2018

2025 1

(major depression)

(behavioral and psychological symptoms

of dementia, BPSD) (delirium)

(insomnia)

35 74 2

(anxiolytic agents)

(hypnotic agents)

(antipsychotics) (antidepressants)

(mood stabilizers) 2

3 74

lorazepam zolpidem4

(atypical antipsychotics)5

6

6

( )

(Antidepressants)

(selective serotonin reuptake inhibitor, SSRI)

(dopamine

norepinephrine reuptake inhibitors, DNRI)

(sero tonin

norepinephrine reuptake inhibitor)

(norepinephrine serotonin

modulators, NSM)

(tricyclic antidepressants, TCA)

(monoamine oxidase

inhibitors, MAOI)

(serotonin syndrome)

2016 60 11 16

6

(Lancet)

mirtazapine(NSM) escitalopram(SSRI)

venlafaxine(SNRI) ser t ra l ine(SSRI)

escitalopram sertraline 6

( ) (SSRI)

1. Fluoxetine

Prozac Tab 20mg Zactin

Tab 20mg

10-40mg/day

10mg/day

8

fluoxetine

4.6 norfluoxetine

9.3

P450(Cytochrome

P450, CYP450) CYP2D6

( Ic )

(Beta-blocker)

CYP1A2

CYP3A46,9

2. Sertraline

Zoloft Tab 50mg

25-200mg/day

8 CKD stage 4

50mg/day stage 5 ESRD

25mg/day

fluoxetine

SSRI

CYP2D6 CYP1A2 CYP2C9 CYP2C19

CYP3A46,9

3. Paroxetine

S e r o x a t C R T a b

12.5mg

12.5-50mg/day

8 CKD stage 3

10mg/day

fluoxetine CYP2D66,9

2016 60 11 17

4. Citalopram Escitalopram

c i t a lopram Ci lopa

20mg escitalopram Lexapro 10mg

c i t a l o p r a m 1 0 - 4 0 m g / d a y

escitalopram 5-20mg/day

8 ci talopram

escitalopram CKD stage 3

10mg/day

escitalopram citalopram S

(S-enantiomer)

CYP450

CYP2D6

6,9

escitalopram

10

(SSRI)

SSRI

Beta-blocker

S S R I

(syndrome of inappropriate

antidiuretic hormone secretion, SIADH)

(Extrapyramidal symptoms, EPS) 6

(serotonin syndrome)

( ) (DNRI)

Bupropion

Wellbutrin SR & SMR SR

Tab 150mg Wellbutrin XL Tab 300mg

100-450mg/day

8 CKD stage 3

150mg/day

CYP2D66,9

( ) (SNRI)

1. Duloxetine

Cymbalta cap 30mg

60mg

20-60mg/day

2016 60 11 18

8 CKD stage 3

40mg/day

6

CYP2D6 CYP3A4

CYP2D6

CYP3A4

(benzodiazepines, BZDs)

(calcium channel blockers, CCBs)

(statins)9

duloxetine

2. Venlafaxine

E f e x o r X R c a p

37.5mg 75mg Valosine SR cap 75mg

37.5-225mg/day8 CKD stage 3

112.5mg/day

Duloxetine

6 CYP450

CYP2D6

(SNRI)

6

( )(norepinephrine serotonin modulators, NSM)

Mirtazapine

Remeron SolTab 30mg

15-45mg/day8 CKD stage 3

5mg/day

6

CYP4509

( )

e s c i t a l o p r a m

citalopram sertraline 11

duloxet ine

venlafaxine11

2016 60 11 19

mirtazapine

( )

(serotonin

syndrome) (TCA)

(MAOI)

(Antipsychotics)

(schizophrenia)

(BPSD) (delirium)

(typical antipsychotics)

(EPS)

(atypical antipsychotics)

EPS (dementia)

(atypical antipsychotics)

( )

1. Clozapine

Clozaril Tab 25mg

100mg6,12

50-150mg/day (Parkinson's

disease)

25-100mg/day

BPSD6

(ANC)

2000/mm3 1000/

mm3

2. Risperidone

Apa-Risdol Tab 2mg

Risperdal Tab 1mg Risperdal oral soln 1mg/

ml Risperdal consta susp for IM inj 25mg/

vial 37.5mg/vial6,12

2-3mg/day BPSD

0.25-2mg/day

(Lewy bodies dementia)

6

(hyperprolactinemia) 6

3. Paliperidone

Invega ER Tab 3mg

9mg Invega sustenna 100mg/ml 150mg/ml6,12 3-12mg/

day

Risperidone6

4. Olanzapine

Zyprexa Zydis OD Tab

5mg 10mg6,12

10-20mg/day BPSD

5-7.5mg/day

2016 60 11 20

6

6

5. Quetiapine

Seroquel tab 25mg XR

Tab 50mg 200mg Utapine Tab 200mg6,12

200-300mg/day BPSD

25-200mg/day

EPS 6

6. Aripiprazole Ziprasidone

Aripiprazole Abil i fy Tab

10mg ziprazsidone Geodon cap 40mg

6

EPS 6,13

13,14

( )

