PRESCRIBING GUIDELINES

Transcription

1 The Maudsley The South London and Maudsley NHS Foundation Trust & Oxleas NHS Foundation Trust PRESCRIBING GUIDELINES 10th Edition David Taylor Carol Paton Shitij Kapur informa healthcare

2 Contents Authors and editors Preface Acknowledgements Notes on using The Maudsley Prescribing Guidelines Notes on inclusion of drugs Notes on commonly used abbreviations v Vl Vll Vlll Vlll Vlll 1 Plasma level monitoring of psychotropics and anticonvulsants Introduction Interpreting sampie results Amisulpride Aripiprazole Clozapine Olanzapine Quetiapine Risperidone Schizophrenia Antipsychotics - general introduction Antipsychotics - equivalent doses Antipsychotics - minimum effective doses Antipsychotics -licensed maximum doses Newantipsychotics New antipsychotics - costs Antipsychotics - general principles of prescribing NICE Guidelines - Schizophrenia First-episode schizophrenia Relapse or acute exacerbation of schizophrenia

3 Switching antipsychotics because of poor tolerability - recommendations Antipsychotic response to increase the dose, to switch, 26 to add or just wait - what is the right move? Speed and onset of antipsychotic action 29 First-generation antipsychotics - place in therapy 31 Antipsychotics - monitoring 32 Depot antipsychotics 35 Risperidone long-acting injection 38 Management of patients on long-term depots - 41 dose reduction Combined antipsychotics 42 High-dose antipsychotics: prescribing and monitoring 44 Negative symptoms 47 Antipsychotic prophylaxis 49 Refractory schizophrenia 53 Optimising clozapine treatment 55 Alternatives to clozapine 58 Clozapine - management of common adverse effects 62 Clozapine - uncommon or unusual adverse effects 64 Clozapine - serious haematological and 66 cardiovascular adverse effects Clozapine, neutropenia and lithium 68 Clozapine-related hypersalivation 71 Clozapine and chemotherapy 74 Guidelines for the initiation of clozapine for patients based 75 in the community Omega-3 fatty acid (fish oils) in schizophrenia 78 Extrapyramidal side-effects 80 Hyperprolactinaemia 83 24

4 Algorithm for the treatment of antipsychotic-induced akathisia 85 Treatment of tardive dyskinesia (TD) 87 Neuroleptic malignant syndrome (NMS) 90 Catatonia 92 Antipsychotics and hypertension 94 Antipsychotic-induced weight gain 96 Treatment of drug-induced weight ga in 97 Psychotropic-related QT prolongation 101 Antipsychotics, diabetes and impaired glucose tolerance 107 Antipsychotics and dyslipidaemia 111 Antipsychotics and sexual dysfunction 114 Antipsychotic-induced hyponatraemia 119 Antipsychotics: relative adverse effects - a rough guide Bipolar disorder Valproate 123 Lithium 128 Carbamazepine 134 Treatment of acute mania or hypomania 140 Antipsychotics in bipolar disorder 145 Bipolar depression 147 Rapid-cycling bipolar affective disorder 151 Prophylaxis in bipolar disorder Depression and anxiety Antidepressants 155 Antidepressant drugs - tricyclics 158 Antidepressant drugs - SSRIs 160 Antidepressant drugs - MAOIs 164 Antidepressant drugs - others 166 Treatment of affective illness 170

5 Drug treatment of depression Recognised minimum effective doses - antidepressants Antidepressant prophylaxis Treatment of refractory depression - first choice Treatment of refractory depression - second choice Treatment of refractory depression - other reported treatments Psychotic depression Electroconvulsive therapy (ECT) and psychotropics Stimulants in depression Antidepressant -induced hyponatraemia Post-stroke depression SSRIs and bleeding Antidepressants and diabetes mellitus Treatment of depression in the elderly Cardiac effects of antidepressants Antidepressant-induced arrhythmia Antidepressants and sexual dysfunction Antidepressants and hyperprolactinaemia Antidepressants - swapping and stopping Antidepressant discontinuation symptoms St John's Wort Drug interactions with antidepressants Antidepressants: relative adverse effects - a rough guide Antidepressants - alternative routes of administration Anxiety spectrum disorders Benzodiazepines Benzodiazepines and disinhibition Benzodiazepines: dependence and detoxification Insomnia

6 5 Children and adolescents Principles of prescribing practice in childhood 252 and adolescence Depression in children and adolescents 253 Bipolar illness in children and adolescents 256 Anxiety in children and adolescents 259 Obsessive compulsive disorder (OCD) in children 260 and adolescents Attention deficit hyperactivity disorder (ADHD) 263 Prescribing in ADHD - a summary 266 Psychosis in children and adolescents 269 Autism spectrum disorders 270 Tics and Tourette syndrome 276 Melatonin in the treatment of insomnia in children 279 and adolescents Rapid tranquillisation (RT) in children and adolescents 281 Doses of commonly used psychotropic drugs in 283 children and adolescents 6 Substance misuse Introduction 284 Alcohol dependence 286 Opioid misuse and dependence 299 Nicotine and smoking cessation 321 Pharmacological treatment of dependence on 325 stimulant drugs Benzodiazepine use 326 Drugs of misuse - a summary 327 Interactions between 'street drugs' and prescribed 331 psychotropic drugs

7 Use of psychotropics in special patient groups Depression and psychosis in epilepsy 335 Pharmacokinetic drug interactions between antiepileptic 339 drugs and other psychotropic drugs Withdrawing anticonvulsant drugs 342 Drug choice in pregnancy 344 Psychotropics in breast-feeding 357 Renal impairment 367 Hepatic impairment 380 Prescribing in the elderly 386 Dementia 388 Behavioural and psychological symptoms of dementia 400 Covert administration of medicines within food and drink 405 Parkinson's disease 407 Multiple sclerosis 410 Eating disorders 414 Acutely disturbed or violent behaviour 417 Chronic behavioural disturbanee (ehallenging behaviour) 423 in learning disability (LD) Self-injurious behaviour in learning disability 425 Psyehotropics and surgery 428 Atrial fibrillation - using psyehotropies 433 General principles of prescribing in HIV 435 Drug treatment of borderline personality disorder 443 Delirium 445 Huntington's disease - pharmacological treatment 451 Velo-cardio-facial syndrome (VCFS) 454 Summary of commonly reported physieal side effects 456 of psychotropies Summary of commonly reported behavioural, cognitive, 462 and psychiatrie side effeets of psyehotropics

8 8 Miscellaneous conditions and substances Psychotropics in overdose 464 Biochemical and haematological effects of psychotropics 470 Prescribing drugs outside their licensed indications 480 Observations on the placebo effect in mental illness 482 Drug interactions with alcohol 484 Nicotine 488 Smoking and psychotropic drugs 491 Caffeine 495 Complementary therapies 498 Enhancing medication adherence 502 Driving and psychotropic drugs 506 Use of antibiotics in psychiatry 515 Index 517