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Doses of selective serotonin reuptake inhibitors used in the treatment of olfactory reference disorder in adults, adolescents, and older youth

Doses of selective serotonin reuptake inhibitors used in the treatment of olfactory reference disorder in adults, adolescents, and older youth
SSRI Starting dose (mg/day)* Target dose (mg/day) Supratherapeutic doses (mg/day)Δ
Fluoxetine 20 80 >80 to 120
Sertraline 50 200 >200 to 400
Escitalopram 10 30 >30 to 60
Fluvoxamine 50 300 >300 to 450
Paroxetine 20 60 >60 to 100

For use in conjunction with UpToDate content on the treatment of olfactory reference disorder. We check an electrocardiogram for changes in QT interval in all individuals treated with escitalopram ≥30 mg/day and any SSRI at supratherapeutic doses.

NOTE: Citalopram is not recommended because proarrhythmic effects may occur at higher doses.

SSRI: selective serotonin reuptake inhibitor.

* A lower starting dose and slower titration are recommended in patients who are younger (eg, <18 years), older (age >65 years), or medically compromised (eg, heart failure, kidney, or liver disease), or patients with panic disorder, medication anxiety, or known to be sensitive to drug side effects.

¶ We typically titrate at twice monthly intervals, as tolerated, to the target dose. However, the pace of titration depends on several factors (eg, side effects). If symptoms start improving at a lower dose, that dose can be tried for a longer time, and the target dose may not be needed.

Δ We gradually increase to supratherapeutic dose in patients who have not had an adequate response to a target dose of an SSRI. We typically do not exceed the target dose in younger youth (eg, 7 to <14 years) and do so cautiously in older patients (age >65 years) if a higher dose is needed. Refer to UpToDate for further discussion of supratherapeutic dosing, therapeutic trials, and adverse effects of SSRI medications.

◊ Due to cardiac conduction concerns, we do not use escitalopram in older individuals (age >65 years).
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