scholarly journals Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults

2020 ◽  
Vol 34 (10) ◽  
pp. 1112-1118
Author(s):  
Rafae Wathra ◽  
Benoit H Mulsant ◽  
Lauren Thomson ◽  
Kyle W Goldberger ◽  
Eric J Lenze ◽  
...  
Keyword(s):  
Older Adults ◽  
Orthostatic Hypotension ◽  
Major Depressive ◽  
Daily Dose ◽  
Norepinephrine Reuptake Inhibitor ◽  
High Doses ◽  
Change In Mean ◽  
Serotonin Norepinephrine Reuptake Inhibitor ◽  
A Current ◽  
New Onset

Background: Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, is often used as first- or second-line therapy for depression in older adults. It can be associated with adverse blood pressure (BP) effects. Methods: Adults ⩾60 years of age in a current major depressive episode were treated in a protocolized manner with venlafaxine XR; 429 participants were treated for 8–16 weeks with a daily dose up to 300 mg to achieve remission from depression. Cardiac measures included sitting and standing BP and heart rate. Results: Of participants who were normotensive at baseline, 6.5% were found to have elevated BP during the study (1.9% <225 mg/day; 9.8% ⩾225 mg/day). There was no significant change in mean BP in the overall sample, or in the subgroup treated with doses ⩾225 mg/day. Additionally, 20.1% of the participants who did not have orthostatic hypotension at baseline were found to have orthostatic hypotension (16.8% <225 mg/day; 22.4% ⩾225 mg/day). Participants with new-onset orthostatic hypotension were significantly more likely to fall than the other participants. Conclusion: A large proportion of older adults treated with venlafaxine experience orthostatic hypotension, putting them at risk for falls. A smaller proportion experience elevated BP. Older patients prescribed venlafaxine, particularly at high doses, should be advised and counseled about these adverse effects.

A Review on Analytical Method for Determination of Venlafaxine HCl in Bulk and Pharmaceutical dosage form

2021 ◽  
pp. 208-212
Author(s):  
Swamini A Dighe ◽  
Suhas S Siddheshwar ◽  
Ganesh S Shinde
Keyword(s):  
Analytical Method ◽  
Uv Spectroscopy ◽  
Major Depressive ◽  
Pharmaceutical Dosage Form ◽  
Pharmaceutical Dosage Forms ◽  
Antidepressant Agent ◽  
Norepinephrine Reuptake Inhibitor ◽  
Depressed Person ◽  
Serotonin Norepinephrine Reuptake Inhibitor

Venlafaxine HCl is one of the antidepressant agent which comes under the category of serotonin-norepinephrine reuptake inhibitor i.e SNRI. This medication is usually used to treat major depressive disorder in adult. It may help to improve the mood and energy level and also to regain the interest in daily activities in the depressed person. The present review focus on various approaches for the analysis on Venlafaxine in bulk and pharmaceutical dosage forms. The review represents the various analytical method like the RP-HPLC, HPTLC, UV Spectroscopy and Stability Indicating Methods which were used for the investigation of Venlafaxine in bulk and different dosage formulations.

scholarly journals Emergent Antidepressant Discontinuation Syndrome Misdiagnosed as Delirium in the ICU

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Peter White ◽  
Carl L. Faingold
Keyword(s):  
Signs And Symptoms ◽  
Hernia Surgery ◽  
Icu Patients ◽  
Icu Discharge ◽  
Norepinephrine Reuptake Inhibitor ◽  
Delayed Recognition ◽  
High Doses ◽  
Serotonin Norepinephrine Reuptake Inhibitor ◽  
Norepinephrine Reuptake ◽  
Discontinuation Syndrome

We present a case of serious antidepressant discontinuation syndrome (ADDS) in a 72- year-old woman in the intensive care unit (ICU). Although this syndrome may be mild under ambulatory conditions, ICU patients can experience serious neurocognitive symptoms that are difficult to differentiate from delirium. We report delayed recognition of the ADDS in a patient in the ICU who was initially diagnosed with severe hyperactive delirium. Subsequent to hiatal hernia surgery, the patient was admitted to the ICU for aspiration and was intubated. Due to increasing agitation the patient received high doses of dexmedetomidine, fentanyl, midazolam, and propofol. The patient was treated with high doses of a serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant, duloxetine, for 2 years. However, the antidepressant was not effectively administered postsurgically due to gastroparesis. The signs and symptoms of ADDS can occur cryptogenically if they are partially masked by sedating agents. Due to concern for the discontinuation syndrome and the inability to administer duloxetine via a nasogastric tube, another SNRI, venlafaxine, was administered. Venlafaxine administration allowed unexpectedly prompt dose reduction and then total discontinuation of all sedating agents, allowing liberation from mechanical ventilation and ICU discharge. This case illustrates the importance of avoiding antidepressant discontinuation in the ICU.

