Venlafaxine Trazodone

Atypical antidepressants Bupropion Duloxetine Mianserin Mirtazapine Nefazodone Reboxetine Trazodone Venlafaxine... 

Dementia SSRIs Bupropion Duloxetine Mirtazapine Nefazodone Trazodone Venlafaxine TCAs... 

IMATINIB 1. ANTIARRHYTHMICS -flecainide, mexiletine, propafenone 2. ANTIDEPRESSANTS - fluoxetine, paroxetine, TCAs, trazodone, venlafaxine 3. ANTIPSYCHOTICS -clozapine, haloperidol, perphenazine, risperidone, thioridazine 4. BETA-BLOCKERS - metoprolol, propanolol, timolol 5. DONEPEZIL 6. METHAMPHETAMINE Imatinib may cause t plasma concentrations of these drugs, with a risk of toxic effects Inhibition of CYP2D6-mediated metabolism of these drugs Watch for early features of toxicity of these drugs... 

DA agonists levodopa, bromocriptine, 1 pergolide, pramipexole 1 MAO-B inhibitor selegOine 1 AAAD inhibitor carbidopa I M blockers benztropine, trihexiphenidyl j COMT inhibitor tolcapone 1 Amantadine MAOIs phenelzine, tranylcypromine TCAs amitriptyline, imipramine, clomipramine SSRIs fluoxetine, paroxetine, sertraline Others bupropion, mirtazapine, trazodone, venlafaxine... 

Anxiolytic antidepressants (trazodone, venlafaxine), clonazepam (or other benzodiazepines note that, generally, benzodiazepines are not recommended for long-term use in SAD), gabapentin,... 

Other antidepressants Duloxetine, Iprindole, Mirtazapine, Milnacipran, Nefazodone, Reboxetine, Trazodone, Venlafaxine, Viloxazine... 

Atypical Antidepressants. StmcturaHy diverse dmgs such as the tetracyclic mianserin (46) and various bicyclic and tricyclic compounds such as trazodone (47), venlafaxine (48), nefazodone (49), and amfebutamone (50) are atypical antidepressants. The exact mechanism of action is unclear but probably... 

The effects of buspirone are decreased when the drug is administered with fluoxetine Increased serum levels of buspirone occur if the drug is taken with erythromycin or itraconazole Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered witii MAOIs or cimetidine There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of trazodone when it is administered with carbamazepine Increased serum digoxin levels have occurred when digoxin is administered with trazodone There is a risk for increased phenytoin levels when phenytoin is administered witii trazodone... 

MISCELLANEOUS ANTIDEPRESSANTS. An uncommon but potentially serious adverse reaction of trazodone is priapism (a persistent erection of die penis). If not treated within a few hours, priapism can result in impotence The nurse instructs the patient to report any prolonged or inappropriate penile erection. Use of the drug is discontinued immediately and the primary care provider notified. Injection of a-adrenergic stimulants (eg, norepinephrine) may be helpful in treating priapism. In some cases, surgical intervention may be required. Venlafaxine may cause an increase in die blood pressure. A sustained increase in die blood pressure may indicate that die dosage of venlafaxine needs to be decreased. 

Antidepressants Trazodone, mirtazapine, paroxetine, other selective serotonin reuptake inhibitors venlafaxine... 

Rotzinger, S, Bourin, M, Akimoto, Y, Coutts, RT and Baker, GB (1999) Metabolism of some second and fourth generation antidepressants iprindole, viloxazine, buproprion, mianserin, maprotiline, trazodone, nefazodone and venlafaxine. Cell. Molec. Neurobiol. 19 427 42. 

Acetaminophen, bosentan, diclofenac, isoniazid, lovastatin, methyldopa, niacin, nefazodone, phenytoin, propylthiouracil, rifampin, trazodone, valproic acid, and venlafaxine... 

Bupropion Venlafaxine Duloxetine Trazodone Nefazodone Mirtazapine... 

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. 

Solid phase extraction (SPE) has been used to efficiently extract several types of antidepressants, which can then be conveniently analyzed on GC-NPD. One assay extracted and analyzed viloxazine, venlafaxine, imipramine, desipramine, sertraline, and amoxapine from whole blood in one procedure (Martinez et al., 2002). The same laboratory analyzed fluoxetine, amitriptyline, nortriptyline, trimipramine, maprotiUne, clomipramine, and trazodone in whole blood in one assay (Martinez et al., 2003). SPE has also been used for the simultaneous analysis of TCAs and their metabolites by de la Torre et al. (1998). 

Many commonly used medications also contain substances that are eliminated by the MAOIs and must not be taken by these patients. The list of medications to be avoided inclndes the narcotic pain reliever meperidine (Demerol), and many over-the-connter cold remedies containing dextromethorphan or pseudoephedrine. Finally, patients taking MAOIs must also avoid medications that elevate serotonin levels. This inclndes certain appetite snppressants and antidepressants including the SSRIs, venlafaxine, duloxetine, mirtazapine, nefazodone, and trazodone. Medications that interact with the MAOIs cannot be taken until at least 2 weeks after the MAOI has been stopped. 

