuation of medication.
 Caution parents/guardians of teenagers or children taking this medication about possible
increase in suicide risk. Teach parents how to assess for suicidal thoughts and to report
concerns immediately.
CONTRAINDICATIONS AND CAUSES OTHER COMPOUNDS
 Contraindicated in: Angle-closure glaucoma; Recent MI; Prolongation of QTc interval; Generic Name: Buproprion
Cardiac arrhythmia; Heart failure. Brand Name: Aplenzin
 Use Cautiously in: Pre-existing cardiovascular disease; Prostatic hyperplasia (increased DRUG CLASSIFICATION
susceptibility to urinary retention); History of seizures (threshold may be lowered); May Therapeutic Class: Antidepressant
↑ risk of suicide attempt/ideation especially during dose early treatment or dose Pharmacologic Class: Aminoketone
adjustment; OB: Use only if clearly needed and maternal benefits outweigh risk to fetus; INDICATION
Lactation: May result in sedation in infant; discontinue drug or bottle feed; Pedi: Suicide  Major depressive disorder (Aplenzin only)
risk, especially at initiation of therapy, may be greater in children and adolescents; Geri:  Seasonal affective disorder (Wellbutrin XL only)
May  Depression
MECHANISM OF ACTION
Generic Name: Clomipramine Unknown. Drug doesn’t inhibit MAO, but it weakly inhibits norepinephrine, dopamine, and
Brand Name: Anafranil serotonin reuptake. Noradrenergic or dopaminergic mechanisms, or both, may cause drug’s
effect
DRUG CLASSIFICATION
SIDE EFFECTS/ADVERSE REACTIONS
Therapeutic Class: Antidepressant CNS: abnormal dreams, insomnia, headache, sedation, tremor, agitation, dizziness, seizures,
Pharmacologic Class: Tricyclic antidepressant suicidal behavior, anxiety, confusion, delusions, euphoria, fever, hostility, impaired
INDICATION concentration, impaired sleep quality, akinesia, akathisia, fatigue, syncope, somnolence
 Obsessive-compulsive disorder CV: tachycardia, arrhythmias, hypertension, hypotension, palpitations, chest pain
 To manage panic disorder with or without agoraphobia EENT: blurred vision, rhinitis auditory disturbances, epistaxis, pharyngitis, sinusitis, dry mouth
GI: constipation, nausea, vomiting, anorexia, taste disturbance, dyspepsia, diarrhea, abdominal
 Depression; chronic pain
pain
MECHANISM OF ACTION GU: impotence, menstrual complaints, urinary frequency, urine retention
Unknown. A tricyclic antidepressant that inhibits reuptake of serotonin and Meta: increased appetite, weight loss, weight gain
norepinephrine at the presynaptic neuron Musculo: arthritis, myalgia
SIDE EFFECTS/ADVERSE REACTIONS Respi: upper respiratory complaints, increase in coughing
CNS: somnolence, tremor, dizziness, headache, insomnia, nervousness, Skin: excessive sweating, pruritus, rash, cutaneous temperature disturbance, urticaria
Other: chills, decreased libido, accidental injury, hot flashes
myoclonus, fatigue, ECG changes, seizures
NURSING RESPONSIBILITIES
CV: orthostatic hypotension, palpitations, tachycardia
 Many patients experience a period of increased restlessness, including agitation,
EENT: pharyngitis, rhinitis, visual changes insomnia, and anxiety, especially at start of therapy
GI: dry mouth, constipation, nausea, dyspepsia, increased appetite, diarrhea,  To minimize the risk of seizures, don’t exceed maximum recommend dose
anorexia, abdominal pain  Patient with major depressive disorder may experience worsening depression or suicidal
GU: urinary hesitancy, UTI, dysmenorrhea, ejaculation failure, impotence thoughts. Carefully monitor patient for worsening of depression or suicidal thoughts,
Hema: purpura especially at the beginning of therapy and during dosage changes
Meta: weight gain  Drug may increase the risk of suicidal thinking and behavior in children, adolescents, and
young adults with major depressive disorder
Musculo: myalgia
 Drug may cause hostility, agitation, and depressed mood
Skin: diaphoresis, rash, pruritus, dry skin  Closely monitor patient with history of bipolar disorder. Antidepressants can cause manic
Other: altered libido episodes during the depressed phase of bipolar disorder. This may be less likely to occur
NURSING RESPONSIBILITIES with bupropion than with other antidepressants
 Monitor mood and watch for suicidal tendencies. Allow patient to have only  Advise families and caregivers to closely observe patient for increased suicidal thinking
minimal amount of drug and behavior and hostility, agitation, and depressed mood
 Tell patient not to chew, crush, or divide tablets
 Don’t withdraw drug abruptly
