Indication Guides Dosing – Primidone and Escitalopram
There are numerous examples of where the indication guides dosing. It is important as a pharmacist to remember this when you see unusual doses. I wanted to share a couple of examples that I came across recently.
When using psychiatric medications, we must recognize how important the diagnosis is. I was reviewing a medication list the other day and noticed that a patient was taking escitalopram 40 mg daily. This isn’t a very common dose for depression, but I did recall that this dose is indicated in PTSD. When using escitalopram, many won’t go above 20 mg per day.
Indeed, when I further reviewed the patient history, a diagnosis of PTSD was noted. This is an appropriate dose in PTSD and was effective and tolerable for this patient.
Indication Guides Dosing – Primidone
When you go and look up primidone in a drug reference, one of the first things you might notice is that it is listed as a seizure medication. It certainly can be used for that, however, the number of times I’ve seen this done is very low. It has lots of adverse effects and potential drug interactions. By far, the most common indication that I see the medication used for is essential tremor.
You must do your due diligence and review the patient history, but the dosing will likely be indicative of what primidone is being used for. The usual dosage range for seizures is in the 750-1500 mg/day range. When using this medication for essential tremor, the usual dosage range is between 250-750 mg/day. In the primarily geriatric patient population that I work with, I rarely see doses greater than 300 mg/day when the drug is being used for essential tremor.
When you see doses that you don’t typically haven’t seen in practice, remember to recognize that the indication guides dosing. Take the time to review the literature and make sure that you understand which dosages are appropriate for each indication. I hope these examples on dosing and indication can help you quickly identify something that may not seem right.
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