Many will be aware of some recent challenges accessing fluoxetine and sertraline.
PHARMAC is aware of the current supply issue affecting fluoxetine cap 20 mg with disruptions to supply of fluoxetine capsules and tablets in New Zealand is not a new issue.
Sertraline Sertrona brand has no supply issues with both the supplier and ProPharma confirming availability.
Phenelzine is one of two non-reversible monoamine oxidase inhibitor (MAOI) indicated for the treatment of depression.
Link Healthcare, the supplier of phenelzine tablets, has notified PHARMAC that they can no longer supply this medication in New Zealand. Nardil is the only Medsafe registered brand of phenelzine tablets in New Zealand. Link Healthcare expect all remaining stock of Nardil, to be depleted by mid-late May 2020
People taking phenelzine will need to be changed to another antidepressant.
Please ensure no new patients are started on phenelzine
Please transition patients currently on phenelzine on to alternative treatments as soon as possible. Mental Health Subcommittee of the Pharmacology and Therapeutics Advisory Committee advise that tranylcypromine sulphate would be an appropriate alternative MAOI for patients, however:
Some GPs are still favouring fluoxetine, which was at one stage the preferred choice. There are risks associated with fluoxetine including earlier delivery, smaller for dates baby and, due to longer half-life (t1/2), more neonatal adaptation syndrome and problems.
Sertraline is the SSRI antidepressant of choice for pregnant women and may be used pre-conception through to the postnatal period and when breastfeeding.
There's good evidence showing that discontinuing antidepressant medication during pregnancy risks a relapse of depression in up to 70 per cent of women.
Try to expose the unborn baby to as few agents as possible by using the lowest effective dose. For sertraline this may be 50-150mg (rarely 200mg is required).
Current thinking is that there is:
It's a good choice in breast feeding as less than 3 per cent of maternal dose secreted into milk with metabolites often being undetectable in the baby.
Email Dr Andrew Darby, Pinnacle primary care psychiatrist.