 Tell patient that it may take 4 weeks to reach full antidepressant effect
 Relieve dry mouth with sugarless or gum. Saliva substitutes may be needed  Advise patient to report mood swings or suicidal thoughts immediately
 Warn patient to avoid hazardous activities requiring alertness and good CONTRAINDICATIONS AND CAUSES
coordination, especially during adjustment. Daytime sedation and dizziness may  Contraindicated in patients hypersensitive to drug, in those who have taken
occur MAO inhibitors within previous 14 days, and in those with seizure disorders
 Tell patient to avoid alcohol during drug therapy or history of bulimia or anorexia nervosa because of a higher risk of seizures
 Warn patient not to stop drug suddenly  Contraindicated in patients abruptly stopping use of alcohol or sedatives
CONTRAINDICATIONS AND CAUSES  Bupropion isn’t approved for use in children
 Contraindicated in patients hypersensitive to drug or other tricyclic  Use cautiously in patients with recent history of MI, unstable heart diseases,
antidepressants, in those who have taken MAO inhibitors within previous 14 days, renal or hepatic impairment, a history of seizures, head trauma, or other
and in patients in acute recovery period after MI predisposition to seizures, and in those treated with drugs lower seizure
 Use cautiously in patients with history of seizure disorders or with brain damage of threshold
varying cause; in patients receiving other seizure threshold-lowering drugs; in
patients at risk for suicide; and in those undergoing elective surgery
 MEDICATION MEDICATION
Generic Name: Venlafaxine Generic Name: Desvenlafaxine
Brand Name: Effexor Brand Name: Pristiq
DRUG CLASSIFICATION DRUG CLASSIFICATION
Therapeutic Class: Antidepressant Therapeutic Class: Antidepressant
Pharmacologic Class: SSNRI Pharmacologic Class: SNRI
INDICATION INDICATION
 Depression  Major depressive disorder
 Generalized anxiety disorder MECHANISM OF ACTION
 Panic disorder Thought to stimulate receptos, increasing the release of serotonin and norepinephrine
 Social anxiety disorder SIDE EFFECTS/ADVERSE REACTIONS
MECHANISM OF ACTION CNS: abnormal dremas, anxiety, asthenia, chills, dizziness, fatigue, jittery feeling,
May increase the amount of norepinephrine, serotonin, or both in the CNS by blocking their headache, insomnia, irritability, paresthesia, somnolence, tremor
reuptake by the presynaptic neurons CV: hot flashes, hypertension, palpitations, tachycardia
SIDE EFFECTS/ADVERSE REACTIONS EENT: blurred vision, mydriasis, tinnitus
CNS: asthenia, headache, somnolence, dizziness, nervousness, insomnia, suicidal GI: constipation, diarrhea, dry mouth, dysgeusia, GI bleeding, nausea, vomiting
behavior, anxiety, tremor, abnormal dreams, paresthesia, agitation GU: proteinuria
CV: hypertension, tachycardia, vasodilation Meta: decreased appetite, weight loss
EENT: blurred vision Skin: hyperhidrosis. rash
GI: nausea, constipation, dry mouth, anorexia, vomiting, diarrhea, dyspepsia, Other: sexual dysfunction, yawning
flatulence NURSING RESPONSIBILITIES
GU: abnormal ejaculation, impotence, urinary frequency, impaired urination  Closely monitor patient being treated for depression for signs
Meta: weight loss, hyponatremia and symptoms of clinical worsening and suicidal ideation,
Skin: diaphoresis, rash especially at the beginning of therapy and with dosage
Other: yawning, chills, infection adjustments. Symptoms may include agitation, insomnia,
NURSING RESPONSIBILITIES anxiety, aggressiveness, or panic attacks
 Closely monitor patients being treated for depression for signs and  Record mood changes. Monitor patient for suicidal tendencies
symptoms of clinical worsening and suicidal ideation, especially at the and allow patient only minimum supply of the drug
beginning of therapy and with dosage adjustments. Symptoms may include CONTRAINDICATIONS AND CAUSES
agitation, insomnia, anxiety, aggressiveness, or panic disorders  Contraindicated in patients hypersensitive to drug or within 14 days of MAO
 Drug may increase the risk of suicidal thinking and behavior in children, inhibitor therapy
adolescent, and young adults ages 18-24, especially during the first few  Use cautiously in elderly patients and in patients with renal impairment,
months of treatment, especially those with major depressive disorder or diseases or conditions that could affect hemodynamic responses or
other psychiatric disorder metabolism, and in those with a history of mania or seizures.
