McGraw Hill’s NAPLEX® Review Guide, 4e >Post-Traumatic Stress Disorder

S. Scott Sutton+
TABLE 59-1Pharmacologic Treatments for PTSD

Comments/Class Side
Drug (Brand) FDA-Approveda Initial Dose (mg/d) Dosage Range (mg/d) Scheduleb Formu- lationsc
Effects

SSRIs

Citalopram (Celexa) N 20 20-40 qd S, T SSRIs are first line

Need 8-12 wk for

improvement

Sertraline and paroxetine

Escitalopram (Lexapro) N 10 10-20 qd S, T are FDA-approved for
PTSD

Paroxetine is most
sedating

CYP-450 interactions with

Fluoxetine (Prozac) N 10-20 10-80 qd C, S, T, EC fluoxetine (2D6),
paroxetine

(2D6), and fluvoxamine

(2D6, 1A2, 2C19)

Paroxetine is pregnancy
Fluvoxamine (Luvox) N 50 100-250 qd, bid EC, T category D. All other
SSRIs are

Paroxetine (Paxil) Y 10-20 20-50 qd ET, OS, T pregnancy category C

Nausea/vomiting

Sertraline (Zoloft) Y 25-50 50-200 qd S, T Sexual dysfunction

Diarrhea/constipation

Headaches

Other Agents

Venlafaxine extended-
N 37.5 37.5-225 qd, bid, tid EC, ET, T Second-line
release (Effexor XR)

Increased blood pressure

at high doses

Nausea/vomiting

Sexual dysfunction

Third-line due to
Amitriptyline (Elavil) N 25-50 50-300 qd, bid, tid T
intolerable adverse events
 Anticholinergic symptoms
Imipramine (Tofranil) N 25-50 50-300 qd, bid, tid T,C (eg, constipation, blurred
vision, dry mouth)

Sedation

Sexual dysfunction

Cardiac toxicity in
overdose

Third line due to limited

Mirtazapine (Remeron) N 15 15-45 qhs D, T evidence and adverse
events

Increased appetite/weight
gain

Sedation

Last-line due to drug-food

Phenelzine (Nardil) N 15 15-90 tid, qid T interactions and adverse
events

Avoid eating foods high in

tyramine

Orthostatic hypotension

Sedation

Edema, weight gain

Sexual dysfunction

Prazosin (Minipress) N 1 1-14 qd, bid, tid C Mostly used adjunctively

Preferably for nightmares

High doses may be

necessary

Orthostatic hypotension

Angina, tachycardia

Abbreviations: FDA, Food and Drug Administration; PTSD, post-traumatic stress disorder; SSRI, selective serotonin reuptake inhibitor.
aN, No; Y, Yes.
bbid, twice daily; qd, daily; qid, four times daily; qhs, at bedtime; tid, three times daily.
cC, capsule; D, (oral tablet) disintegrating; EC, extended-release capsule; ET, extended-release tablet; OS, oral suspension; S, oral solution; T, tablet.

Date of download: 12/26/22 from AccessPharmacy: accesspharmacy.mhmedical.com, Copyright © McGraw Hill. All rights reserved.