Venlafaxine respiratory

MAOIs have the most serious pharmacodynamic interactions of any antidepressant class. As discussed earlier, they can cause a hypertensive crisis and the serotonin syndrome. They potentiate the hypertensive effects of most sympathomimetic amines, as well as tyramine, which is the reason for the avoidance of over-the-counter preparations containing such agents, in addition to the tyramine-free diet ( 508, 509). The serotonin syndrome occurs most often when MAOIs are used in combination with SSRIs and venlafaxine but it can also occur when MAOIs are used with tryptophan, 5-hydroxytryptophan, and some narcotic analgesics. In addition, MAOIs can also significantly potentiate the sedative and respiratory depressant effects of narcotic analgesics. 

Fetotoxicity There have been reports of neonatal withdrawal symptoms with SSRIs, but httle is known of this phenomenon with other antidepressants. When seven mother-child pairs exposed to venlafaxine from the second trimester were studied p "], five of the neonates had a withdrawal syndrome, including tachypnea and respiratory distress the changes corresponded to falling plasma venlafaxine concentrations. The neonate exposed to the highest maternal dose of venlafaxine (300 mg/day) had the most severe and most persistent signs. 

A 21-year-old woman, who used cocaine regularly and occasionally other drugs of abuse, took moclobemide 1800 mg at 15.00 h and venlafaxine 1800 mg at 18.00 h. At 20.14 h she was conscious but restless and agitated. She had excessively clammy skin with a normal body temperature, increased symmetrical reflexes, ataxia, increased muscle tone, and dilated pupils her blood pressure was 180/120 mmHg, pulse rate 105/minute, and respiratory rate 16/minute. She deteriorated at around 23.30 h, with loss of verbal contact, severe agitation, hallucinations, periodic coma, continuously dilated pupils, a tachycardia of 124/minute and a blood pressure of 105/90 mmHg. Two hours later, her respiratory rate was 34/minute, and her temperature 41-42 °C. She had bloody respiratory secretions and loose bloody stools. Her heart rate increased to 170/minute and she developed ventricular fibrillation. Deflbrillation was unsuccessful and she died. 

Comparative studies In a 12-week randomized controlled trial in 276 depressed patients allocated to agomelatine 50 mg/ day or venlafaxine (titrated to a target dose of 150 mg/day), of those randomized to agomelatine 20% reported treatment-emergent adverse effects, the most common being nausea (12%), headache (10%), and upper respiratory tract infections (7%) 2% withdrew because of adverse effects [67 ]. The rate of treatment-emergent sexual dysfunction (reduced libido in males and impaired orgasm in females) was lower than in those who took venlafaxine. 

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