SNRI Toxicity: Difference between revisions
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==Background== | ==Background== | ||
*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]] | ||
*Venlafaxine (Effexor) | *[[Venlafaxine]] (Effexor) | ||
**Can produce mild to moderate hypertension | **Can produce mild to moderate hypertension | ||
*Duloxetine (Cymbalta) | *[[Duloxetine]] (Cymbalta) | ||
**Nausea, vomiting, dizziness | **Nausea, vomiting, dizziness | ||
==Clinical Features== | ==Clinical Features== | ||
*Sympathomimetic: tachycardia, hypertension, diaphoresis, tremor, mydriasis | *Sympathomimetic: tachycardia, hypertension, diaphoresis, tremor, mydriasis | ||
Revision as of 18:19, 28 March 2017
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
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