SSRIs Comparison Table for Clinical Pharmacists
| Drug (Generic / Brand) | Usual Dose Range | Half-life | CYP Interactions | Notable Side Effects | Clinical Pearls | Common Indications |
|---|---|---|---|---|---|---|
| Fluoxetine (Prozac) | 10–80 mg/day | ~4–6 days (norfluoxetine ~9 days) | CYP2D6 inhibitor | Insomnia, agitation, sexual dysfunction | Long half-life (good for poor adherence); activating | MDD, OCD, Bulimia, Panic Disorder |
| Sertraline (Zoloft) | 50–200 mg/day | ~26 hours | Weak CYP2D6 inhibitor | Diarrhea, sexual dysfunction | Activating; safe in CVD; GI side effects common | MDD, PTSD, OCD, Panic, PMDD |
| Paroxetine (Paxil) | 10–60 mg/day | ~21 hours | Strong CYP2D6 inhibitor | Sedation, weight gain, anticholinergic effects | Avoid in elderly (anticholinergic); difficult withdrawal | MDD, OCD, Panic, GAD, PTSD |
| Citalopram (Celexa) | 20–40 mg/day | ~35 hours | Minimal CYP effects | QT prolongation, sexual dysfunction | Max 40 mg/day (20 mg in elderly); monitor ECG if >40 mg | MDD |
| Escitalopram (Lexapro) | 10–20 mg/day | ~27–32 hours | Minimal CYP effects | Similar to citalopram, better tolerated | S-enantiomer of citalopram; fewer side effects | MDD, GAD |
| Fluvoxamine (Luvox) | 50–300 mg/day | ~15–22 hours | Strong CYP1A2 & 2C19 inhibitor | Sedation, GI upset, sexual dysfunction | Often used in OCD; many drug interactions | OCD, Social Anxiety |
Key Notes for Clinical Pharmacists
- Titration: Start low and go slow, especially in elderly or anxious patients.
- Discontinuation syndrome: Risk higher with Paroxetine and Fluvoxamine due to short half-life.
- Drug Interactions: Watch for CYP450 inhibitors (especially Fluvoxamine and Paroxetine).
- QTc concerns: Monitor Citalopram in patients with cardiac risk or those on other QTc-prolonging drugs.
- Pregnancy: Sertraline generally preferred due to safety profile.
- Activation vs Sedation:
- More activating: Fluoxetine, Sertraline
- More sedating: Paroxetine, Fluvoxamine