 Monitor patients weight, particularly underweight depressed patients
 Warn family members to closely monitor patient for signs of worsening
condition or suicidal ideation
 Tell patient to take each dose with food and a full glass of water
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or within 14
days of MAO inhibitor therapy
 Use cautiously in patients with renal impairment, diseases or
conditions that could affect hemodynamic responses or
metabolism, and in those with history of mania or seizures
 MEDICATION
Generic Name: Trazodone
Brand Name: Oleptro
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: Triazolopyridine derivative
INDICATION
 Depression
 Insomnia
 Prevention of migraine
MECHANISM OF ACTION
Unknown. Inhibits CNS neuronal uptake of serotonin; not a tricyclic derivative
SIDE EFFECTS/ADVERSE REACTIONS
CNS: drowsiness, dizziness, nervousness, fatigue, confusion, tremor, weakness, hostility, anger,
nightmares, vivid dreams, headache, insomnia, syncope
CV: orthostatic hypotension, tachycardia, hypertension, shortness of breath, ECG changes
EENT: blurred vision, tinnitus, nasal congestion
GI: dry mouth, dysgeusia, constipation, nausea, vomiting, anorexia
GU: urine retention, priapism possibly leading to impotence, hematuria
Hema: anemia
Skin: rash, urticaria, diaphoresis
Other: decreased libido
NURSING RESPONSIBILITIES
 Monitor patient for signs and symptoms of serotonin syndrome or
neuroleptic malignant syndrome. If these signs and symptoms occur,
immediately discontinue trazodone and any other serotogenic,
antidopaminergic, or antipsychotic drugs
 Record mood changes. Monitor patient for suicidal tendencies and allow
only minimum supply of drug
 Drug may increase the risk of suicidal thinking and behavior in children,
adolescents, and young adults ages 18-24, especially those with major
depressive disorder or other psychiatric disorder
 Tell patient to report a persistent painful erection (priapism) right away
because he may need immediate intervention
 Warn patient to avoid activities that require alertness and good coordination
until effects of drugs are known. Drowsiness and dizziness usually subside
after first few weeks
 Teach caregivers how to recognize signs and symptoms of suicidal tendency
or suicidal thoughts
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug
 Use cautiously in patients with cardiac disease or in the initial
recovery phase of MI and in patients at risk for suicide
MEDICATION
Generic Name: Nefazodone
Brand Name: Serzone
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class:
INDICATION
 Depression
MECHANISM OF ACTION
Unknown. Thought to be linked to drug’s inhibition of CNS neuronal uptake of serotonin and
norepinephrine; it also occupies serotonin and alpha1-adrenergic receptors in the CNS
SIDE EFFECTS/ADVERSE REACTIONS
CNS: fever, headache, somnolence, dizziness, asthenia, insomnia,
lightheadedness, confusion, memory impairment, paresthesia, vasodilation,
abnormal dreams, impaired concentration, ataxia, incoordination, psychomotor
retardation, tremor, hypertonia, suicidal behavior
CV: orthostatic hypotension, hypotension, peripheral edema
EENT: blurred vision, abnormal vision, tinnitus, visual field defect, pharyngitis
GI: dry mouth, nausea, constipation, taste perversion, dyspepsia, diarrhea,
increased appetite, vomiting
GU: urinary frequency, UTI, urine retention, vaginitis
Hepa: liver failure
Musculo: neck rigidity, arthralgia
Respi: cough
Skin: pruritus, rash
Other: infection, flulike syndrome, chills, breast tenderness, thirst
NURSING RESPONSIBILITIES
 A thorough risk-versus-benefit assessment should be considered before
using nefazodone to treat depression, taking into account the risk for hepatic
failure and emergence of suicidal thoughts and attempts
 Warn patient not to engage in hazardous activity until effects of drug are
known
 Inform family members to be particularly vigilant for suicidal tendencies
during therapy with nefazodone
 Instruct patient to avoid alcohol during therapy
 Inform patient that several weeks of therapy may be needed to obtain full
antidepressant effect. Once improvement occurs, advise him not to stop drug
until directed by prescriber
