SNRI Toxicity: Difference between revisions
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==Background== | ==Background== | ||
* | *Inhibits reuptake of serotonin, norepinephrine and small effect on dopamine | ||
* | **Examples: venlafaxine, duloxetine | ||
*Adverse effects similar to [[SSRIs]] | |||
*Venlafaxine (Effexor) | |||
**Can produce mild to moderate hypertension | |||
*Duloxetine (Cymbalta) | |||
**Nausea, vomiting, dizziness | |||
==Clinical Features== | ==Clinical Features== | ||
*Sympathomimetic: tachycardia, hypertension, diaphoresis, tremor, mydriasis | *Sympathomimetic: tachycardia, hypertension, diaphoresis, tremor, mydriasis | ||
**Secondary to inhibition of norepinephrine reuptake | |||
*Sedation | *Sedation | ||
* | *[[Seizures]] | ||
**More common than with [[SSRI toxicity]] | |||
*[[Rhabdomyolysis]] | |||
**25% occur without seizures | |||
*ECG | *ECG | ||
** | **Most common abnormality: sinus tachycardia | ||
**May see QRS widening or QT prolongation | |||
==Diagnosis== | |||
*Suggestive history with appropriate clinical features | |||
==Management== | |||
*Cardiac monitoring | |||
*Supportive Care: IV fluids for hypotension, [[Benzodiapazines]] for seizures | |||
*Consider single dose activated charcoal | |||
==Disposition== | ==Disposition== | ||
*Admit all symptomatic pts to a monitored bed | *Admit all symptomatic pts to a monitored bed | ||
* | *Monitor for 6 hours, longer for extended-release preparations | ||
==See Also== | ==See Also== | ||
*[[SSRI Toxicity]] | *[[SSRI Toxicity]] | ||
== | ==References== | ||
*Tintinalli | *Mills K. Atypical Antidepressants, Serotonin Reuptake Inhibitors, and Serotonin Syndrome In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1198-2002 | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 02:23, 30 August 2015
Background
- Inhibits reuptake of serotonin, norepinephrine and small effect on dopamine
- Examples: venlafaxine, duloxetine
- Adverse effects similar to SSRIs
- 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
Diagnosis
- 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 pts 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