{ "schema_version": 1, "kind": "condition", "id": "obsessive-compulsive-disorder-referral", "name": "Obsessive-compulsive disorder (OCD referral pathway)", "category": "chronic", "sources": "Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552)", "review_status": "reviewed", "verified_against": "Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552) · Obsessive-Compulsive Disorder - disease-level clinical article (obsessive-compulsive-disorder-referral-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1230, "generic": "Fluoxetine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "20 mg once daily initially; if after 2 weeks response is insufficient, dose may be increased gradually up to a maximum of 60 mg daily", "adult_duration": null, "dose_source": "Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909)", "rationale": "Higher SSRI doses are routinely required for OCD compared to depression", "cautions": [ "Onset of therapeutic effect in OCD takes 8-12 weeks at maximum tolerated dose.", "Fluoxetine has a long half-life (the active metabolite norfluoxetine persists for weeks after stopping).", "Agitation, insomnia, GI upset, and sexual dysfunction are common.", "Contraindicated in combination with irreversible, non-selective monoamine oxidase inhibitors.", "Fluoxetine is contra-indicated in combination with irreversible, non-selective monoamine oxidase inhibitors." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "FLUOXETINE should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe major depressive episodes and it should not be used in other indications.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FLOROSIN 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHILOZAC 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLUOXETINE 20 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 18.6, "pack_count": 10, "unit_price": 1.86, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELEVAMOOD 20 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 56.0, "pack_count": 28, "unit_price": 2.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OCTOZAC 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHILOZAC 20MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 75.0, "pack_count": 30, "unit_price": 2.5, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROZAC 20MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ELI LILLY", "price_egp": 118.0, "pack_count": 14, "unit_price": 8.43, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLUOXETINE 20 MG H.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "obsessive-compulsive-disorder-referral" }, { "id": 1231, "generic": "Sertraline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 mg once daily initially, titrate by 50 mg steps every 2-4 weeks up to 200 mg once daily", "adult_duration": null, "dose_source": "Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501)", "rationale": "SSRI that increases synaptic serotonin availability; first-line pharmacotherapy for OCD symptoms while specialist referral is arranged.", "cautions": [ "Monitor for increased agitation and suicidal ideation early in treatment.", "Taper off gradually when discontinuing.", "Diarrhea and nausea are common early side effects.", "Never stopped abruptly - come down over at least one to two weeks or withdrawal follows.", "Watch sodium in the elderly. SSRI hyponatraemia is easy to miss and presents as confusion or a fall.", "Concomitant treatment with irreversible monoamine oxidase inhibitors (MAOIs) is contraindicated." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Age 13-17 years: Initially 50 mg once daily. Age 6-12 years: Initially 25 mg once daily.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "6 to 12 years", "age_min_months": 72, "age_max_months": 155, "dose_text": "25 mg once daily to start" }, { "label": "13 to 17 years", "age_min_months": 156, "age_max_months": 215, "dose_text": "50 mg once daily to start" } ], "peds_doses": null, "brands": [ { "trade_name": "OPIRALINE 50 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 29.0, "pack_count": 20, "unit_price": 1.45, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AGRELOCIT 50 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES", "price_egp": 34.8, "pack_count": 20, "unit_price": 1.74, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPR-STAT 50MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SESERINE 50MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 75.0, "pack_count": 30, "unit_price": 2.5, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SERPASS 50MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 102.0, "pack_count": 30, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SIRTO 50MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 34.0, "pack_count": 10, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOODAPEX 50 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LUSTRAL 50 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIATRIS", "price_egp": 136.0, "pack_count": 20, "unit_price": 6.8, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "obsessive-compulsive-disorder-referral" }, { "id": 1233, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Obsessive-Compulsive Disorder - disease-level clinical article (obsessive-compulsive-disorder-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Suicide risk assessment: OCD is significantly associated with suicidal tendencies, particularly with comorbid anxiety/depression or a prior suicide attempt.", "RED FLAG - Carry out a safety assessment for immediate risk to the patient or others, including vigilance for postpartum OCD with intrusive thoughts of harming the baby." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "obsessive-compulsive-disorder-referral" }, { "id": 1232, "generic": "Clomipramine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "25 mg at bedtime initially, titrate gradually over 2-3 weeks to 100-150 mg daily (max 250 mg daily)", "adult_duration": null, "dose_source": "Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552)", "rationale": "Potent serotonergic TCA reserved for SSRI-resistant OCD due to higher side effect burden", "cautions": [ "Cardiotoxic in overdose (QTc prolongation, arrhythmias, heart block); baseline ECG required.", "Severe anticholinergic effects, sedation, and a lowered seizure threshold can occur.", "Avoid co-administration with MAOIs or other QTc-prolonging drugs." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in children and adolescents (0 to 17 years) (safety and efficacy not established).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ANAPRAMINE 25 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 31.5, "pack_count": 30, "unit_price": 1.05, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANAFRONIL 25 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS > SANDOZ", "price_egp": 66.0, "pack_count": 30, "unit_price": 2.2, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SUPRANIL 25 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 66.0, "pack_count": 30, "unit_price": 2.2, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "obsessive-compulsive-disorder-referral" } ] }