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or other
phenylpiperazine antidepressants; also contraindicated within 14 days
of MAO inhibitor therapy
 Contraindicated in patients who stopped using nefazodone because of
liver injury
 Use cautiously in patients with CV or cerebrovascular disease that
could be worsened by hypotension and conditions that would
predispose patients to hypotension
 Use cautiously in patients with a history of mania
MEDICATION
Generic Name: Duloxetine
Brand Name: Cymbalta
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: SSNRI
INDICATION
 Major depressive disorder
 Generalized anxiety disorder
 Neuropathic pain related to diabetic peripheral neuropathy
MECHANISM OF ACTION
May inhibit serotonin and norepinephrine reuptake in the CNS
SIDE EFFECTS/ADVERSE REACTIONS
CNS: dizziness, fatigue, headache, insomnia, somnolence, suicidal thoughts,
fever, hypoesthesia, irritability, lethargy, nervousness, nightmares, restlessness,
sleep disorder, anxiety, asthenia, tremor
CV: hot flashes, hypertension, increased heart rate
EENT: blurred vision, nasopharyngitis, pharyngolaryngeal pain
GI: constipation, diarrhea, dry mouth, nausea, dyspepsia, gastritis, vomiting
GU: abnormal orgasm, abnormally increased frequency of urinating
Meta: decreased appetite, hypoglycemia, increased appetite, weight gain or loss,
Musculo: muscle cramps, myalgia
Respi: cough
Skin: increased sweating, night sweats, pruritus, rash
Other: decreased libido, rigors
NURSING RESPONSIBILITIES
 Monitor patient for worsening of depression or suicidal behavior, especially when
therapy starts or dosage changes
 Drug may increase risk of suicidal thinking and behavior in children, adolescents, and
young adults ages 18 to 24, especially during the first few months of treatment, especially
in those with major depressive disorder or other psychiatric disorder
 If taken with tricyclic antidepressants, duloxetine metabolism will be prolonged, and
patient will need extended monitoring
 Periodically reassess patient to determine the need for continued therapy
 Decreased dosage gradually, and watch for symptoms that may arise when drug is
stopped, such as dizziness, nausea, headache, paresthesia, vomiting, irritability, and
nightmares
 If intolerable symptoms arise when decreasing or stopping drug, restart at previous dose
and decrease even more gradually
 Monitor blood pressure periodically during treatment
 Older patients may be more sensitive to drug effects than younger adults
 Warn families or caregivers to report signs of worsening depression and signs of suicidal
behavior to prescriber immediately
 Urge patient to avoid activities that are hazardous or require mental alertness until he
knows how the drug affects him
 If patient takes drug for depression, explain that it may take 1 to 4 weeks to notice an
effect
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to drug or its ingredients, patients taking
MAO inhibitors, patients with uncontrolled angle-closure glaucoma, and patients
with a creatinine clearance less than 30mL/minute. Drug isn’t recommended for
patients with hepatic dysfunction or end-stage renal disease
 Use cautiously in patients with a history of mania or seizures, patients
who drink substantial amounts of alcohol, patients with hypertension,
patients with controlled angle-closure glaucoma, and those with
conditions that slow gastric emptying
MONOAMINE OXIDASE INHIBITORS
MEDICATION
Generic Name: Phenelzine
Brand Name: Nardil
DRUG CLASSIFICATION
Therapeutic Class: Antidepressants
Pharmacologic Class: MAO inhibitor
INDICATION
 Treatment of neurotic or atypical depression (usually reserved for
patients who do not tolerate or respond to other modes of therapy
[e.g. tricyclic antidepressants, SSRIs, SSNRIs or electroconvulsive
therapy])
MECHANISM OF ACTION
Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various
neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the
body. Therapeutic Effects: Improved mood in depressed patients
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, dizziness, drowsiness, fatigue, headache, hyperreflexia, insomnia, tremor,
twitching, weakness, euphoria, paresthesia, restlessness.
