SNRI Toxicity: Difference between revisions
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==Management== | ==Management== | ||
*Cardiac monitoring | *Cardiac monitoring | ||
*Supportive Care: IV fluids for hypotension, [[Benzodiapazines]] for seizures | *Supportive Care: IV fluids for hypotension (norepinephrine if refractory), [[Benzodiapazines]] for seizures | ||
* | *No role for activated charcoal or gastric emptying | ||
*[[Sodium bicarbonate]] if widened QRS | |||
==Disposition== | ==Disposition== | ||
Revision as of 14:32, 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
- ECG
- Assess for rhabdomyolysis
Management
- Cardiac monitoring
- Supportive Care: IV fluids for hypotension (norepinephrine if refractory), Benzodiapazines for seizures
- No role for activated charcoal or gastric emptying
- Sodium bicarbonate if widened QRS
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