Venlafaxine cardiovascular

Bupropion and venlafaxine may also be chosen because of their milder anticholinergic and less frequent cardiovascular side effects. 

Tricyclic drugs have, as the name implies, a three-ring structure, and interfere with reuptake of norepinephrine and/or serotonin into axon terminals. Tricyclic drugs include imipramine (Tofranil), amitriptyline (Elavil), clomipramine (Anafranil), and nortriptyline (Pamelor, Aventil). Tricyclics have the occasional but unfortunate cardiovascular side effects of arrhythmia and postural hypotension. Newer, nontricyclic antidepressants have been developed that are collectively referred to as SSRIs. These have a potent and selective action on serotonin, and lack the cardiovascular side effects of the tricyclics. These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). A fifth SSRI, citalopram (Celexa) has been used in Europe and has recently been approved in the United States. Venlafaxine (Effexor) blocks reuptake of norepinephrine and serotonin, while bupropion (Wellbutrin) acts on both dopamine and norepinephrine. 

Regarding side-effect profiles, all three SSNRIs are generally well tolerated, most adverse events occurring early in treatment, with a mild to moderate severity and a tendency to decrease or disappear with continued treatment. Venlafaxine (1) seems to be the least weU-toIerated SNRI, combining a higher level of serotonergic adverse events (nausea, sexual dysfunction, withdrawal problems) with dose-dependent hypertension. In contrast, milnacipran (2) and duloxetine (3) appear better tolerated and essentially devoid of cardiovascular toxicity. 

Lessard E, Yessine MA, Hamelin BA, O Hara G, LeBlanc J, Turgeon J (1999) Influence of CYP2D6 activity on the disposition and cardiovascular toxicity of the antidepressant agent venlafaxine in humans. Pharmacogenetics 9 435-443 Lockhart DJ, Winzeler EA (2000) Genomics, gene expression and DNA arrays. Nature 405 827-836... 

Patients with cardiovascular disorders or those predisposed to anticholinergic adverse effects (e.g., elderly or diabetic patients) probably do best on drugs low in these effects (e.g., an SSRI, venlafaxine, or bupropion). 

Venlafaxine Bicyclic cyclohexanol Serotonin and noradrenaline uptake inhibitor Nausea, sexual dysfunction, and cardiovascular adverse effects... 

Early descriptions of duloxetine suggested that it might be less likely than venlafaxine to cause increased blood pressure. The cardiovascular profile of duloxetine has been reviewed from a database of eight double-blind... 

In physically healthy subjects venlafaxine has a generally benign cardiovascular profile, although hypotension and dose-related hypertension have been reported (SEDA-23, 20). 

Venlafaxine has not been studied systematically in patients with cardiovascular disease, although there are reports that older patients can have clinically significant disturbances of cardiac rhythm (10). 

Taken together with the information that the authors cited in their review, the current data suggest that venlafaxine should be used with caution in patients with established cardiovascular disease. 

Blythe D, Hackett LP. Cardiovascular and neurological toxicity of venlafaxine. Hum Exp Toxicol 1999 18(5) 309-13. 

LeBlanc J, Turgeon J. Influence of CYP2D6 activity on the disposition and cardiovascular toxicity of the antidepressant agent venlafaxine in humans. Pharmacogenetics 1999 9(4) 435-43. 

AMPHETAMINES VENLAFAXINE Risk of severe and life-threatening hypertension and arrhythmias Additive effects on cardiovascular system due to enhanced noradrenergic activity Avoid concurrent use... 

Theoretically, other agents with norepinephrine reuptake blocking properties, such as venlafaxine, duloxetine, atomoxetine, milnacipran, and reboxetine, could also add to amphetamine s CNS and cardiovascular effects... 

CYP2D6 is the major enzyme involved in the metabolism of venlafaxine, and diphenhydramine alters the disposition of venlafaxine, increasing plasma concentrations and predisposing to cardiovascular adverse effects (16). 

Eeighner JR Cardiovascular safety in depressed patients Eocus on venlafaxine. J CUn PsycUiatry 1995 56 574-579. 

Cardiovascular Cardiomyopathies have been attributed to venlafaxine in two cases [21, 22 ]. 

However, in a case series of 273 patients who took an overdose of venlafaxine, overdose caused only minor abnormalities in the QT and QRS intervals, and was unlikely to be associated with major dysrhythmias, except possibly with large doses (>8 g) [63 "]. The commonest cardiovascular effects were tachycardia (54% of patients) and mild hypertension (40%). 

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