Clinician tool
Psychotropic medication reference
AI-assisted — clinician review required.Prompts, checklists, and any suggested language here are a scaffold, not clinical advice. Confirm accuracy, apply your professional judgment, and follow your agency's policies and NH statute before anything enters the record.
SSRIs — Selective Serotonin Reuptake Inhibitors
First-line for depression and most anxiety disorders. They raise available serotonin and generally take 4–6 weeks for full effect.
Monitoring: Watch for early activation/agitation, mood or suicidality changes (especially early and in youth), serotonin syndrome if combined with other serotonergic agents, and a flu-like discontinuation syndrome if stopped abruptly.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| fluoxetine | Prozac | 20–80 mg/day | GI upset, sexual dysfunction, insomnia/activation, headache; long half-life so less discontinuation syndromeBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| sertraline | Zoloft | 50–200 mg/day | GI upset and diarrhea, sexual dysfunction, activation, sweatingBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| escitalopram | Lexapro | 10–20 mg/day | Generally well tolerated; nausea, sexual dysfunction, fatigue, mild QT effect at high doseBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| citalopram | Celexa | 20–40 mg/day (max 20 mg over 60 yr / hepatic impairment) | Nausea, sexual dysfunction, dose-dependent QT prolongation — hence the 40 mg ceilingBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| paroxetine | Paxil | 20–50 mg/day | Most anticholinergic and sedating SSRI; weight gain, sexual dysfunction, marked discontinuation syndrome (short half-life)Black-box: Increased suicidal thoughts/behavior in patients under 25. |
| fluvoxamine | Luvox | 50–300 mg/day | Nausea/sedation; many drug interactions (potent CYP1A2 inhibitor); often used for OCDBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
SNRIs — Serotonin-Norepinephrine Reuptake Inhibitors
Used for depression, generalized anxiety, and some for chronic/neuropathic pain. They act on both serotonin and norepinephrine.
Monitoring: Check blood pressure (dose-dependent rise, especially venlafaxine), watch for discontinuation syndrome, and screen for the same early mood/suicidality changes as SSRIs.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| venlafaxine | Effexor XR | 75–225 mg/day | Nausea, sweating, dose-dependent hypertension, notably difficult discontinuation syndromeBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| duloxetine | Cymbalta | 30–120 mg/day | Nausea, dry mouth, fatigue, sweating; also used for neuropathic pain and fibromyalgia; avoid in significant hepatic diseaseBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| desvenlafaxine | Pristiq | 50–100 mg/day | Active metabolite of venlafaxine; nausea, sweating, BP elevationBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
| levomilnacipran | Fetzima | 40–120 mg/day | More noradrenergic; increased heart rate and BP, urinary hesitancy, nauseaBlack-box: Increased suicidal thoughts/behavior in patients under 25. |
Atypical (Second-Generation) Antipsychotics
Used for psychosis and bipolar disorder, and often added (adjunctively) to antidepressants for depression. They act on dopamine and serotonin receptors.
Monitoring: Track weight/BMI, waist, fasting glucose and lipids for metabolic syndrome; use the AIMS exam to screen for tardive dyskinesia; watch for EPS, akathisia (inner restlessness), sedation, prolactin elevation, and QT prolongation.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| aripiprazole | Abilify | 10–30 mg/day (2–15 mg as antidepressant add-on) | Akathisia/restlessness, activation, insomnia; more weight-neutral; rare impulse-control behaviorsBlack-box: Increased mortality in elderly with dementia-related psychosis; suicidality under 25 when used in depression. |
| quetiapine | Seroquel | 50–800 mg/day (low doses often used for sleep) | Sedation, weight gain, orthostatic hypotension, metabolic effectsBlack-box: Increased mortality in elderly with dementia-related psychosis; suicidality under 25 when used in depression. |
| risperidone | Risperdal | 1–6 mg/day | Dose-dependent EPS, the most prolactin elevation of the group (galactorrhea, menstrual changes), weight gainBlack-box: Increased mortality in elderly with dementia-related psychosis. |
| olanzapine | Zyprexa | 5–20 mg/day | Among the highest weight gain and metabolic risk; sedation, dyslipidemia, glucose elevationBlack-box: Increased mortality in elderly with dementia-related psychosis. |
| lurasidone | Latuda | 20–160 mg/day | More weight-neutral; akathisia, nausea, sedation. Must be taken with food (≥350 kcal) for absorptionBlack-box: Increased mortality in elderly with dementia-related psychosis; suicidality under 25 when used in depression. |
| ziprasidone | Geodon | 40–160 mg/day | More weight-neutral; QT prolongation is the key concern; sedation. Must be taken with foodBlack-box: Increased mortality in elderly with dementia-related psychosis. |
| paliperidone | Invega | 3–12 mg/day (also long-acting injectable) | Active metabolite of risperidone; prolactin elevation, EPS, weight gainBlack-box: Increased mortality in elderly with dementia-related psychosis. |
| clozapine | Clozaril | 300–450 mg/day (up to 900 mg) | Reserved for treatment-resistant schizophrenia; sedation, hypersalivation, weight gain, constipation, seizuresBlack-box: Agranulocytosis (REMS with mandatory ANC monitoring); seizures; myocarditis; orthostatic hypotension/syncope; plus increased mortality in elderly with dementia-related psychosis. |
Mood Stabilizers
Used for bipolar disorder to reduce mania and stabilize mood, and some (lithium) to reduce suicide risk. Several are also anticonvulsants.
