Q&A Series: (Q.1)

question-mark-blue-1630386-639x1115

 

 ?

Q&A SERIES

 

 

(Q.1) 43 year old male with history of major depression disorder is referred to you by his primary care physician for management of depression with following laboratory workup:.

  • CBC with Diff: within normal range
  • Liver function test: within normal range
  • Kidney function test: moderate renal impairment.
  • Thyroid function test: within normal range.
  • EKG: normal sinus rhythm.
  • Urine Drug Screen: Negative

Which of the following antidepressant will need dosage adjustment for this patient?

  • (a) Fluoxetine
  • (b) Sertraline
  • (c) Escitalopram
  • (d) Nefazodone
  • (e) Mirtazapine

 


Answer: (e) Mirtazapine.

Mirtazapine: Total body clearance of mirtazapine is reduced approximately 30% in patients with moderate (Clcr = 11–39 mL/min/1.73 m2 ) and approximately 50% in patients with severe (Clcr = < 10 mL/min/1.73 m2 ) renal impairment. Hence E is the correct answer.

Fluoxetine: In depressed patients on dialysis, fluoxetine administered as 20 mg once daily for 2 months produced steady-state fluoxetine and norfluoxetine plasma concentrations comparable with those seen in patients with normal renal function. Hence use of a lower or less frequent dose of fluoxetine is not routinely necessary in renally impaired patients.

Sertraline: Sertraline is extensively metabolized and excretion of unchanged drug in urine is a minor route of elimination. Thus sertraline multiple dose pharmacokinetics appear to be unaffected by renal impairment.

Escitalopram: No dosage adjustment is necessary for patients with mild or moderate renal impairment. Lexapro should be used with caution in patients with severe renal impairment. 

Nefazodone: Renal impairment (creatinine clearances ranging from 7 to 60 mL/min/1.73m2 ) had no effect on steady-state nefazodone plasma concentrations. 

Also check this post for more information on Antidepressants in Dialysis patients:

https://www.psychiatryeducationforum.com/project1/2016/10/18/antidepressants-dialysis-patients-part-1/



Q&A Series by Admin © Psychiatry Education Forum, All rights reserved.

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.


Related Articles