NUR 647 Medication Guide 3 Antidepressant
Psychiatric Medication Guide
Instructions:
For each category, select at least 3 medications. Complete all fields: Brand name, Generic name, Starting dose, Dosage range, Monitoring needed, Common side effects, Dangerous side effects, and Clinical pearls.
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Antipsychotics
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Risperdal | Risperidone | 1 mg/day (divided BID) | 2–6 mg/day | Weight, BMI, glucose, lipids, prolactin, EPS symptoms | Sedation, weight gain, hyperprolactinemia | Tardive dyskinesia, NMS, QT prolongation | Higher EPS risk at >6 mg/day, prolactin elevation common (Juki et al., 2022) |
| Geodon | Ziprasidone | 20 mg BID with food | 40–80 mg BID | ECG (QT interval), metabolic panel, weight | Nausea, dizziness, somnolence | QT prolongation, torsades de pointes | Must be taken with at least 500 kcal meal for absorption |
| Clozaril | Clozapine | 12.5 mg once or twice daily | 300–900 mg/day | CBC weekly ×6 months (then q2w), ANC, metabolic panel | Sedation, sialorrhea, weight gain, constipation | Agranulocytosis, myocarditis, seizures | Most effective for treatment-resistant schizophrenia, requires REMS enrollment (Stahl, 2021) |
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Mood Stabilizers
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Lithobid | Lithium carbonate | 300 mg 2–3× daily | Target serum level: 0.6–1.2 mEq/L | Serum lithium level 5–7 days after dose change, renal and thyroid function q6–12 months, electrolytes | Tremor, thirst, polyuria, weight gain, GI upset | Toxicity (confusion, ataxia, seizures), nephrotoxicity, hypothyroidism, arrhythmias | Narrow therapeutic index, maintain hydration and stable sodium intake, avoid NSAIDs unless cleared (Stahl, 2021) |
| Depakote | Divalproex sodium / Valproic acid | 10–15 mg/kg/day divided doses | 50–125 mcg/mL (therapeutic level) | LFTs, CBC with platelets, drug levels after 3–5 days, pregnancy test in women of childbearing age | Nausea, tremor, alopecia, weight gain, sedation | Hepatotoxicity, pancreatitis, thrombocytopenia, teratogenic effects | Avoid in pregnancy (high teratogenic risk), may be preferred for rapid cycling or mixed states |
| Tegretol | Carbamazepine | 200 mg twice daily | 600–1200 mg/day (serum 4–12 mcg/mL) | CBC, liver function tests, electrolytes, carbamazepine levels | Drowsiness, dizziness, blurred vision, nausea | Agranulocytosis, aplastic anemia, Stevens-Johnson Syndrome (esp. in HLA-B*1502 allele carriers) | Strong enzyme inducer (many drug interactions), check genetics in Asian patients, may worsen absence seizures (Rybakowski, 2023) |
| Trileptal | Oxcarbazepine | 300 mg twice daily | 900–2400 mg/day | Sodium levels, renal function | Dizziness, headache, fatigue, double vision | Hyponatremia, rare Stevens-Johnson Syndrome, suicidal ideation (Stahl, 2021) | Similar to carbamazepine, but with fewer interactions, a higher risk of hyponatremia, no autoinduction of metabolism
(Rybakowski, 2023) |
| Topamax | Topiramate | 25–50 mg/day | 100–400 mg/day | Bicarbonate levels, renal function, eye exams | Cognitive slowing, weight loss, paresthesias, fatigue | Kidney stones, acute angle-closure glaucoma, metabolic acidosis (Stahl, 2021) | Helpful for patients with obesity, avoid in patients at risk for kidney stones, may reduce the effectiveness of oral contraceptives |
| Lamictal | Lamotrigine | 25 mg daily (titrate slowly) | 100–200 mg/day | Monitor for rash during titration, adherence, drug interactions (e.g., valproate) | Headache, dizziness, blurred vision, insomnia(Stahl, 2021) | Stevens-Johnson syndrome, toxic epidermal necrolysis | Titrate over 6–8 weeks to minimize rash risk, preferred for bipolar depression maintenance |
Antidepressants
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Elavil | Amitriptyline (TCA) | 25 mg at bedtime | 25–150 mg/day | Blood pressure, ECG in older adults, anticholinergic burden | Dry mouth, constipation, blurred vision, sedation | Cardiac arrhythmias, seizures, lethal overdose risk | Very sedating, helpful for insomnia and neuropathic pain, avoid in cardiac disease (Meyer et al., 2022) |