CV: hypertensive crisis edema, orthostatic hypotension
EENT: blurred vision, glaucoma, nystagmus
GI: constipation, dry mouth, abdominal pain, liver function test elevation, nausea, vomiting
GU: sexual dysfunction, urinary retention
Meta: weight gain
Skin: pruritus, rashes
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level frequently. Assess for suicidal tendencies,
especially during early therapy. Restrict amount of drug available to patient.
 Monitor BP and pulse rate before and frequently during therapy. Report significant changes
promptly.
 Monitor intake and output ratios and daily weight. Assess patient for peripheral edema and
urinary retention.
 Monitor serum glucose closely in diabetic patients; hypoglycemia may occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-rich foods and many medications may
result in a life-threatening hypertensive crisis. Signs and symptoms of hypertensive crisis include
chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, photosensitivity, neck
stiffness, sweating, and enlarged pupils. Treatment includes IV phentolamine
 Instruct patient to take medication as directed. Take missed doses if remembered within 2
hr; otherwise, omit and return to regular dosage schedule. Do not discontinue abruptly as
withdrawal symptoms (nausea, vomiting, malaise, nightmares, agitation, psychosis,
seizures) may occur.
 Caution patient to avoid alcohol, CNS depressants, OTC drugs, and foods or beverages
containing tyramine or excessive caffeine during and for at least 2 wk after therapy has
been discontinued; they may precipitate a hypertensive crisis. Instruct patient to notify
health care professional immediately if symptoms of hypertensive crisis develop.
 Instruct parents or guardians of children to contact health care professional immediately
if child exhibits any suicidal thoughts or behaviors
 May cause dizziness or drowsiness. Caution patient to avoid driving and other activities
requiring alertness until response to medication is known.
 Caution patient to change positions slowly to minimize orthostatic hypotension. Geriatric
patients are at increased risk for this side effect.
 Instruct patient to consult with health care professional before taking any new
prescription, OTC, or herbal product.
 Advise patient to notify health care professional if dry mouth, urinary retention, or
constipation occurs. Frequent rinses, good oral hygiene, and sugarless candy or gum
may diminish dry mouth. An increase in fluid intake, fiber, and exercise may prevent
constipation.
