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Osteoarthritis — MRCGP AKT MCQ

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A patient has tapered an antidepressant slowly to the smallest available tablet strength. Further proportionate reductions are needed because previous final-dose steps caused withdrawal, but the tablets cannot be divided accurately. What should be considered?

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Correct answer: B — Change to an available liquid formulation for smaller proportional dose reductions

The best answer is “Change to an available liquid formulation for smaller proportional dose reductions”. NICE recommends reducing antidepressants in stages, often using progressively smaller proportionate decrements as the dose becomes low. If very small doses have been reached and a sufficiently slow taper cannot be achieved with available tablets or capsules, a liquid preparation can be considered when one is available. Alternate-day dosing produces fluctuating exposure for most antidepressants, while imprecise crushing, abrupt cessation and substitution with a dependence-forming sedative do not provide a controlled taper.

Reference: NICE NG222: Depression in adults treatment and management: https://www.nice.org.uk/guidance/ng222/chapter/recommendations