Venlafaxine Alcohol

Although many patients believe that dietary supplements will not interact with medications, recent literature suggests otherwise. Recently, many St. John s wort-drug interactions have been reported in the literature. Cases of patients developing symptoms of serotonin syndrome have been reported with St. John s wort alone and in concomitant therapy with other antidepressants such as monoamine oxidase inhibitors, serotonin reuptake inhibitors, and venlafaxine. St. John s wort may exacerbate the sedative effects of benzodiazepines, alcohol, narcotics, and other sedatives. St. John s wort may decrease the levels of protease inhibitors, cyclosporine, digoxin, and theophylline. 

Drugs that may affect antihistamines include aluminum/magnesium-containing acids, cimetidine, erythromycin, ketoconazole, MAO inhibitors, and rifamycins (eg, rifampin). Drugs that may be affected by antihistamines include alcohol and CNS depressants, beta-blockers, MAO inhibitors, metyrapone, nefazodone, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine. 

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. 

Although more stimulating antidepressants (e.g., bupropion, SSRIs, venlafaxine, or certain MAOIs) do not potentiate alcohol, they can produce insomnia. To minimize this problem, the dose may be given earlier in the day. TCAs may cause episodes of excitement (rare), confusion, or mania, usually in patients with an underlying psychotic illness, suggesting that a preexisting disorder must be present for these drugs to exert any psychotomimetic effects. 

Nefazodone, like the SSRIs and venlafaxine, has negligible effect on Na ion fast channels and therefore does not slow intracardiac conduction. As a result, during clinical trials development, patients survived drug overdoses exceeding 11,200 mg without the need for any intervention beyond observation and routine nursing care (146, 451). One nonstudy patient who took 2,000 to 3,000 mg of nefazodone with methocarbamol and alcohol experienced a seizure (type not documented) but otherwise recovered uneventfully. 

RBD is characterized by a relative absence of the atonia characteristic of REM sleep. This lack of atonia permits the physical acting out of dream mentation, particularly dreams involving confrontation, aggression and violence. RBD is seen most frequently in older men. RBD occurs in both acute and chronic forms. Acute RBD can occur during withdrawal from alcohol or sedative-hypnotics. RBD has also been induced by the tricyclics, SSRIs and venlafaxine. The chronic form of RBD may occur as part of an identifiable underlying neurological disorder, but typically is idiopathic. RBD may also be an initial manifestation of parkinsonism. RBD is very responsive to clonazepam, although this use has not been FDA approved. 

The death of a 36-year-old patient with a history of alcohol dependence who was taking tramadol, venlafaxine, trazodone, and quetiapine has highlighted the increased risk of seizures with concomitant use of tramadol and selective serotonin re-uptake inhibitors (125). 

A 34-year-old man took 2.625 g of venlafaxine (therapeutic dose 75-375 mg/day) and 3 g of moclobemide, plus an unknown amount of alcohol 1 hour before being admitted to hospital. Within 20 minutes of arrival his conscious level deteriorated and he had increased muscle tone, with clonus in all limbs. He was treated with intubation, paralysis, and ventilation, and sedated with midazolam and morphine. He regained consciousness after 2 days. 

Deaths have been described after venlafaxine overdose, but in combination with other agents and alcohol. However, there have been two fatal cases of overdosage in which venlafaxine was the only agent detected postmortem (30). It therefore appears that venlafaxine can occasionally prove fatal in overdosage, probably through cardiac conduction abnormalities and seizures (30,31). It is possible that poor metabolizers may be especially liable to develop toxic effects. 

Venlafaxine is an antidepressant and, like many neuroactive agents, it is an amino-alcohol. In this case, the two functional groups are 1,3-related, so we aim to use a 1,3-diO disconnection. Usually,... 

Venlafaxine does not alter the pharmacokinetic disposition of alcohol in healthy volunteers. 

For treatment-resistant patients who do not respond to SSRIs or TCAs, or to the combination of TCAs/SSRIs with benzodiazepines, other antidepressants have shown at least some beneficial effects in alleviating PD symptoms (e.g. mirtazapine, moclobemide, nefazodone, phenelzine, reboxetine, and venlafaxine). Other agents have also been reported to exert beneficial effects in PD, especially when combined with SSRIs/TCAs (lithium, pindolol, and propranolol). In cases where all treatments have failed, valproate or olanzapine should be considered.2 - ° In order to optimize treatment, patients should avoid or reduce the consumption of compounds that could potentially induce/exacerbate panic attacks (e.g. caffeine, alcohol, and nicotine) and should exercise regularly. i... 

No important psychomotor interaction normally appears to occur between duloxetine or venlafaxine and alcohol. However, the manufacturer warns that use of duloxetine with heavy alcohol intake may be associated with severe liver injury. 

Venlafaxine 50 mg every 8 hours was found to have some effect on psychomotor tests (digit symbol substitution, divided attention reaction times, profile of mood scales) in 15 healthy subjects, but these changes were small and not considered to be elinieally significant. No pharmacodynamic or pharmacokinetic interactions occurred when alcohol 0.5 g/kg was also given. ... 

In therapeutie doses venlafaxine does not appear to interact significantly with alcohol, however, the manufaeturers state that, as with all centrally-active drugs, patients should be advised to avoid alcohol whilst taking venlafaxine. This is presumably because both drugs act on the CNS and also because alcohol is more likely to be abused by depressed patients. 

Two cases of the serotonin syndrome have been reported when tramadol was given with venlafaxine one patient was also receiving mirtazapine. Fatal seizures occurred in an alcoholic man receiving tramadol, venlafaxine, quetiapine and trazodone. 

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