Introduction: Selecting an Antidepressant

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S12) ◽  
pp. 4-7 ◽  
Author(s):  
Mark Zimmerman
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Subsequent Treatment ◽  
Major Depressive ◽  
Treatment Of Depression ◽  
Remission Rates ◽  
Norepinephrine Reuptake Inhibitor ◽  
Serotonin Norepinephrine Reuptake Inhibitor

Four years ago, my colleagues and I published an article titled “Why isn't bupropion the most frequently prescribed antidepressant?” The goal of that article was not to advocate bupropion as the preferred agent for treating depression, but rather to stimulate discussion about how psychiatrists choose an antidepressant as well as to highlight the gap between results of efficacy studies and clinical decision making in real-world practice.The argument in support of bupropion being the preferred antidepressant was based on three premises: all antidepressants are equally effective; adverse effects (AEs) of greatest concern to patients who take antidepressants are weight gain and sexual dysfunction; and bupropion does not cause either of these AEs. Acceptance of these three premises suggested the title of that article.Although many reviews of the antidepressant literature, including the revised American Psychiatric Association Practice Guideline for the Treatment of Major Depressive Disorder, conclude that antidepressants are equally effective in general, several experts in the treatment of depression have suggested that medications with >1 mechanism of action may be more effective than agents that have more selective neurotransmitter effects. In a meta-analysis of eight studies comparing the remission rates in patients treated with the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine or selective serotonin reuptake inhibitors (SSRIs), Thase and colleagues demonstrated that venlafaxine was more effective than SSRIs in achieving remission in depressed patients. However, these conclusions were tentative as most of the included studies were comparisons of venlafaxine and fluoxetine; only one study included sertraline, and there were no studies of citalopram included in the review. In addition, patients who had previously failed treatment with an SSRI were not excluded, and, although patients who fail with one SSRI may respond to subsequent treatment with another SSRI, the inclusion of SSRI failures may favor venlafaxine in comparisons with SSRIs. Lastly, all of the studies included in the meta-analysis were funded by the manufacturer of venlafaxine.

Dose-Related Paresthesias With Venlafaxine

2013 ◽  
Vol 26 (5) ◽  
pp. 514-517 ◽  
Author(s):  
Louise J. Angelo ◽  
Kelly C. Lee
Keyword(s):  
Young Male ◽  
Upper Extremities ◽  
Clinical Implications ◽  
Major Depressive ◽  
Symptoms Of Depression ◽  
Published Evidence ◽  
Patient Reported ◽  
Norepinephrine Reuptake Inhibitor ◽  
Pain Symptoms ◽  
Serotonin Norepinephrine Reuptake Inhibitor

Introduction: Venlafaxine is a serotonin norepinephrine reuptake inhibitor that is used for mood, anxiety, and pain disorders. We report a case of dose-related paresthesias in association with venlafaxine use in a patient with major depressive disorder. Case report: A young male patient with major depression started treatment with venlafaxine XR at 37.5 mg/d, and the dose was titrated to 75 mg/d with no significant adverse effects. Upon increasing the dose to 150 mg/d, the patient reported tingling, numbness, and itching in his upper extremities. The dose was reduced to 75 mg/d, at which time, the symptoms disappeared. Since the patient still had target symptoms of depression, the patient was willing to try increasing the dose back to 150 mg/d. Upon rechallenge, the tingling, numbness, and itching reappeared. The dose of venlafaxine was decreased back to 75 mg/d. Per the Naranjo scale, the probability score for the above adverse drug reaction is 5 (probable). We discuss the published evidence of paresthesias associated with antidepressants and clinical implications for recognizing paresthesias during venlafaxine treatment that may be useful for clinicians. Conclusion: Clinicians need to be aware of the possible emergence of paresthesias with venlafaxine treatment, especially at doses of ≥150 mg/day. Patients who receive venlafaxine for pain disorders should be closely monitored for worsening of pain symptoms and may require adjustment of their doses.

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