1.3. Renal Impairment

Many antidepressants do not require significant dosage modifications in renal impairment. However, dosage guidelines for select SSRIs in renal impairment are available. Table 5 summarizes dosage modifications and/or restrictions for specific SSRI antidepressant medications.

Table 5: Select SSRI Antidepressant Dosage Modifications in Renal Impairment^{1-5, 12-13}

Drug Name	Dosage in Renal Impairment
Citalopram	Severe renal impairment (creatinine clearance less than 20 mL/min): use cautiously, as specific dosage guidelines not available
Escitalopram	Severe renal impairment (creatinine clearance less than 20 mL/min): use cautiously, as specific dosage guidelines not available
Paroxetine (Paxil®, Pexeva®, Paxil CR®)	Serum levels, AUC increase as renal function declines; therefore, maximum doses when creatinine clearance less than 30 mL/min are: IR: 40 mg/day CR: 50 mg/day

Legend:

• CR = controlled-release
• IR = immediate-release