Selective serotonin reuptake inhibitors (SSRIs) - Dosage

Dosage-Selective serotonin reuptake inhibitors (SSRIs)

Contents

1. Overview
2. Cautions
3. Dosage
4. Side effects

When prescribing selective serotonin reuptake inhibitors (SSRIs), your doctor will usually select the lowest possible dose thought necessary to improve your symptoms.

This approach is intended to reduce the risk of side effects. If the prescribed dose proves ineffective, it can be gradually increased.

SSRIs are usually taken in tablet form. Depending on the type of SSRI prescribed and the severity of your depression, you'll usually have to take 1 to 3 tablets a day.

It will usually take 2 to 4 weeks before you begin to notice the effects of SSRIs. You'll have regular meetings with your doctor when you first start taking SSRIs and you should let them know if you haven't noticed any improvement after 4 to 6 weeks. They may recommend increasing your dose or trying an alternative antidepressant.

It's usually recommended that a course of SSRIs lasts at least 6 months to prevent your condition recurring when you stop. However, if you've experienced previous episodes of depression, a 2-year course may be recommended. Some people with recurring problems are advised to carry on taking medication indefinitely.

Missed or extra doses

It's important not to miss any of your doses, because this could make your treatment less effective.

If you do miss a dose, take it as soon as you remember, unless it's almost time to take your next dose, in which case you should just skip the missed dose. Don't take a double dose to "make up" for the one you missed.

If you take more tablets than prescribed, contact your GP as soon as possible for advice. If this isn't possible, contact your local out of hours service, or call NHS 111.

Taking a double dose is unlikely to be harmful, but you should only do so if advised by a medical professional.

Stopping SSRIs

You shouldn't suddenly stop taking SSRIs, even if you feel better. Stopping suddenly can lead to withdrawal symptoms such as:

• stomach upsets
• flu-like symptoms 
• anxiety
• dizziness
• sensations in the body that feel like electric shocks
• seizures (fits)

If your GP or mental health specialist decides to stop your course of SSRIs, they'll reduce the dose gradually over a few weeks.

Antidepressants - Dosage

Dosage-Antidepressants

Contents

1. Overview
2. Uses
3. Cautions
4. Dosage
5. Side effects
6. Alternatives

When prescribing antidepressants, your GP usually selects the lowest possible dose thought necessary to improve your symptoms.

This approach is intended to reduce the risk of side effects. If this dose doesn't work, it can be gradually increased.

Antidepressants are usually taken in tablet form. Depending on the type of antidepressant prescribed and the severity of your depression, you'll usually have to take 1 to 3 tablets a day.

It usually takes around 7 days before you begin to notice the effects of antidepressants. Contact your doctor if you haven't noticed any improvement after 4 weeks, as they may recommend increasing your dose or trying a different antidepressant.

It's usually recommended that a course of antidepressants lasts at least 6 months, to prevent your condition recurring when you stop. Some people with recurrent illness are advised to carry on taking medicine indefinitely.

The recommended course of treatment largely depends on weighing up the benefits of the medicine against the side effects. If your illness is severe and the medicine is effective, treatment will often be continued. If your illness is mild and the medicine doesn't help and causes side effects, continued treatment won't be recommended.

Missed or extra doses

It's important not to miss any of your doses, as this could make your treatment less effective.

If you do miss 1 of your doses, take it as soon as you remember, unless it's almost time to take your next dose. In this case, you should just skip the missed dose. Don't take a double dose to "make up" for the 1 you missed.

If you take more tablets than prescribed, contact your GP as soon as possible for advice. If this isn't possible, contact your local out of hours service, or call NHS 111. Taking a double dose is unlikely to be harmful, but you should only do so if advised by a medical professional.

Stopping antidepressants

You shouldn't suddenly stop taking antidepressants, even if you feel better. Stopping suddenly can lead to withdrawal symptoms, such as:

• stomach upsets
• flu-like symptoms 
• anxiety 
• dizziness 
• sensations in the body that feel like electric shocks 
• seizures (fits) 

Coming off antidepressants too soon can cause your condition to return. Stopping before you have been taking them for 4 weeks may mean the medicine hasn't had a chance to take effect.

If your GP or mental health specialist decides to stop your course of antidepressants, they'll reduce the dose gradually over a few weeks.

Anticoagulant medicines - Dosage

Dosage-Anticoagulant medicines

Contents

1. Overview
2. Uses
3. Dosage
4. Considerations
5. Side effects

*Your doctor or nurse should tell you how much of your anticoagulant medicine to take and when to take it. *

If you're unsure how to take your medicine, check the patient information leaflet that comes with it or ask your anticoagulant clinic, GP or pharmacist what to do. You can also call NHS 111 for advice.

About your anticoagulant dose

For most people, anticoagulant tablets or capsules should be taken at the same time once or twice a day. It's important to take your medicine as scheduled because the effect of some anticoagulants can start to wear off within a day.

Warfarin, apixaban (Eliquis) and dabigatran (Pradaxa) should be taken with water. Rivaroxaban (Xarelto) is normally taken with food.

Depending on your dose, you may need to take more than one tablet or capsule at a time. 

Warfarin tablets come in different colours (white, brown, blue and pink) to indicate their strength. You may need to take a combination of different coloured tablets to reach your total dose. Other anticoagulants come in different strengths and colours.

Your doctor or nurse will explain how many tablets you need to take, when to take them, and what the different colours mean.

Missed or extra doses

Warfarin

If you're taking warfarinand you miss one of your doses, you should skip the dose you missed and wait to take your next scheduled dose as normal. Don't take a double dose to make up for the one you missed.

If you accidentally take a dose that was much higher than recommended, contact your anticoagulant clinic or GP for advice.

Newer anticoagulants

If you're taking apixaban or dabigatran twice a day and you miss one of your doses, you should take it as soon as you remember if it's still more than 6 hours until your next scheduled dose. If it's less than 6 hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, skip your next scheduled dose and take the following dose the next day as scheduled.

If you're taking rivaroxaban once a day and you miss one of your doses, you should take it as soon as you remember if it's still more than 12 hours until your next scheduled dose. If it's less than 12 hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, take your next dose the next day as scheduled.

Monitoring your dose

Warfarin

If you're taking warfarin, you will need regular blood tests to check how quickly your blood clots. This is measured using the international normalisation ratio (INR).

Your INR will be regularly tested at your GP surgery or anticoagulant clinic to make sure your blood doesn't clot too slowly or too quickly. Your warfarin dose will be adjusted until your INR is in the correct range.

Your INR may need to be tested every other day at first until you're on the right dose. Once your INR stabilises in the correct range, these tests will be needed less frequently.

There are now home testing kits to monitor your INR. These mean you don't need to go to your GP surgery or anticoagulant clinic for the INR test. This kit may be useful for some people, but you'll need training to use it and you'll usually need to pay for one yourself. 

Speak to your doctor or nurse if you're considering using a home testing kit.

Newer anticoagulants

If you're taking apixaban, dabigatran or rivaroxaban, you won't need to have regular blood tests to monitor your INR. 

However, you should still have appointments every few months to check you're taking your medication correctly and to discuss whether you've experienced any side effects.