Antidepressant PRN

[goodknight]

Hello,

I have a patient in clinical tomorrow on two antidepressants, Prozac and Desyril. The Desyril is PRN, Prozac is daily.

Can someone explain the rational of a PRN antidepressant to me? I have no psych knowledge (I'm in 2nd semester, that's covered in 3rd).

What type of patient can I expect with these meds?

I searched on the internet and in my drug books but didn't find anything useful.

Thanks,

Jessica

[mel82]

Desyrel is given PRN because it acts as a sleep aide. It's fairly ineffective as an antidepressant but works well as a sleep aide. That is probably why the patient is taking it.

Hope this helps,

Melanie, LPN

[goodknight]

Thanks!

I figured it must have some other use that I couldn't find. That makes sense.

[RENAISSANCE RN]

trazadone is only effective as a AD in doses over 300 mgs ( So it really is not a great AD.) So at lower doses it causes sleep. It is non addictive as well unlike some of the benzos.

[Thunderwolf, MSN, RN]

Desyrel is a good sleep aid...non-addictive as previously mentioned. It is used as a sleeper because of its sedative effects.

[Nickle]

I've seen amitriptyline (Elavil, tricyclic AD) used this way also. Tricyclics should be given at HS because they cause drowsiness.

[CharlieRN]

Amitriptyline is really dangerous to od on. If you are going to send a depressed pt out with a rx trazadone is much safer.

[Nickle]

I was speaking of the use of amitriptyline and trazadone in the acute setting for short-term use. To date, I have not seen patients sent home with prescriptions for either of these meds for use as a PRN sleep aid. It would be dangerous to overdose on Ambien, trazadone, amitriptyline, Benadryl, Tylenol PM, or any other sleep aid, for that matter.

I don't have prescriptive privileges; I don't get to decide what prescriptions a patient leaves with! :)

[CharlieRN]

Any depression pt is a high OD risk. Back when I worked ER we would get a lot of OD's. Most were treated with Ipacac, followed, after vomiting, with activated charcoal in citrate of magnesia. Most would then seem stable so they were sent where they could be observed overnight and given a psych consult. Amitriptyline OD's were sent to the ICU and put on a heart monitor overnight.

[elizabells, BSN, RN]

Any depression pt is a high OD risk. Back when I worked ER we would get a lot of OD's. Most were treated with Ipacac, followed, after vomiting, with activated charcoal in citrate of magnesia. Most would then seem stable so they were sent where they could be observed overnight and given a psych consult. Amitriptyline OD's were sent to the ICU and put on a heart monitor overnight.

Amytriptyline can cause heart palpitations even in non-OD situations if it's stacked on top of an SSRI, as well. I was given it as adjuvant chronic pain therapy and ended up in the ER as I was also taking Lexapro, Bextra, and Xanax...

[Nickle]

Right - the tricyclics pose a risk of causing arrhythmias, that's why pt's should have a baseline EKG before starting therapy. Does this happen? No . . . Add in an SSRI and you're in deep trouble.