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Choosing an anti-anxiety medication Increase, Augment or Switch Switchrx.ca Drug Interactions Checker
| Medication (brand name) | Starting dose (usually given in am) | Initial target dose (mg) | Max dose* | Anti-cholinergic | Sedation | Insomnia / Agitation | Orthostatic Hypotension | QT | GI | Weight Gain | Sexual | Comments | |
| SSRI | Citalopram (Celexa) | 10 | 20 | 40 | 0 | 0 | 1+ | 1+ | 1+ | 1+ | 1+ | 3+ | Watch for QTc prolongation if >40 mg daily. Max dose of 20 mg in patients over 65 |
| Escitalopram (Cipralex) | 5 | 10 | 20 (30**) | 0 | 0 | 1+ | 1+ | 1+ | 1+ | 1+ | 3+ | S-isomner of Citalopram Max. dose of 10 mg in patients over 65 | |
| Fluoxetine (Prozac) | 10 | 20 | 60 | 0 | 0 | 2+ | 1+ | 1+ | 1+ | 1+ | 3+ | Long half-life useful for teenagers; however, caution in elderly Watch for drug-drug interactions | |
| Fluvoxamine (Luvox) | 50 | 100 | 300 | 0 | 1+ | 1+ | 1+ | 0 to 1+ | 2+ | 1+ | 3+ | Significant GI side effects Dosages up to 150 mg can be given at night. Divide dose above 150 mg | |
| Paroxetine (Paxil) | 10 | 20 | 50 | 1+ | 1+ | 1+ | 2+ | 0 to 1+ | 1+ | 2+ | 4+ | Short half-life; watch for discontinuation syndrome Avoid in elderly and pregnancy | |
| Sertraline (Zoloft) | 25 | 50 | 200 | 0 | 1+ | 2+ | 1+ | 0 to 1+ | 2+ | 1+ | 3+ | May be used in panic disorder; consider in postpartum | |
| Vilazadone (Viibryd) | 10 | 20 | 40 | 0 | 1+ | 1+ | 0 | 0 to 1+ | 3+ | 1+ | 0 to 1+ | Should be taken with food. Minimal sexual side effects. Significant nausea so titrate slowly. Second line treatment for depression | |
| Vortioxetine (Trintellix) | 5 | 10 | 20 | 0 | 0 | 0 | 0 | 0 | 2+ | 0 | 0 to 3+ | Sexual side effects are dose dependent Crossover when switching | |
| SNRI | Desvenlafaxine (Pristiq) | 50 | 50 | 100*** | 0 | 1+ | 2+ | 0 | 0 | 1+ | 0 | 3+ | May increase blood pressure! Watch for discontinuation syndrome |
| Duloxetine (Cymbalta) | 30 | 60 | 120*** | 0 | 0 | 2+ | 0 | 0 | 2+ | 0 | 3+ | Also approved for several pain conditions | |
| Levomilnacipran (Fetzima) | 20 | 40 | 120 | 0 | 0 | 2+ | 1+ | 0 | 2+ | 0 | 3+ | Avoid in those with uncontrolled BP or HR, CHF or recent MI Reduce dose in renal failure Palpitations and nausea common | |
| Venlafaxine XR (Effexor) | 37.5 | 75 | 225 (300**) | 0 | 1+ | 2+ | 0 | 1+ | 1+ | 0 | 3+ | May increase blood pressure! Watch for discontinuation syndrome | |
| NDRI | Bupropion XL (Welbutrin) | 150 | 300 | 300 (450**) | 0 | 0 | 2+ | 0 | 1+ | 1+ | 0 | 0 | Avoid in those prone to seizures and in eating disorder |
| NaSSA | Mirtazapine (Remeron) | 30 at hs | 30 | 45 | 1+ | 4+ | 0 | 0 | 1+ | 0 | 4+ | 1+ | Significant sedation and increased appetite. |
| Other | Pregabalin (Lyrica) | 25-50 at hs | 150 in divided doses | 600 | 0 | 2+ | 0 | 0 | 0 | 1+ | 2+ | 1+ | Increase the dose slowly to assess tolerability. Suggest increases by 25-50 mg weekly in divided doses. Consolidate the dose in the evening if daytime sedation occurs. Ataxia and peripheral edema can occur. Lower dose in renal failure. |
| Gabapentin | 50 bid | 600-900 in divided doses (tid) | 900 | 0 | 2+ | 0 | 0 | 0 | 1+ | 2+ | 1+ | Increase slowly to assess tolerability. Suggest increases by 100 mg weekly in divided doses (tid). If sedation a problem consolidate more of the dose in the evening. Ataxia and peripheral edema can occur. Lower dose in renal failure. | |
| Clomipramine | 25 at hs | 100-200 | 250 | 3+ | 3+ | 0 | 3+ | 3+ | 2+ | 2+ | 2+ | Increase slowly to 100 mg over 2 weeks, then increments of 25-50 mg every 2 weeks based on response and tolerance. Baseline ECG recommended due to risk of QT prolongation. Plasma blood levels can be used. Risk of seizures at higher doses. |
* Based on the recommendations found in the Compendium of Pharmaceuticals and Specialties (CPS)
** Consider exceeding recommended maximum dosage in special circumstances with input from psychiatry when possible
*** CPS states that no evidence of benefit above dose of desvenlafaxine 50 mg and duloxetine 60 mg