The Effect of Serotonin-Norepinephrine Reuptake Inhibitor Milnacipran on Anxiety-like Behaviors in Diabetic Mice

Background: Diabetes mellitus is a chronic disease that causes neuronal plasticity and increased hypothalamic pituitary adrenal (HPA) axis of stress disorders. The change in metabolism is reportedly associated with inadequate response to antianxiety and antidepressant agents. Objective: This study aimed to determine the effect of milnacipran antidepressants on anxiety-like behavior in mice with diabetes mellitus. Methods: Male ICR mice were divided into naive, stress, diabetes mellitus (DM), DM + stress groups to measure anxiety-like behavior. Diabetes mellitus was induced using alloxan, and electric footshock stress was used as a stressor for 14 consecutive days. Anxiety-like behavior was measured using the light-dark box (LDB) and elevated plus maze (EPM) test at days 0, 7 and 14. The antidepressant milnacipran (MIL) was given for 7 days, on days 8 to 14. On day 14, evaluation of anxiety-like behavior after administration of MIL was carried out in all groups using LDB and EPM tests. Results: The results showed that administration of milnacipran effectively ameliorated anxiety-like behavior in the non-DM, but not in the DM group, using the LDB test. A similar result was demonstrated in the EPM test showing the non-DM group's attenuation after milnacipran administration. Conclusion: The present results indicate that there is an inadequate attenuation of the anxiety-like behavior after treatment with milnacipran in diabetes conditions.

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

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.

EFFICACY AND SAFETY OF DULOXETINE IN THE TREATMENT OF CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: One of the adverse effects of chemotherapy in the neurological field is chemotherapy-induced peripheral neuropathy (CIPN), it was an adverse effect caused by many chemotherapeutic regimens and a major cause of continuous pain in patients who survived cancer. When the symptoms get worse, survivor’s quality of life is declining and they are often having problems with mental health, insomnia, cognitive functioning, fatigue, physical functioning, and pain. So far the choice of therapy for CIPN is still limited. Now, there was no drug approved to treat pain due to CIPN. Duloxetine are a SNRI (serotonin norepinephrine reuptake inhibitor), which it’s useful in CIPN are highly supported by evidence. Methods: We conducted a systemactic-computer based literature search on January 4, 2019 in PubMed database for article published between 2013 and 2018. We searched for a literature related with used a duloxetine for management of chemotherapy induced peripheral neuropathy. Results: From the 4 studies that included in this review, the total participants are 478 patients with neuropathic pain and already get a chemotherapy regiment. From the meta-analysis showed one study had no effect, two studies had small effect, and one study had medium effect. Conclusion: Duloxetine is a great option for the treatment of CIPN in especially reducing neuropathic pain.

Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults

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.

THU0644-HPR TRENDS IN DIAGNOSIS AND TREATMENT OF FIBROMYALGIA AMONG MEXICAN PHYSICIANS.

Background:Fibromyalgia (FM) is a disease characterized by widespread pain which affects 2-8% of the population. Previous studies have shown lack of awareness of classification criteria and accompanying symptoms of FM, as well as heterogeneity in the management of these patients among both rheumatologist and non-rheumatologist physicians.Objectives:The objective of this study was to explore the trends in diagnosis and management of fibromyalgia among general practitioners, family physicians, psychiatrists, neurologists and rheumatologists in northeastern MexicoMethods:We designed an online survey to yield data on perception of FM, knowledge of existing classification criteria including the ACR 1990, ACR 2010, ACR 2010 modified and AATP classification criteria, as well as pharmacologic and nonpharmacologic therapy for the treatment of FM. Participants should have finished their residence at least in 2019. General practitioners, family physicians, psychiatrists, neurologists and rheumatologists were included.Results:A total of 236 participants were included, most of the participants were general practitioners, 149 (59.3%). Other specialties included were rheumatologists 21 (8.9%), neurologists 18 (7.6%), psychiatrists 8 (3.4%), and family physicians 49 (20.8%). FM was considered a clinical entity by 208 (88.1%) participants. Participants’ characteristics are shown in Table 1. Twenty-eight (11.9%) participants didn’t know any classification criteria for FM, and 38 (16.1%) participants answered that they didn’t use any classification criteria to make a formal diagnosis of FM. The 1990 ACR classification criteria was used the most, 62 (26.3%); closely followed by the 2010 modified ACR classification criteria, 61 (25.8%). A total of 101 (42.8%) participants made a formal diagnosis of FM in the previous year and 179 (75.8%) referred the patient to another specialist. Most patients were referred to a rheumatologist, 126 (53.4%). One-hundred and fifty-eight (66.9%) participants believe rheumatologist should be the main care providers for patients with FM.Table 1.Participants’ characteristics.VariableAge, median (25p-75p)33 (27-38)Women, n (%)203 (86)Rheumatologists, n (%)21 (8.9)General practitioners, n (%)140 (59.3)Public practice, n (%)113 (47.9)Public and private practice, n (%)51 (21.6)< 5 years of practice, n (%)100 (42.4)> 15 years of practice, n (%)30 (12.7)Conclusion:A total of 88.1% of physicians know at least one classification criteria for the diagnosis of FM. In Mexico, rheumatologists are considered the main care providers for patients with FM. Regarding therapies with level 1A evidence for efficacy in the treatment of FM, only cognitive behavioral therapy and patient education were used by more than 50% of physicians. Serotonin-norepinephrine reuptake inhibitor and tricyclic antidepressants (both of which have level 1A evidence) were only used by 20.8 and 29.2%, respectively.References:[1]Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55.Table 2.Pharmacologic and non-pharmacologic treatment of fibromyalgia among physicians.Variablen (%)Exercise (any kind), n (%)91 (38.6)Aerobic exercise (aerobic), n (%)86 (36.4)Cognitive behavioral therapy, n (%)127 (53.8)Patient education, n (%)142 (60.2)Gabapentinoids, n (%)107 (45.3)Tricyclic antidepressants, n (%)69 (29.2)Selective serotonin reuptake inhibitors, n (%)121 (51.3)Serotonin-norepinephrine reuptake inhibitor, n (%)49 (20.8)Muscle relaxers, n (%)85 (36)NSAID, n (%)137 (58.1)Opioids, n (%)27 (11.4)Mindfulness, n (%)42 (17.8)Disclosure of Interests:None declared