B P S D

quetiapine risperidone olanzapine

quetiapine clozapine12

(Anxiolytic agents)(Hypnotics)

B Z D

Z-drug

zolpidem(Stilnox) zaleplon(Onsleep)

zopiclone(Imovane) BZD

6

Z-drug

BZD

12 BZD15

BZD BZD

1

1 BZD 16

( ) ( )Alprazolam(Xanax) 6-27Bromazepam(Lexotan) 8-20Brotizolam(Lendormin) 3.1-8.4Lorazepam(Ativan) 10-20Estazolam(Eurodin) 10-24Clonazepam(Rivotril) 18-50

2016 60 11 21

BZD

Z-drug14

(generalized anxiety disorder,

GAD) BZD

SSRI escitalopram citalopram

sertral ine SNRI venlafaxine

duloxetine 17

1. (2016)

(105 150 )

2. Su TP, Chen TJ, Hwang SJ, et al: Utilization

of psychotropic drugs in Taiwan: an overview

of outpatient sector in 2000. Zhonghua Yi

Xue Za Zhi (Taipei) 2002; 65(8): 378–91.

3 . C h e n g J S , H u a n g W F, L i n K M , e t

a l : C h a r a c t e r i s t i c s a s s o c i a t e d w i t h

benzodiazepine usage in elderly outpatients in

Taiwan. Int J Geriatr Psychiatry 2008; 23(6):

618–24.

4. Huang WF, Lai IC: Patterns of sleep-related

medications prescribed to elderly outpatients

with insomnia in Taiwan. Drugs Aging 2005;

22(11): 957–65.

5. Wu YH, Lai CY, Chang YS: Antipsychotic

p o l y p h a r m a c y a m o n g e l d e r l y p a t i e n t s

with schizophrenia and dementia during

hospitalization at a Taiwanese psychiatric

hospital. Psychogeriatrics 2015; 15(1): 7–13.

6 . P o l l o c k B G , S e m l a T P, F o r s y t h C E :

Psychoactive drug therapy. In Jeffrey B.

Halter, Joseph G. Ouslander, Mary E. Tinetti,

Stephanie Studenski, Kevin P. High, Sanjay

Asthana, eds. Hazzard's Geriatric Medicine

and Gerontology. 6th ed, 2009. McGraw-Hill

Education / Medical publishing. Columbus.

America. P.767-778.

7. Cipriani A, Furukawa TA, Salanti G, et al:

Comparative efficacy and acceptability of 12

new-generation antidepressants: a multiple-

t reatments meta-analysis . Lancet 2009;

373(9665): 746–58.

8. Nagler EV, Webster AC, Vanholder R, et al:

Antidepressants for depression in stage 3-5

chronic kidney disease: a systematic review

2016 60 11 22

of pharmacokinetics, efficacy and safety with

recommendations by European Renal Best

Practice (ERBP). Nephrol Dial Transplant

2012; 27(10): 3736–45.

9. Spina E, Santoro V, D'Arrigo C: Clinically

relevant pharmacokinetic drug interactions

with second-generation antidepressants: an

update. Clin Ther 2008; 30(7): 1206–27.

10. Ramsberg J, Asseburg C, Henriksson M:

Effectiveness and cost-effectiveness of

antidepressants in primary care: A multiple

treatment comparison meta-analysis and

cost-effectiveness model. PLoS One 2012;

7(8) : e42003.

11. Mulsant BH, Blumberger DM, Ismai l

Z , e t a l : A s y s t e m a t i c a p p r o a c h t o

p h a r m a c o t h e r a p y f o r g e r i a t r i c m a j o r

depression. Clin Geriatr Med 2014; 30(3):

517–34.

12. Gareri P, Segura-García C, Manfredi VGL,

et al: Use of atypical antipsychotics in the

elderly: a clinical review. Clin Interv Aging

2014; 9: 1363–73.

13. Maher AR, Maglione M, Bagley S, et al:

Efficacy and comparative effectiveness of

atypical antipsychotic medications for off-

label uses in adults: a systematic review and

meta-analysis. JAMA 2011; 306(12): 1359–

69.

14. American Geriatrics Society 2015 Beers

Criteria Update Expert Panel: American

Geriatrics Society 2015 Updated Beers

Cr i te r ia fo r Po ten t ia l ly Inappropr ia te

Medication Use in Older Adults . J Am

Geriatr Soc 2015; 63(11): 2227–46.

15. Fetveit A: Late-life insomnia: a review.

Geriatr Gerontol Int 2009; 9(3): 220–34.

1 6 . H o w a r d G r e l l e r , A m i t G u p t a ,

Benzodiazepine poisoning and withdrawal.

( 2 0 1 6 ) . U p t o d a t e . R e t r i e v e d f r o m

h t t p : / / w w w. u p t o d a t e . c o m / c o n t e n t s /

benzodiazepine-poisoning-and-withdrawal

17. Andreescu C, Varon D: New Research on

Anxiety Disorders in the Elderly and an

Update on Evidence-Based Treatments. Curr

Psychiatry Rep 2015; 17(7): 53.

2016 60 11 23