珍珠草酸艾司西酞普兰片课件.ppt

* Escitalopram-莱士普通用名 * Nausea: p ?0.05 vs VLF. * Bielski et al WFSBP * Significances: SBP supine mmHg, p0.05 Pulse supine bpm, p0.001 Ventricular heart rate (measured by ECG leads), p0.001 * * * Background Citalopram is a racemic mixture comprised of an S- and an R-enantiomer. Clinical research has uncovered is that the S-enantiomer is active while the R-enantiomer is inactive and actually impedes the full effect of the S-enantiomer. Key Points The recommended dose for escitalopram is 10 mg/day, anytime of day, without regard to food. Escitalopram can be increased to 20 mg/day, where necessary, after a minimum period of one week. It may be desirable to start at 5 mg daily and titrate upwards as needed and tolerated, as some patients may respond to the 5 mg/day dose. A longer half-life and decreased clearance have been demonstrated in the elderly, therefore a lower maximum dose should be considered. It may be desirable to start at 5 mg daily and titrate upwards as needed and tolerated, as some patients may respond to the 5 mg/day dose. No dosage adjustment is necessary for patients with mild or moderate renal impairment. However, escitalopram should be used with caution in patients with several renal impairment. The significance of this simple and easy dosing regimen is that physicians do not have to focus on complex titration schedules, to reach an effective dose. Reference Escitalopram Product Monograph, 2004 * Background Antidepressants have varying degrees of efficacy in different patients. Furthermore, all SSRIs are not the same and have different pharmacodynamic profiles.1 Recent guidelines from the Canadian Network for Mood and Anxiety Treatments (CANMAT)2 has indicated that switching among SSRIs may be an important strategy to optimize outcomes for individual patients. Once the clinician has tried all possible strategies that have been outlined to improve treatment response with the first antidepressant, it may be necessary to switch to another antid