SNRI Toxicity: Difference between revisions
ClaireLewis (talk | contribs) |
|||
| Line 2: | Line 2: | ||
*Inhibits reuptake of serotonin, norepinephrine and small effect on dopamine | *Inhibits reuptake of serotonin, norepinephrine and small effect on dopamine | ||
**Examples: [[venlafaxine]], [[duloxetine]] | **Examples: [[venlafaxine]], [[duloxetine]] | ||
*Adverse effects similar to [[SSRIs]] | *Adverse effects similar to [[SSRIs]], but more dangerous | ||
*[[Venlafaxine]] (Effexor) | *[[Venlafaxine]] (Effexor) | ||
**Can produce mild to moderate hypertension | **Can produce mild to moderate hypertension | ||
Revision as of 14:26, 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 or QT prolongation
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