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PTSD MedicationsSSRIs: Selective Serotonin Reuptake InhibitorsSymptom clusters: targets all symptom clusters (DSM IV)Common side effects:Upset stomachSexual dysfunctionSerious side effectsSuicide Risk: Black Box Warning under 24 years oldSerotonin syndrome (fever, stiffness, agitation, tremor)Time to Effect6-8 weeks at a therapeutic doseMedicationsGenericBrandDosing RangeCitalopramCelexa10-40 mg dailyEscitalopramLexapro5-20 mg dailyFluoxetineProzac10-80 mg dailyParoxetinePaxil10-60 mg dailySertralineZoloft25-200 mg dailySNRIs:Serotonin Norepinephrine Reuptake InhibitorsOnly venlafaxine has really been studiedSymptom clusters: targets all symptom clusters (DSM IV)Common side effects:Increased blood pressureUpset stomachSexual dysfunctionSerious side effectsSuicide Risk: Black Box Warning under 24 years oldSerotonin syndrome (fever, stiffness, agitation, tremor)Time to Effect6-8 weeks at a therapeutic doseMedicationsGenericBrandDosing RangeDesvenlafaxinePristiq50 mg dailyDuloxetineCymbalta20-120 mg dailyVenlafaxineEffexor37.5 mg – 300 mgOther Classes: Mirtazapine (Remeron)Works in CNS to increase serotonin and norepinephrine availabilitySymptom clusters: targets all symptom clusters (DSM IV)Common side effects:Sleepiness (we can take advantage of this!)Increased hungerNo sexual dysfunctionSerious side effectsSuicide Risk: Black Box Warning under 24 years oldSerotonin syndrome (fever, stiffness, agitation, tremor)Time to Effect6-8 weeks at a therapeutic dosePrazosin (MiniPress)Old blood pressure medication working by α blockade and relaxing smooth muscleSymptom clusters: Re-experiencing (specifically nightmares), mixed for hyperarousalCommon side effects:DizzinessOrthostatic hypotension LethargySerious Side effects: very rareSyncopeHypotensionTime to effect: A couple weeks of titrationBenzodiazepinesContraindicated in PTSD, may be harmful and worsen symptomsInhibits memory formationCommon Side EffectsDisinhibitionDizziness, unsteadinessDepressionSedationCognitive effectsFallsRebound anxietySerious Side EffectsPhysical dependence and abuseSevere withdrawal (tremor, anxiety, seizures, death)Risk in overdose: can be fatal in combination Drug InteractionsWorsening of PTSD symptomsTime to effect: 15-60 minutesNote: Effect only lasts 2-12 hoursMedicationsGenericBrandEquivalent DoseDosing RangeAlprazolamXanax1 mg0.25 – 1 mg QID(4 times daily)ClonazepamKlonopin0.5 mg0.25 – 2 mg BID(2 times daily)DiazepamValium10 mg2-10 mg BID-QID(2-4 times daily)LorazepamAtivan1 mg0.5 – 2 mg TID (3 times daily)VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress, 2010 ................
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