CONTRAINDICATIONS AND CAUSES Generic Name: Tranylcypromine
 Contraindicated in: Hypersensitivity; Liver disease; Severe renal disease; Pheochromocytoma; Brand Name: Parnate
Heart failure; Patients undergoing elective surgery requiring general anesthesia (should be
DRUG CLASSIFICATION
discontinued at least 10 days before surgery); Excessive consumption of caffeine; Concurrent use
of meperidine, SSRI antidepressants, SSNRI antidepressants, tricyclic antidepressants,
Therapeutic Class: Antidepressant
tetracyclic antidepressants, nefazodone, trazodone, procarbazine, selegiline, linezolid, Pharmacologic Class: MAO inhibitor
carbamazepine, cyclobenzaprine, bupropion, buspirone, sympathomimetics, other MAO INDICATION
inhibitors, dextromethorphan, narcotics, alcohol, general anesthetics, diuretics, or tryptophan;  Treatment of major depressive episode without melancholia
Concurrent use of foods containing high concentrations of tyramine (see Appendix J); Lactation. (usually reserved for patients who do not tolerate or
 Use Cautiously in: Patients who may be suicidal or have a history of drug dependency; Pedi: respond to other modes of therapy [e.g. tricyclic
May ↑ risk of suicide attempt/ideation especially during first 1–2 mo of treatment or with dose
antidepressants, SSRIs, SSNRIs or electroconvulsive
adjustments; Schizophrenia; Bipolar disorder; Seizure disorders; Diabetes (↑ risk of
hypoglycemia); Geri: Geriatric patients (↑ risk of adverse reactions); Pregnancy (safety not therapy])
established) Children (safety and effectiveness not established) MECHANISM OF ACTION
Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various
neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the
body. Therapeutic Effects: Improved mood in depressed patients.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, confusion, dizziness, drowsiness, headache, insomnia, restlessness,
tremor, paresthesia, weakness
CV: hypertensive crisis, edema, orthostatic hypotension, tachycardia
EENT: blurred vision, tinnitus
GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, hepatitis, nausea.
GU: sexual dysfunction, urinary retention.
Hema: agranulocytosis, leukopenia, thrombocytopenia
Musculo: muscle spasm
Skin: alopecia, rashes
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level frequently. Assess for
suicidal tendencies, especially during early therapy. Restrict amount of drug
available to patient.
 Monitor serum glucose closely in diabetic patients; hypoglycemia may occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-rich foods and many
medications may result in a life-threatening hypertensive crisis. Signs and
symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia,
severe headache, nausea, vomiting, photosensitivity, neck stiffness, sweating, and
enlarged pupils
 Instruct patient to take medication as directed. Take missed doses if remembered
within 2 hr; otherwise, omit and return to regular dosage schedule. Do not
discontinue abruptly as withdrawal symptoms may occur.
 Caution patient to avoid alcohol, CNS depressants, OTC drugs, and foods or
beverages containing tyramine or excessive caffeine during and for at least 2 wk
after therapy has been discontinued; they may precipitate a hypertensive crisis.
Instruct patient to notify health care professional immediately if symptoms of
hypertensive crisis develop.
 Instruct parents or guardians of children to contact health care
professional immediately if child exhibits any suicidal thoughts or
behaviors
 May cause dizziness or drowsiness. Caution patient to avoid driving and
other activities requiring alertness until response to medication is known.
 Caution patient to change positions slowly to minimize orthostatic
hypotension. Geriatric patients are at increased risk for this side effect.
 Instruct patient to consult with health care professional before taking any
new prescription, OTC, or herbal product.
 Instruct patient to carry identification describing medication regimen at all
times.
 Emphasize the importance of participation in psychotherapy if
recommended by health care professional and follow-up exams to evaluate
progress.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Liver disease; Cerebrovascular
disease; Cardiovascular disease; Hypertension; Pheochromocytoma; Patients
undergoing elective surgery requiring general anesthesia History of
headache; Excessive consumption of caffeine; Concurrent use of
meperidine, SSRI antidepressants, SSNRI antidepressants, tricyclic
antidepressants, tetracyclic antidepressants, nefazodone, trazodone,
procarbazine, selegiline, linezolid, carbamazepine, cyclobenzaprine,
bupropion, buspirone, sympathomimetics, other MAO inhibitors,
dextromethorphan, narcotics, alcohol, general anesthetics, diuretics,
antihistamines, or tryptophan; Concurrent use of foods containing high
concentrations of tyramine; Lactation.
 Use Cautiously in: Patients who may be suicidal or have a history of drug
dependency; Pedi: May ↑ risk of suicide attempt/ideation especially during
first 1–2 mo of treatment or with dose adjustments; Hyperthyroidism;
Schizophrenia; Bipolar disorder; Seizure disorders; Renal dysfunction;
Diabetes (↑ risk of hypoglycemia); Geri: Geriatric patients (↑ risk of adverse
reactions); Pregnancy (safety not established); Children (safety and
effectiveness not established).
