PAD Refills
Last updated on April 1, 2025April 2025
Antidepressant medication table update
This is a 2025 update to the cost and coverage of the BC Provincial Academic Detailing Service’s 2020 Table 1: Antidepressant Drug Information found in the Antidepressants for Major Depressive Disorder PAD newsletter. For complete details on Special Authority criteria of limited coverage antidepressants, please refer to the BC PharmaCare Special Authority drug list. It is also downloadable as a PDF
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| Generic/brand name Strengths, dosage form |
Dosing Initial, maximum, dose decrease recommendations |
Annual cost BC PharmaCare |
|
|---|---|---|---|
| serotonin reuptake inhibitors | |||
| citalopram CELEXA, generics 10, 20, 30, 40 mg tablets |
initial dose | 10 to 20 mg once a day | $35 to $265 Regular benefit |
| maximum dose | 40 mg/day due to risk of QTc prolongation | ||
| reduce dose | advanced age, hepatic impairment, CYP2C19 poor metabolizer, concomitant CYP2C19 inhibitor, cimetidine | ||
| escitalopram CIPRALEX, generics 10, 15, 20 mg tablets |
initial dose | 5 to 10 mg once a day | $65 to $135 Regular benefit 15 mg: Non-benefit |
| maximum dose | 20 mg/day due to risk of QTc prolongation | ||
| reduce dose | advanced age, hepatic impairment, CYP2C19 poor metabolizer, concomitant CYP2C19 inhibitor, cimetidine | ||
| escitalopram ODT CIPRALEX ODT generics 10, 20 mg orodispersible tablets |
initial dose | 10 mg once a day dissolved on the tongue | $620 to $660 Non-benefit |
| maximum dose | 20 mg/day due to risk of QTc prolongation | ||
| reduce dose | 5 mg dose not available: cannot be used when lower doses are required (see escitalopram above) | ||
| fluoxetine PROZAC, generics 10, 20, 40, 60 mg capsules 20 mg/5 mL solution |
initial dose | 20 mg once a day in the morning (swallow capsules whole) | $135 to $395 solution: $305 to $1825 Regular benefit |
| maximum dose | 60 mg/day | ||
| reduce dose | advanced age, renal or hepatic impairment | ||
| fluvoxamine LUVOX, generics 50, 100 mg tablets |
initial dose | 50 mg at bedtime (swallow whole) | $215 to $1160 Regular benefit |
| maximum dose | 300 mg/day (maximum 150 mg per dose) | ||
| reduce dose | renal or hepatic impairment | ||
| paroxetine PAXIL, generics 10, 20, 30 mg tablets |
initial dose | 10 to 20 mg once a day in the morning | $130 to $415 Regular benefit 10 mg: Non-benefit |
| maximum dose | 50 mg/day | ||
| reduce dose | advanced age, renal or hepatic impairment | ||
| paroxetine CR PAXIL CR 12.5, 25 mg controlled-release tablets |
initial dose | 12.5 to 25 mg once a day in the morning (swallow whole) | $925 to $2935 Non-benefit |
| maximum dose | 62.5 mg/day | ||
| reduce dose | advanced age, renal or hepatic impairment | ||
| sertraline ZOLOFT, generics 25, 50, 100 mg capsules |
initial dose | 50 mg once a day with food | $60 to $265 Regular benefit |
| maximum dose | 200 mg/day | ||
| reduce dose | hepatic impairment | ||
| serotonin norepinephrine reuptake inhibitors | |||
| venlafaxine EFFEXOR XR, generics 37.5, 75, 150 mg extended -release capsules |
initial dose | 37.5 mg once a day for 4 to 7 days, then 75 mg (swallow whole) | $40 to $145 Regular benefit |
| maximum dose | 225 mg | ||
| reduce dose | renal or hepatic impairment | ||
| desvenlafaxine PRISTIQ, generics 50, 100 mg extended-release tablets |
initial dose | 50 mg once a day (swallow whole) | $925 Non-benefit |
| maximum dose | 100 mg/day | ||
| reduce dose | renal impairment | ||
| duloxetine CYMBALTA generics 30, 60 mg delayed-release capsules |
initial dose | 30 mg once a day for 7 to 14 days, then 60 mg (swallow whole) | $145 to $290 Non-benefit for depression |
| maximum dose | 60 mg/day | ||
| reduce dose | renal impairment; contraindicated in any hepatic impairment, CrCl < 30 mL/min | ||
| levomilnacipran FETZIMA 20, 40, 80, 120 mg extended-release capsules |
initial dose | 20 mg once a day for 2 days, then 40 mg (swallow whole) | $1535 to $1810 Non-benefit |
| maximum dose | 120 mg/day | ||
| reduce dose | renal impairment, CYP3A4 inhibitor; not recommended in CrCl < 15 mL/min | ||
| alpha 2 antagonist, noradrenergic, serotonergic, antihistaminic, antimuscarinic, alpha 1 antagonist | |||
| mirtazapine REMERON, generics 15, 30, 45 mg tablets |
initial dose | 15 mg once a day in the evening | $40 to $120 Regular benefit |
| maximum dose | 45 mg/day | ||
| reduce dose | advanced age, renal and hepatic impairment | ||
| mirtazapine RD REMERON RD, generics 15, 30, 45 mg orally disintegrating tablets |
initial dose | 15 mg RD once a day in the evening dissolved on the tongue | $160 to $480 Regular benefit |
| maximum dose | 45 mg RD/day | ||
| reduce dose | advanced age, renal and hepatic impairment | ||