| Prozac | Fluoxetine | 10–20 mg daily | 20–80 mg daily | Weight, sleep, mood changes, suicidal thoughts in early phase | Nausea, insomnia, headache, anxiety | Serotonin syndrome, QT prolongation | Long half-life; good for patients with poor adherence; activating—best taken in the morning (Meyer et al., 2022) |
| Zoloft | Sertraline | 25–50 mg daily | 50–200 mg daily | Liver function, mood, sexual side effects | GI upset, fatigue, insomnia | Serotonin syndrome, hyponatremia (SIADH) | Safe in elderly and cardiac patients; taper slowly to avoid withdrawal (Procyshyn et al., 2025) |
| Cymbalta | Duloxetine | 30 mg daily | 30–120 mg daily | Blood pressure, liver function, mood | Dry mouth, constipation, fatigue | Hepatotoxicity, serotonin syndrome
(Meyer et al., 2022) |
Useful for patients with pain syndromes (neuropathy, fibromyalgia); avoid in liver disease |
| Wellbutrin | Bupropion (NDRI) | 150 mg once daily (XL) | 150–450 mg/day | Monitor for anxiety, blood pressure, seizure history | Insomnia, dry mouth, tremor, anxiety | Seizures at >450 mg/day, hypertensive crisis (rare) | No sexual side effects, weight-neutral, activating — avoid in eating disorders |
| Remeron | Mirtazapine | 15 mg at bedtime | 15–45 mg/day | Weight, CBC (rare agranulocytosis), lipid panel | Sedation, weight gain, increased appetite | Agranulocytosis (rare), serotonin syndrome (if combined) | Sedating at lower doses, appetite stimulant, good for underweight or insomnia patients |
Anxiolytics / OCD
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Ativan | Lorazepam (benzodiazepine) | 0.5–1 mg BID–TID | 1–6 mg/day | Sedation level, cognitive effects, risk of dependence | Drowsiness, fatigue, dizziness | Respiratory depression, withdrawal seizures, delirium (with abrupt stop) | Shorter half-life than diazepam, safer in liver impairment |
| Klonopin | Clonazepam (benzodiazepine) | 0.25–0.5 mg BID | 0.5–4 mg/day | Sedation and cognitive effects taper slowly. | Somnolence, impaired coordination | Severe withdrawal if stopped abruptly, respiratory depression | Longer half-life, less frequent dosing than lorazepam |
| Anafranil | Clomipramine (TCA for OCD) | 25 mg at bedtime | 100–250 mg/day | ECG (QT prolongation risk), BP, anticholinergic burden | Dry mouth, constipation, blurred vision, sedation | Seizures (dose-related), arrhythmias, lethal overdose risk | Gold standard for severe OCD, titrate slowly to reduce side effects |
Chronic Pain
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Lyrica | Pregabalin | 50 mg TID | 150–600 mg/day (divided) | Weight, renal function (dose adjust if impaired), sedation | Dizziness, somnolence, weight gain, edema | Angioedema, suicidal thoughts, respiratory depression (with CNS depressants) | Effective for neuropathic pain, fibromyalgia, and GAD; taper gradually to avoid withdrawal. |
| Neurontin | Gabapentin | 300 mg at bedtime | 900–3600 mg/day (divided) | Renal function, sedation, misuse potential | Drowsiness, fatigue, ataxia | Severe respiratory depression (with opioids), misuse/abuse potential | Titrate slowly, useful for neuropathic pain, postherpetic neuralgia (Procyshyn et al., 2025) |
| Cymbalta | Duloxetine (SNRI) | 30 mg daily | 30–120 mg/day | Blood pressure, LFTs if risk factors | Nausea, constipation, sweating, fatigue | Hepatotoxicity (rare), serotonin syndrome | Dual benefit for pain and depression/anxiety, good option for fibromyalgia and diabetic neuropathy |
Sleep
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Desyrel | Trazodone | 25–50 mg at bedtime | 50–150 mg/night | Monitor for daytime sedation, orthostatic BP | Sedation, dizziness, dry mouth | Priapism (rare), cardiac arrhythmia | Very commonly used off-label for insomnia, good choice in depressed patients |
| Rozerem | Ramelteon | 8 mg at bedtime | 8 mg nightly | Monitor for mood changes, next-day sedation | Fatigue, dizziness, nausea | Severe allergic reactions (rare), depression worsening | Melatonin receptor agonist, no abuse potential, safe for long-term use |