Monitoring: Most require blood-level and organ monitoring; several carry serious rash and organ-toxicity risks and are teratogenic — pregnancy status matters.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| lithium | Lithobid / Eskalith | 600–1200 mg/day (target level 0.6–1.2 mEq/L) | Narrow therapeutic index — tremor, thirst/polyuria, weight gain; toxicity causes confusion, ataxia, seizures. Monitor levels, renal function, thyroid, calcium |
| valproate / divalproex | Depakote | 750–2000 mg/day (target level 50–125 µg/mL) | Weight gain, tremor, hair loss, thrombocytopenia; monitor LFTs, CBC, and levelBlack-box: Hepatotoxicity; pancreatitis; teratogenicity (neural tube defects, lowered IQ) — avoid in pregnancy. |
| lamotrigine | Lamictal | 100–200 mg/day (slow titration over weeks) | Well tolerated at steady state; headache, dizziness. Any new rash needs urgent evaluation. Titrate slowly and never restart at full dose after a gapBlack-box: Serious, potentially fatal rash (Stevens-Johnson syndrome / toxic epidermal necrolysis), higher with rapid titration. |
| carbamazepine | Tegretol | 400–1200 mg/day (target level 4–12 µg/mL) | Sedation, dizziness, hyponatremia; strong CYP3A4 inducer with many interactions; monitor CBC, LFTs, sodium, levelBlack-box: Aplastic anemia and agranulocytosis; serious dermatologic reactions (SJS/TEN) — test HLA-B*1502 in at-risk ancestries before starting. |
Anxiolytics & Sedative-Hypnotics
Used for short-term anxiety, panic, agitation, and insomnia. Benzodiazepines act fast but carry tolerance and dependence risk; the non-benzo options are safer for longer use.
Monitoring: For benzodiazepines, watch for sedation, falls (especially in elders), cognitive slowing, tolerance, and physiologic dependence — abrupt withdrawal can cause seizures. Avoid combining with opioids or alcohol.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| lorazepam | Ativan | 0.5–2 mg, 2–3× daily as needed | Sedation, dizziness, dependence; no active metabolites so often used in liver disease/elderlyBlack-box: Concomitant use with opioids can cause profound sedation, respiratory depression, and death; risk of dependence and withdrawal. |
| alprazolam | Xanax | 0.25–1 mg, 2–3× daily as needed | Fast onset, short-acting; high dependence and inter-dose rebound anxiety risk; difficult taperBlack-box: Concomitant use with opioids can cause profound sedation, respiratory depression, and death; risk of dependence and withdrawal. |
| clonazepam | Klonopin | 0.5–2 mg, 1–2× daily | Longer-acting, smoother coverage; sedation, dependence, cognitive effectsBlack-box: Concomitant use with opioids can cause profound sedation, respiratory depression, and death; risk of dependence and withdrawal. |
| diazepam | Valium | 2–10 mg, 2–4× daily as needed | Long half-life with active metabolites — accumulation in elderly; sedation, muscle relaxation, dependenceBlack-box: Concomitant use with opioids can cause profound sedation, respiratory depression, and death; risk of dependence and withdrawal. |
| buspirone | BuSpar | 15–60 mg/day (divided) | Non-benzodiazepine, non-sedating, no dependence; dizziness, nausea. Takes weeks to work; for generalized anxiety, not acute panic |
| hydroxyzine | Vistaril / Atarax | 25–100 mg up to 4× daily as needed | Antihistamine used for anxiety/insomnia; sedation, dry mouth, anticholinergic effects; no dependence |
| zolpidem | Ambien | 5–10 mg at bedtime | Z-drug hypnotic for insomnia; complex sleep behaviors (sleep-driving/eating), next-day impairment, dependence with prolonged use |
Stimulants & ADHD Medications
Used mainly for ADHD (and stimulants also for narcolepsy). Stimulants boost dopamine/norepinephrine; the non-stimulants are alternatives when abuse risk, tics, or side effects are concerns.
Monitoring: Screen cardiovascular history and check blood pressure and heart rate; monitor appetite, weight, sleep, and (in youth) growth; watch for new or worsening anxiety, tics, or mood changes.
| Generic | Brand | Typical adult dose | Common side effects & warnings |
|---|---|---|---|
| methylphenidate | Ritalin / Concerta | 18–72 mg/day (extended-release) | Decreased appetite, insomnia, headache, increased heart rate/BP, irritability as it wears offBlack-box: High potential for abuse and dependence; assess for cardiac risk before use. |
| amphetamine / dextroamphetamine | Adderall | 5–40 mg/day (XR up to ~30 mg) | Appetite suppression, insomnia, elevated BP/HR, anxiety, potential for misuseBlack-box: High potential for abuse and dependence; assess for cardiac risk before use. |
| lisdexamfetamine | Vyvanse | 30–70 mg/day | Prodrug (activated in the body), giving smoother onset and somewhat lower misuse potential; appetite loss, insomnia, dry mouthBlack-box: High potential for abuse and dependence; assess for cardiac risk before use. |
| atomoxetine | Strattera | 40–100 mg/day | Non-stimulant (norepinephrine reuptake inhibitor); no controlled-substance status; nausea, appetite loss, fatigue, BP/HR increase. Takes weeks for full effectBlack-box: Increased suicidal ideation in children and adolescents. |
| guanfacine | Intuniv | 1–4 mg/day (extended-release) | Non-stimulant alpha-2 agonist; sedation, low blood pressure, dry mouth; taper to stop (rebound hypertension). Helpful for hyperactivity and tics |
Doses and warnings change. Ranges, black-box warnings, and monitoring requirements are updated frequently and vary by patient. Use this only as a memory jog and verify every detail against current prescribing information (FDA labeling or a current drug reference), and route any medication questions back to the treating prescriber.