Venlafaxine Diazepam

CYP2D6 TCAs, SSRIs, haloperidol, mirtazepine, zuclopenthoxil, venlafaxine, sertraline CYP2C19 TCAs, mephenytoin, diazepam, moclobemid, venlafaxine... 

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD. Sertraline is also effective. Acute response and remission rates are approximately 65% and 30%, respectively. Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs). In one trial, diazepam, trazodone, and imipramine had greater anxiolytic activity than placebo. 

There has been a report of two patients with treatment-resistant PD who responded to treatment with olanzapine added to ongoing treatment with clonazepam (2 mg per day), ketazolam (30 mg per day), and venlafaxine (150 mg per day). The first patient was started on 7.5 mg at bedtime, and 2 weeks later he was much calmer and sleeping well. Olanzapine was increased to 12.5 mg per day, and venlafaxine was replaced with nefazodone up to 60 mg per day. Over the next few weeks, he improved progressively and clonazepam and ketazolam were discontinued. After 4 months, he was free from panic attacks and left his home alone. The second patient had 10 mg olanzapine daily added to ongoing treatment with 75 mg per day amitriptyline and 10 mg per day diazepam. After 2.5 months, she was being given olanzapine and had started going out on her own (126). 

Venlafaxine extended-release, a serotonin-norepinephrine reuptake inhibitor (SNRI), alleviates anxiety in patients with and without co-morbid depression. The reduction in psychic symptoms of anxiety and tension is not accompanied by significant reductions in somatic symptoms. Venlafaxine (dosed once daily) was effective at doses of 150 and 225 mg for 2 months in patients with GAD, and efficacy was maintained for an additional 6 months of therapy." Paroxetine was significantly more effective than placebo at achieving response in 62% and 68% of patients at 20 and 40 mg daily, respectively, after 2 months. Remission occurred in 30% and 36% of patients taking 20 and 40 mg of paroxetine, respectively." Escitalopram was more efficacious than placebo in three 8-week trials in patients with GAD. In a four paraUel-group comparison, diazepam and trazodone were found to be equivalent in anxiolytic activity (remission rates of 66% and 69%, respectively) compared with placebo (47% remission rate), but rmipramine s rate of remission (73%) exceeded that of the other three treatments. ... 

Clomipramine Diazepam Clomipramine Venlafaxine Atorvastatin Nicardipine... 

Single-dose venlafaxine does not alter the single-dose pharmacokinetic profile of drugs metabolized by CYP3A4 (alprazolam and diazepam). When milnacipran was administered with lorazepam in healthy volunteers, no changes in the pharmacokinetics of any drug were detected. 

Visual hallucinations have been seen in one patient given zolpidem and venlafaxine. No important interaction normally appears to occur between venlafaxine and alprazolam or diazepam. The pharmacokinetics of duloxetine were not affected by lorazepam or temazepam. 

The studies suggest that no special precautions are necessary during the concurrent use of venlafaxine and diazepam or alprazolam, or between duloxetine and lorazepam or temazepam. Similarly, the manufacturer of duloxetine reports that its pharmacokinetics were not affected by lorazepam or temazepam under steady state conditions. ... 

Troy SM) Luck I, Peirgies AA, Parker VD, Klockowski PM, Chiang ST. Pharmacokinetic and pharmacodynamic evaluation of the potential drug interaction between venlafaxine and diazepam. 7 Cli Pharmacol (1995) 35, 410-19. 

A 32-year-old man taking moclobemide 20 mg twice daily and diazepam developed the serotonin syndrome 40 minutes after taking a single 150-mg dose of venlafaxine. Serotonin toxicity (the serotonin syndrome) occurred in 4 patients who took an overdose of moclobemide with venlafaxine (just 150 mg in one case and 750 mg in another). In this analysis of moclobemide overdoses, the risk of developing serotonin toxicity was increased 35 times in patients who also took another serotonergic drug. Venlafaxine was taken in 4 of the 11 cases mentioned." Another man very rapidly developed the serotonin syndrome after taking considerable overdoses of moclobemide (3 g) and venlafaxine (2.625 g). ... 

A 32-year-old woman with depression who had been taking venlafaxine 225 mg daily in divided doses for 3 years was admitted to hospital after a fall. She developed a movement disorder and a period of unresponsiveness after being given a 10-mg intravenous dose of metoclopramide. After a second dose of metoclopramide the symptoms recurred and were associated with confusion, agitation, fever, diaphoresis, tachypnoea, tachycardia, and hypertension. The symptoms were consistent with the serotonin syndrome, with a serious extrapyramidal movement disorder. The venlafaxine was withheld and she was given diazepam. The symptoms resolved over the next two days, after which she continued to take venlafaxine. Information seems to be limited to this report, and the general significance of this interaction is unclear. 

Noninterfering acetaminophen, amineptine, amphotericin B, aspirin, bromazepam, buspirone, citalopram, clobazam, diazepam, didanosine, fluconazole, flunitrazepam, flu-voxamine, hydroxyitraconazole, isoniazid, itraconazole, lamivudine, loprazolam, lora-zepam, metronidazole, minalcipram, nordiazepam, omeprazole, paroxetine, pyrimethamine, rifampin, sertraline, stavudine, sulfadiazine, trimethoprim, venlafaxine, zal-citabine, zidovudine, zolpidem, zopiclone... 

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