| dopamine norepinephrine reuptake inhibitor | |||
| bupropion SR WELLBUTRIN SR generics 100, 150 mg sustained-release tablets |
initial dose | 100 to 150 mg SR once a day in the morning (swallow whole) | $210 to $725 Limited Coverage |
| maximum dose | 300 mg SR daily, divided twice a day 8 hours apart (150 mg per dose due to seizure risk (Health Canada) | ||
| reduce dose | advanced age, renal and hepatic impairment; not recommended in severe hepatic impairment | ||
| bupropion XL WELLBUTRIN XL, generics 150, 300 mg extended-release tablets |
initial dose | 150 mg XL once a day in the morning (swallow whole) | $120 to $235 Limited Coverage |
| maximum dose | 300 mg XL once a day | ||
| reduce dose | advanced age, renal and hepatic impairment; not recommended in severe hepatic impairment | ||
| serotonin reuptake inhibitor, serotonin partial agonist, serotonin antagonist | |||
| vortioxetine TRINTELLIX 5, 10, 20 mg tablets |
initial dose | 5 to 10 mg once a day | $1140 to $1295 Limited Coverage |
| maximum dose | 20 mg/day | ||
| reduce dose | advanced age, CYP2D6 poor metabolizer, concomitant CYP2D6 inhibitor | ||
| serotonin reuptake inhibitor, serotonin partial agonist | |||
| vilazodone VIIBRYD, generics 10, 20, 40 mg tablets |
initial dose | 10 mg once a day for 7 days, then 20 mg; take with food | $1205 to $1600 Non-benefit |
| maximum dose | 40 mg/day | ||
| reduce dose | concomitant strong CYP3A4 inhibitor | ||
| controlled release (CR), delayed release (DR), extended release (ER, XR, XL), orodispersible/orally disintegrating (ODT) and sustained release (SR) tablets should not be split immediate release tablets can be split into quarters to achieve lower doses PharmaCare Plan G: provides 100% coverage of eligible drug and professional fee costs (up to the maximum recognized by PharmaCare) for benefit psychiatric medications to individuals for whom the cost of these medications is a serious barrier to treatment |
|||
References: Health Canada Drug Product Database; annual wholesale cost rounded up to the nearest $5 calculated from McKesson Canada (accessed Feb 24, 2025); BC PharmaCare Formulary
2025
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2024
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- May: What is the evidence for bupropion for ADHD in adults? (PDF, 239KB)
- April: COPD inhaled medication table update (PDF, 308KB) – updated in February 2025
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- February: What is romosozumab (Evenity™) and what is the evidence for it compared to bisphosphonates? (PDF, 241KB)
- January: What is the rationale for potentially holding GLP1 agonists, such as semaglutide (Ozempic®), preoperatively? (PDF, 253KB)
2023
- December: Is 300 mg per day the target dose of bupropion (Wellbutrin®) for major depressive disorder? (PDF, 293KB)
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- February: Medications marketed in Canada for T2DM (PDF, 271KB)
- January: Melatonin supplementation in children with ADHD
2022
- December: SGLT2 inhibitors in patients with reduced kidney function (PDF, 285KB)
- November: Special Authority eForms (PDF, 321KB)
- October: Lipid-lowering medications (PDF, 303 KB)
- September: Increasing insulin glargine in people with type 2 diabetes (PDF, 253KB)
- June: The Why, Who, What, Where and How of nirmatrelvir/ritonavir (Paxlovid™) (PDF, 255KB)
- May: Osteoporosis Medication Table Update (PDF, 241KB)
- April: Can thiazides be continued in patients with chronic kidney disease when eGFR progresses below 30 mL/min/1.73m2? (PDF, 260KB)
- February: What do I need to know about sulfonylurea medications’ glucose lowering effect, dose and cost? (PDF, 247KB)
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2021
- December: Is quetiapine a safer alternative to zopiclone for insomnia? (PDF, 246KB)
- November: For people with type 2 diabetes, how does the oral daily formulation of semaglutide (Rybelsus®) compare with the subcutaneous weekly formulation (Ozempic®)? (PDF, 248KB)
- October: How does eszopiclone (Lunesta®) differ from zopiclone? (PDF, 242KB)
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- May: Hypertension Medication Table Update (PDF, 251KB)
- April: Why and how should adverse drug reactions be reported? (PDF, 257KB)
- March: Is there a relationship between mirtazapine (Remeron®) dose and sedation? (PDF, 190.5KB)
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- January: Is venlafaxine (an SNRI antidepressant) more efficacious than SSRI antidepressants for generalized anxiety disorder? (PDF, 166KB)
2020
- December: Asthma Inhaled Medication Table Update (PDF, 216KB)
- November: COPD inhaled medication table update (PDF, 307KB) – updated in November 2024
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