| Silenor | Doxepin (low-dose) | 3–6 mg at bedtime | 3–6 mg nightly | Monitor for anticholinergic effects, QT interval if cardiac risk | Dry mouth, drowsiness | QT prolongation at high doses | Low-dose formulation FDA-approved for insomnia, avoid in severe urinary retention |
ADHD
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Adderall XR | Mixed amphetamine salts (ER) | 10 mg once daily | 10–40 mg/day | BP, HR, weight, mood, misuse risk | Appetite loss, dry mouth, anxiety, insomnia | Cardiovascular events, serotonin syndrome (with MAOIs), psychosis | Long-acting stimulant, convenient once-daily dosing, monitor for diversion/misuse |
| Vyvanse | Lisdexamfetamine | 30 mg once daily | 30–70 mg/day | BP, HR, weight, appetite, mood | Decreased appetite, insomnia, irritability | Hypertensive crisis, psychosis, sudden cardiac death (rare) | Prodrug, lower abuse potential than other stimulants, smooth onset/offset |
| Intuniv | Guanfacine ER | 1 mg at bedtime | 1–4 mg/day | BP, HR, sedation level | Fatigue, dizziness, dry mouth | Hypotension, bradycardia, syncope | Non-stimulant alpha-2 agonist, helpful for impulsivity and tics, taper slowly to avoid rebound hypertension |
Dementia
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Aricept | Donepezil | 5 mg once daily (bedtime) | 5–10 mg/day | Weight, HR (bradycardia risk), GI tolerance | Nausea, diarrhea, insomnia, muscle cramps | Bradycardia, syncope, GI bleed (rare) | Once-daily dosing can be used in all dementia stages, taken at night to limit nausea |
| Exelon | Rivastigmine | 1.5 mg BID (capsule) or 4.6 mg/24 hr (patch) | 3–6 mg BID (capsule) or up to 13.3 mg/24 hr (patch) | Weight, GI side effects, skin reaction (patch) | Nausea, vomiting, dizziness, anorexia | Severe GI intolerance, bradycardia, allergic dermatitis (patch) | Patch preferred for patients with poor adherence or GI intolerance (Agravat, 2024) |
| Namenda | Memantine | 5 mg daily | 10 mg BID (IR) or 28 mg daily (XR) | Renal function, cognitive response | Dizziness, headache, constipation, confusion | Stevens-Johnson syndrome (rare), hypertension | NMDA receptor antagonist, used for moderate-to-severe dementia, can be combined with donepezil |
Addiction / Controlled Substances
| Brand Name | Generic Name | Starting Dose | Dosage Range | Monitoring Needed | Common Side Effects | Dangerous Side Effects | Clinical Pearls |
| Suboxone | Buprenorphine/Naloxone | 2–4 mg SL daily (induction) | 8–24 mg/day (maintenance) | Liver function, urine drug screens, adherence | Constipation, sweating, insomnia, headache | Respiratory depression (with other sedatives), precipitated withdrawal | Start once moderate withdrawal is present (COWS >8), first-line for opioid use disorder (Meyer et al., 2022) |
| Vivitrol | Naltrexone (IM) | 380 mg IM every 4 weeks | Fixed monthly dose | LFTs, opioid-free status (must be off opioids 7–10 days) | Injection site pain, nausea, fatigue | Hepatotoxicity (rare), risk of overdose if opioids used after discontinuation | Good for motivated patients, reduces alcohol and opioid cravings, no abuse potential |
| Methadose | Methadone | 20–30 mg PO (induction under supervision) | Maintenance: 60–120 mg/day | ECG (QT prolongation), respiratory status, urine drug screens | Constipation, sweating, drowsiness | Respiratory depression, QT prolongation, overdose risk | Dispensed in certified OTPs, very effective for long-term opioid use disorder management |
References
Agravat, M. (2024). Psychotropic medications. OrangeBooks Publication.
Jukic, M., Milosavljević, F., Molden, E., & Ingelman-Sundberg, M. (2022). Pharmacogenomics in treatment of depression and psychosis: An update. Trends in Pharmacological Sciences, 43(12), 1055-1069. https://doi.org/10.1016/j.tips.2022.09.011
Meyer, J. S., Meyer, J., Farrar, A. M., Biezonski, D., & Yates, J. R. (2022). Psychopharmacology: Drugs, the brain, and behavior. Oxford University Press.
Procyshyn, R. M., Halpape, K., & Kim, D. D. (Eds.). (2025). Clinical handbook of psychotropic drugs. Hogrefe Publishing.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.
Rybakowski, J. K. (2023). Mood stabilizers of first and second generation. Brain Sciences, 13(5), 741. https://doi.org/10.3390/brainsci13050741