SNRI Toxicity: Difference between revisions
| Line 18: | Line 18: | ||
*[[ECG]] | *[[ECG]] | ||
**Most common abnormality: sinus tachycardia | **Most common abnormality: sinus tachycardia | ||
**May see QRS widening | **May see QRS widening, QT prolongation and ventricular dysrhythmias | ||
*[[Serotonin syndrome]] | |||
==Evaluation== | ==Evaluation== | ||
*Suggestive history with appropriate clinical features | *Suggestive history with appropriate clinical features | ||
Revision as of 14:28, 1 September 2019
Background
- Inhibits reuptake of serotonin, norepinephrine and small effect on dopamine
- Examples: venlafaxine, duloxetine
- Adverse effects similar to SSRIs, but more dangerous
- Venlafaxine (Effexor)
- Can produce mild to moderate hypertension
- Duloxetine (Cymbalta)
- Nausea, vomiting, dizziness
Clinical Features
- Sympathomimetic: tachycardia, hypertension, diaphoresis, tremor, mydriasis
- Secondary to inhibition of norepinephrine reuptake
- Sedation
- Seizures
- More common than with SSRI toxicity
- Rhabdomyolysis
- 25% occur without seizures
- ECG
- Most common abnormality: sinus tachycardia
- May see QRS widening, QT prolongation and ventricular dysrhythmias
- Serotonin syndrome
Evaluation
- Suggestive history with appropriate clinical features
Management
- Cardiac monitoring
- Supportive Care: IV fluids for hypotension, Benzodiapazines for seizures
- Consider single dose activated charcoal
Disposition
- Admit all symptomatic patients to a monitored bed
- Monitor for 6 hours, longer for extended-release preparations
See Also
References
- Mills K. Atypical Antidepressants, Serotonin Reuptake Inhibitors, and Serotonin Syndrome In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1198-2002