Selective serotonin reuptake inhibitor (SSRI) formulations suggested for adults with swallowing difficulties

Karoline Brennan, Senior Medicines Information Pharmacist, North West Medicines Information CentrePublished

A range of selective serotonin reuptake inhibitors (SSRIs) are suitable for adults with swallowing difficulties.

Licensed medicines in suitable formulations

There are no suitable licensed formulations of sertraline or fluvoxamine. Other SSRIs are available in suitable formulations and may be preferred.

Citalopram 40mg/ml oral drops

Available as a licensed product and should be mixed with water, orange juice or apple juice before administration.  They have an expiry of 16 weeks once opened and do not require fridge storage.
Note: Citalopram drops are not bioequivalent to citalopram tablets; four drops (8mg) is equivalent in effect to one 10mg tablet.

Escitalopram 20mg/ml oral drops

Available as a licensed product and can be mixed with water, apple juice or orange juice before administration. They have an eight-week expiry once opened and do not require fridge storage.

Fluoxetine 20mg/5ml oral solution

Available as a licensed product. Some brands have a one-month expiry once opened (check the relevant SPC for details); they do not require fridge storage.

Fluoxetine 20mg dispersible tablets

Available as a licensed product. A whole or half tablet can be dispersed in half a glass of water. The tablets should not be crushed or chewed.

Paroxetine 10mg/5ml oral suspension

Available as a licensed product. It has an expiry of one month once opened and does not require fridge storage.

Licensed medicines used in an unlicensed manner

Citalopram, escitalopram, paroxetine or sertraline tablets

Can be crushed and/or dispersed in water, or crushed and given with soft food. The tablets are film-coated and contents may taste bitter or unpleasant. Crushed sertraline and paroxetine tablets may have a local anaesthetic effect on the tongue.

Fluoxetine capsules

Can be opened and the contents dispersed in water or given with soft food.

Special-order medicines

In view of the licensed products available, special-order preparations may not be required.

The following is listed in Part VIIIB of the Drug Tariff.

Sertraline oral suspension

Available as 25mg/5ml, 50mg/5ml and 100mg/5ml oral suspensions