Many, but not all, antidepressants are available as liquid formulations, which include oral solutions or oral concentrates. These are useful in many situations—for children, those with trouble swallowing, when fine titration is required, and so on.
The following are the liquid preparations of antidepressants that are available in the US as of May 2022.
SSRIs
Citalopram (generic) 10 mg/5 mL (150 mL, 200 mL, 225 mL, 240 mL, 300 mL)
Escitalopram oral solution (generic) 5 mg/5 mL (150 mL, 240 mL, 300 mL, 450 mL, 600 mL). The escitalopram oral solution may be mixed with other liquids like water, orange juice, or apple juice (source).
Fluoxetine (generic) 20 mg/5 mL (120 mL)
Paroxetine (generic) 10 mg/5mL (250 mL)
Sertraline (generic) 20 mg/mL (60 mL). Note: Sertraline is available as an “oral concentrate”, which is not the same as an oral solution. Sertraline oral concentrate contains 20 mg per mL and it must be diluted before it is taken.
Fluvoxamine (not available as a liquid)
SNRIs
None of them is available as a liquid (desvenlafaxine ER, duloxetine, levomilnacipran, milnacipran, venlafaxine/venlafaxine ER).
Tricyclic antidepressants
Nortriptyline 10 mg/5 mL (75 mL, 115 mL, 150 mL, 300 mL, 473 mL)
MAO inhibitors
None of them is available as a liquid (phenelzine, tranylcypromine, isocarboxazid).
Other antidepressants
Bupropion/ bupropion SR/ bupropion XL—not available as a liquid
Mirtazapine—not available as a liquid
Summary
SSRIs: As of May 2022, liquid formulations are available in the US for all but one of the six SSRIs—for citalopram, escitalopram, fluoxetine, paroxetine, and sertraline, but not for fluvoxamine.
TCAs: A liquid formulation is available for nortriptyline.
Other antidepressants: A liquid formulation is NOT available for any of the serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants other than nortriptyline, or any of the MAO inhibitors.
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I believe this was widely done in the U.S. Fluoxetine is stable in acidic solutions. Alan Schatzberg’s Biological Therapies in Psych once had an article about “the end of Cranzac”.
I would have pts dissolve a 10-20mg FLX cap in 20 ounces of orange or cranberry juice and slowly titrate down their SRI dose as tolerated. Usually folks seem to benefit from encouragement to proceed slowly. Altering proportions, it becomes possible to ingest very small increments of SRI. Giving pts substantial control over the rate of titration seemed to facilitate the process and mitigate some of the distress at hving a withdrawal reaction.
Your newsletter is the ideal mix of expert opinion and evidenced based care. It is the most useful resource I’ve encountered in years. Thank you so much for your efforts!
Do you ever have patients make their own liquid formulation of fluoxetine in acidic fruit juice, typically orange or cranberry?
Hi Dr Miller. I have not done this. Please do share your experience with this, if any. At 20 mg/day, a month’s supply of fluoxetine oral solution costs $34 out of pocket per goodrx.com. Thanks!