Thuốc ức chế tái hấp thu serotonin có chọn lọc: Dược lý, cách dùng và tác dụng phụ

HIỆU QUẢ CHO TRẦM CẢM NẶNG

Hiệu quả của thuốc ức chế tái hấp thu serotonin có chọn lọc trong điều trị trầm cảm nặng đơn cực được thảo luận riêng biệt trong bối cảnh lựa chọn chế độ điều trị ban đầu cho trầm cảm nặng và trầm cảm kháng điều trị.

QUÁ LIỀUQuá liều thuốc ức chế tái hấp thu serotonin có chọn lọc (SSRI) đơn chất hiếm khi gây tử vong hoặc để lại di chứng nghiêm trọng. SSRI (ngoại trừ citalopram và escitalopram ) có phạm vi điều trị rộng, chẳng hạn như dùng quá liều tới 30 lần liều thông thường hàng ngày thường gây ra triệu chứng nhẹ hoặc không có triệu chứng, trong khi uống nhiều hơn có thể gây buồn ngủ, run và nôn. Gần như tất cả các trường hợp tử vong do dùng quá liều SSRI đều liên quan đến liều lượng cực lớn hoặc sử dụng đồng thời các chất khác. Tổng quan nhanh về các đặc điểm lâm sàng và xử lý quá liều SSRI được cung cấp trong bảng ( bảng 5 ). Thông tin bổ sung về ngộ độc cấp tính từ SSRI được xem xét ở nơi khác.

Trong số các SSRI khác nhau, bằng chứng có chất lượng tương đối thấp cho thấy citalopram có thể gây tử vong nhiều hơn khi dùng quá liều so với các SSRI khác [ 118 ]. Một nghiên cứu hồi cứu đã kiểm tra các báo cáo gửi tới Trung tâm Kiểm soát Chất độc Hoa Kỳ bao gồm phơi nhiễm với SSRI (n >180.000) trong khoảng thời gian 15 năm [ 119 ]. Nguy cơ tử vong trên 10.000 lần phơi nhiễm đối với citalopram cao gấp ba lần so với paroxetine và đối với citalopram cao gấp năm lần so với escitalopram , fluoxetine và sertraline . Tỷ lệ tử vong tăng lên khi dùng citalopram có thể liên quan đến việc kéo dài khoảng QT phụ thuộc vào liều lượng.

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