Atypical Antidepressants. The atypical antidepressants are not a true class in the same sense as SSRIs or TCAs. There is no unifying property to these antidepressants. Each of these antidepressants is actually a class unto itself that is structurally and functionally different from all other antidepressants. The atypical antidepressants include trazodone (Desyrel), bupropion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), nefazodone (Serzone), and mirtazapine (Remeron). 

Atypical Antidepressants. Preliminary open label studies suggested that ven-lafaxine and trazodone might be effective for OCD. However, controlled studies have not yet been completed for venlafaxine, and a controlled study of trazodone (100-200 mg/day) did not find it an effective treatment for OCD. 

Drugs that may affect trazodone include carbamazepine, phenothiazines, and venlafaxine. Drugs that may be affected by trazodone include alcohol, barbiturates, CNS depressants, digoxin, MAOIs, phenytoin, and warfarin. 

Drugs that may affect venlafaxine include cimetidine, cyproheptadine, and MAOIs. Drugs that may be affected by venlafaxine include clozapine, desipramine, haloperidol, indinavir, St. John s wort, trazodone, sibutramine, sumatriptan, and warfarin. 

Sertraline (Zoloft) Trazodone (Desyrel) Venlafaxine (Effexor, Effexor XR)... 

Side effects, mainly due to serotonin reuptake inhibition include G1 upset, nervousness, and sexual dysfunction. SSRls are associated with an increased risk of falls. Hyponatraemia due to SIADH is an uncommon, but important side effect in elderly patients. Selective serotonin and norepinephrine reuptake inhibitors (S SNRls) such as venlafaxine and duloxetine are also useful in older patients. Other heterocyclic antidepressants of importance in older patients because of relative safety include bupro-prion and mirtazepine. They are reserved for patients with resistance to or intolerance of SSRls. Currently, trazodone is used mostly for sleep disturbance in depression in doses of 50-100 mg at bedtime. The monoamine oxidase inhibitors phenelzine. 

Fenfluramine Dextromethorphan Meperidine Methylene dioxymethamphetamine Meta-chlorophenylpiperazine (mCPP) Trazodone (mCPP) Selegiline Nefazodone Trazodone Pethidine Tramadol Mirtazapine TCA medications Venlafaxine SSRI agents... 

Scant data exist about the effects of trazodone, ne-fazodone, venlafaxine, or mirtazapine. Eimited animal data do not suggest teratogenicity however, little or no human data are available. Reports on individual agents have been reviewed by Briggs and colleagues (1998). 

Venlafaxine, paroxetine, sertraline, imipramine, and trazodone have all proven effective in relieving symptoms of GAD. Venlafaxine, a combined serotonin and norepinephrine reuptake blocker, may be an exceptionally good choice for people who have other psychiatric illnesses in addition to GAD, or when it is not clear whether the patient has GAD or a depressive illness, or both. Although, to date, only certain SSRIs have been... 

Virtually all studies on the monotherapy of PMD have employed TCAs. At this time, no data exist on the utility of the selective serotonin reuptake blockers [SSRls], serotonin type 2 antagonists [trazodone or nefazodone], or other newer agents such as venlafaxine in the monotherapy of PMD. 

Nierenberg AA, Amsterdam JD Resistant depression definition and treatment approaches. J Chn Psychiatry 51 (suppl) 39-47, 1990 Nierenberg AA, Adler LA, Peselow E, et al Trazodone for antidepressant-associated insomnia. Am J Psychiatry 151 1069-1072, 1994a Nierenberg AA, Feighner JP, Rudolph R, et al Venlafaxine for treatment-resistant unipolar depression. J Chn Psychopharmacol 14 419-423, 1994b... 

The one study done to date with venlafaxine used a double-blind continuation design rather than a crossover design used with the SSRIs ( Table 7-21). Responders in the double-blind, placebo- and active-controlled acute efficacy phase could elect to remain on double-blind treatment for a 1-year follow-up phase ( 271). The treatment arms in these studies included venlafaxine, trazodone, imipramine, and placebo. At the end of 1 year, 18% of patients on venlafaxine had relapsed versus 32% on placebo. The difference between the venlafaxine and the placebo groups was smaller than that seen between the SSRIs and their respective placebo groups (Table 7-20), consistent with the difference in the design of these studies. 

In contrast to decreased libido seen with SSRIs and venlafaxine, concerns about priapism invariably arise when trazodone is discussed. This adverse effect is rare, occurring in only 1 of 6,000 treated male patients (456, 457). If the patient is informed of this possibility and discontinues the drug promptly, priapism usually resolves without further intervention. Although earlier persistent cases were treated surgically, this approach carries a 50% chance of permanent impotence pharmacological intervention via direct injections into the cavernous bulbosa is preferable ( 458, 459). Using this approach, the chance of permanent impotence is low and depends on the duration of symptoms before treatment (460). This latter fact is another reason to fully inform the male patient on trazodone, so that early detection and intervention can be implemented. 

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