MEDICATION
Generic Name: Isocarboxazid
Brand Name: Marplan
DRUG CLASSIFICATION
Therapeutic Class: Antidepressant
Pharmacologic Class: MAO inhibitor
INDICATION
 Treatment of depression (usually reserved for patients who do not tolerate or
respond to other modes of therapy
MECHANISM OF ACTION
Inhibits the enzyme monoamine oxidase, resulting in an accumulation of various
neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) in the body
SIDE EFFECTS/ADVERSE REACTIONS
CNS: seizures, dizziness, headache, akathisia, anxiety, ataxia, drowsiness, euphoria, insomnia,
restlessness, weakness
CV: hypertensive crisis, orthostatic hypotension
EENT: blurred vision
GI: nausea, black tongue, constipation, diarrhea, dry mouth
GU: dysuria, sexual dysfunction, urinary incontinence, urinary retention
Skin: photosensitivity.
NURSING RESPONSIBILITIES
 Assess mental status, mood changes, and anxiety level frequently. Assess for
suicidal tendencies, especially during early therapy. Restrict amount of drug
available to patient.
 Monitor serum glucose closely in diabetic patients; hypoglycemia may
occur.
 Toxicity and Overdose: Concurrent ingestion of tyramine-rich foods and
many medications may result in a life-threatening hypertensive crisis. Signs
and symptoms of hypertensive crisis include chest pain, tachycardia or
bradycardia, severe headache, nausea, vomiting, photosensitivity, neck
stiffness, sweating, and enlarged pupils
 Instruct patient to take medication as directed. Take missed doses if
remembered within 2 hr; otherwise, omit and return to regular dosage
schedule. Do not discontinue abruptly as withdrawal symptoms may occur.
 Caution patient to avoid alcohol, CNS depressants, OTC drugs, and foods or
beverages containing tyramine or excessive caffeine during and for at least 2
wk after therapy has been discontinued; they may precipitate a hypertensive
crisis. Instruct patient to notify health care professional immediately if
symptoms of hypertensive crisis
 Instruct parents or guardians of children to contact health care professional
immediately if child exhibits any suicidal thoughts or behaviors
 May cause dizziness or drowsiness. Caution patient to avoid driving and
other activities requiring alertness until response to medication is known.
 Caution patient to change positions slowly to minimize orthostatic
hypotension. Geriatric patients are at increased risk for this side effect.
 Instruct patient to consult with health care professional before taking any
new prescription, OTC, or herbal product.
 Advise patient to notify health care professional of medication regimen
before surgery. If possible, therapy should be discontinued at least 2 wk
before surgery.
 Instruct patient to carry identification describing medication regimen at all
times.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Liver disease; Severe renal disease;
Cerebrovascular disease; Cardiovascular disease; Uncontrolled
hypertension; Pheochromocytoma; History of severe or frequent headaches;
Patients undergoing elective surgery requiring general anesthesia (should be
discontinued at least 10 days before surgery); Excessive consumption of
caffeine; Concurrent use of meperidine, SSRI antidepressants, SSNRI
antidepressants, tricyclic antidepressants, tetracyclic antidepressants,
nefazodone, trazodone, procarbazine, selegiline, linezolid, carbamazepine,
cyclobenzaprine, bupropion, buspirone, sympathomimetics, other MAO
inhibitors, dextromethorphan, narcotics, alcohol, general anesthetics,
diuretics, tryptophan, or antihistamines; Concurrent use of foods containing
high concentrations of tyramine; Lactation; Children <16 yr (safety and
effectiveness not established).
 Use Cautiously in: Patients who may be suicidal or have a history of drug
dependency; Pedi: May ↑ risk of suicide attempt/ideation especially during
first 1–2 mo of treatment or with dose adjustments (approved for use in
children ≥16 yr); Hyperthyroidism; Schizophrenia; Bipolar disorder; Seizure
disorders;

ANTIDEPRESSANTS