Many, but not all, antidepressant medications are available as liquid formulations, which include “oral solutions” (to be taken as provided) and “oral concentrates” (must be diluted before taking). These are useful in many situations—for children, those with trouble swallowing, when very slow increases or decreases in dose are required, and so on.
The following are the liquid preparations of antidepressant medications that are available in the US.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram (generic only) 10 mg/5 mL (Prescribing Information). Available in 75 mL, 150 mL, 240 mL, 300 mL, and 450 mL packaging (source: goodrx.com).
Escitalopram oral solution (generic only) 5 mg/5 mL (Prescribing Information). Available in 150 mL, 240 mL, 300 mL, 450 mL, and 600 mL packaging (source: goodrx.com). The brand name Lexapro® oral solution is no longer available (source: Lexapro® Prescribing Information).
Fluoxetine oral solution (generic only) 20 mg/5 mL (Prescribing Information). Available only in 120 mL packaging (source: goodrx.com).
Paroxetine oral suspension (Paxil® oral suspension and generic) 10 mg/5 mL (Paxil® Prescribing Information; generic Prescribing Information). Both brand-name and generic paroxetine oral solutions are available only in 250 mL packaging (source: goodrx.com).
Sertraline oral solution (Zoloft® oral solution and generic) 20 mg/mL (Zoloft® oral solution Prescribing Information; generic Prescribing Information). Both brand-name and generic sertraline oral solutions are available only in 60 mL packaging (source: goodrx.com). Note: Sertraline oral solution is a “concentrate” that must be diluted before it is taken.
Fluvoxamine (not available in a liquid formulation)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
None of the SNRIs is available in the United States in a liquid formulation. This includes (alphabetically): desvenlafaxine extended-release, duloxetine, levomilnacipran, milnacipran, and venlafaxine/venlafaxine extended-release.
In Europe, venlafaxine is available as an oral solution (75 mg/5 mL; Summary of Product Characteristics)
Tricyclic antidepressants (TCAs)
Nortriptyline 10 mg/5 mL. Available in 75 mL, 115 mL, 150 mL, 300 mL, and 473 mL packaging (source: goodrx.com).
MAO inhibitors (MAOIs)
None of them is available as a liquid (phenelzine, tranylcypromine, isocarboxazid).
Other antidepressants
Bupropion/ bupropion sustained-release (SR)/ bupropion extended-release (XL)—not available as a liquid
Mirtazapine—not available as a liquid
Summary
SSRIs: 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!