Immunosuppressants, rheumatic and gastrointestinal topics
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
The initial treatment should be the prescription of a SSRI, but in the current state of affairs, we cannot recommend one drug over another [29]. The target dosage is 5 to 40 mg for fluoxetine, 50 to 200 mg for fluvoxamine and sertraline. Maintenance is reached by a process of stepwise increases. Therapeutic effects of the drug are observable within 3 to 8 weeks. Because long-term studies are rare in children, the optimal duration of treatment is not clearly established [30]. One study [31] showed that sertraline remained useful and well tolerated after 52 weeks of treatment. It is generally advised that treatment be maintained during a period of 12 to 18 months after a therapeutic response has been obtained; discontinuation of treatment is best accomplished during a period of vacation, when the child is minimally stressed.
Pharmacotherapies for PTSD and Substance Use Disorders
Anka A. Vujanovic, Sudie E. Back in Posttraumatic Stress and Substance Use Disorders, 2019
One of the earliest RCTs was conducted by Brady and colleagues (2005) and examined the effectiveness of sertraline, an SSRI commonly used to treat PTSD. This study included 94 individuals with comorbid PTSD and AUD based on Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-IV; American Psychiatric Association, 1994). For this study, subjects were included if AUD was present within the past three months and PTSD within the past six months. Index traumas were primarily civilian in nature (e.g., sexual assault, physical assault, serious accident). Subjects were randomly assigned to 150 mg/day of sertraline or placebo for 12 weeks. The study found that sertraline was no better than placebo at decreasing PTSD symptom severity assessed via the CAPS or alcohol use frequency. However, in post hoc analyses, it was noted that there was an improvement in alcohol use outcomes for a subset of individuals (n = 14) who received sertraline. Specifically, individuals with early onset PTSD and less severe AUD evidenced a positive response to sertraline and had fewer self-reported drinks per drinking day and fewer heavy drinking days as compared to placebo (Brady et al., 2005).
Psychotropic Use during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Paroxetine and sertraline are listed under the old FDA category B drugs, but recent research calls the safety of paroxetine use during pregnancy into question. The frequency of congenital anomalies was not increased above background among 394 infants exposed to paroxetine during the first trimester (Diav-Citrin et al., 2002; Ericson et al., 1999; Inman et al., 1993; Kulin et al., 2002; McElhatton et al., 1996; Wilton et al., 1998). However, as recently as July 2006, the manufacturer of Paxil (paroxetine) reported that first trimester use increased the risk of birth defects by between two and three times, with the risk of congenital heart defects being doubled. This contradicts prior studies of the drug’s use during the first trimester.
SSRI withdrawal syndrome in children and adolescents: a narrative literature review
Published in Expert Opinion on Drug Safety, 2023
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Yahia Albobali, Peter M. Haddad
A book chapter by Hernández-Otero and colleagues reviewed the scientific evidence for the use of antidepressants in children and adolescents [34]. It reported that downward titration at the time of discontinuation is not needed in the case of fluoxetine due to its long half-life. For Sertraline, it proposed a gradual reduction of dose to avoid withdrawal symptoms. It concluded that some patients could tolerate a reduction of 50% of the total dose over 3 days and the remaining 50% dose reduction over the subsequent 3 days. The recommendation is not much different for citalopram except that no progressive reduction is necessary however, a gradual reduction in the rate similar to what is reported for Sertraline is advisable. In relation to Escitalopram, the authors advise that it is wise to carry out a gradual titration to avoid withdrawal syndrome.
Safety considerations for the management of cholestatic itch
Published in Expert Opinion on Drug Safety, 2021
Juan Trivella, Cynthia Levy
Serotoninergic signals originated in the medulla may modulate the itch pathway by stimulating inhibitory interneurons in the spinal cord. This neurotransmitter also seems to regulate the afferent evoked stimuli that carries the pruritic sensation to the central nervous system. Despite this evidence, the hypothesis that sertraline - a selective serotonin receptor inhibitor (SSRI) - improves pruritus was initially derived from anecdotal clinical experience and was not based on physiologic data, with many mechanistic details remaining unknown. A small randomized, placebo-controlled trial including 12 patients showed that sertraline at a dose of 75–100 mg/day significantly improved itch scores by a mean of 33% after 6 weeks of treatment [66]. An additional benefit of sertraline is its action as a mood stabilizer and antidepressant which has proven to be independent to its antipruritic activity [66]. The majority of side effects reported with this medication are mild including diarrhea, insomnia and mood stability. Serotonin syndrome can be seen even when using this drug at a therapeutic dose and represents a major safety concern in clinical practice. Life-threatening manifestations include autonomic hyperactivity, neuromuscular abnormalities, and mental status changes. Antidepressant discontinuation syndrome has also been described in patients who stop sertraline abruptly and manifests clinically with sensory disturbances, insomnia, nausea, hyperarousal and a flu-like syndrome [67,68].
Pharmacotherapeutic considerations for the treatment of posttraumatic stress disorder during and after pregnancy
Published in Expert Opinion on Pharmacotherapy, 2021
Michael Thomson, Verinder Sharma
PTSD is a chronic and debilitating illness which is one of the most prevalent psychiatric disorders in the perinatal population [1]. In perinatal women the onset of PTSD can pre-date the pregnancy, occur during the pregnancy or occur during the postpartum period. The development of PTSD is multifactorial involving a complex interplay between trauma, biology and psychosocial factors [2]. This disorder has been associated with worsened outcomes in pregnancy and in child development [7–10]. Despite this, there are no existing clinical trials of pharmacotherapy for perinatal PTSD. As such, data from non-perinatal populations must be extrapolated to the perinatal population with additional consideration given to medication safety in pregnancy and breastfeeding. If pharmacotherapy is opted for, an SSRI or venlafaxine are generally the first-line treatment options. Among the SSRI medications sertraline has the best safety profile in both pregnancy and postpartum. The evidence base for second-line treatments are generally poor and use of these medications are not recommended for most cases of perinatal PTSD. However, previous non-response, intolerabilities and co-morbid psychiatric conditions may necessitate the use of a second-line medication.
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