Venlafaxine


Generic Medicine Info
Contraindications
Children. Concomitant use with MAOIs (including methylene blue, linezolid) or within 14 days of therapy. Avoid alcohol.
Special Precautions
Patient with CV disease (e.g. recent history of MI, unstable heart disease, cerebrovascular conditions or hyperthyroidism), bipolar disorder, diabetes, suicidal ideation/behaviour, at risk of acute narrow-angle glaucoma, history of convulsions, predisposing factors of bleeding. Volume-depleted or dehydrated patients. Renal and hepatic impairment. Elderly. Pregnancy and lactation. CYP2D6 extensive and poor metabolisers. Avoid abrupt discontinuation. Patient Counselling This drug may impair judgement, thinking and motor skills, if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood pressure, prior to therapy and regularly, thereafter, serum cholesterol levels (prolonged use). Observe signs of clinical worsening of depression, suicide ideation or unusual behavioural changes, signs and symptoms of serotonin syndrome (e.g. mental status changes, neuromuscular changes). Perform screening for bipolar disorder (e.g. psychiatric history). Reassess patient regularly.
Adverse Reactions
Significant: Withdrawal symptoms (e.g. dizziness, sensory and sleep disturbances, agitation, nausea, vomiting, headache), anxiety, insomnia, nervousness, CNS depression, dyslipidaemia, bone fracture, hypertension, sexual dysfunction, weight loss and anorectic effect, mild pupillary dilation, suicidal thoughts and behaviour, mild pupillary dilation. Rarely, hyponatraemia, akathisia, interstitial lung disease, eosinophilic pneumonia, ventricular tachycardia. Cardiac disorders: Palpitations, dyspnoea. Ear and labyrinth disorders: Tinnitus. Eye disorders: Visual impairment, accommodation disorder. Gastrointestinal disorders: Nausea, constipation, vomiting, diarrhoea. General disorders and administration site conditions: Hyperhidrosis, asthenia, fatigue, chills. Investigations: Weight gain, increased heart rate, increased triglycerides. Metabolism and nutrition disorders: Decreased appetite. Musculoskeletal and connective tissue disorders: Hypertonia. Nervous system disorders: Dizziness, headache, sedation, tremor, paraesthesia, dysgeusia. Psychiatric disorders: Insomnia, confusional state, depersonalisation, anorgasmia, nervousness, abnormal dreams, agitation, anxiety. Renal and urinary disorders: Urinary retention, urinary frequency, dysuria, urinary incontinence. Reproductive system and breast disorders: Decreased libido, metrorrhagia, ejaculation disorder, menorrhagia, impotence. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Hot flush, vasodilation, orthostatic hypotension, bleeding events (e.g. ecchymoses, hematomas, epistaxis, petechiae).
Potentially Fatal: Serotonin syndrome (e.g. dizziness, agitation, hallucination, tachycardia, tremor, severe headache), cardiac arrhythmias.
Drug Interactions
Increased risk of hyponatraemia with diuretics. Altered glycaemic control of antidiabetic agents (e.g. insulin). Increased risk of QTc prolongation and/or ventricular arrhythmias with concomitant use of other QTc prolonging agents [e.g. class IA and III antiarrhythmics (e.g. quinidine, amiodarone, sotalol, dofetilide), antipsychotics (e.g. thioridazone), macrolides (e.g. erythromycin), quinolone antibiotics (e.g. moxifloxacin)]. Increased serum concentration with CYP3A4 inhibitors (e.g. atazanavir, clarithromycin, itraconazole). Increased serum or plasma concentrations of imipramine metabolite (2-hydroxydesipramine), haloperidol, risperidone, and metoprolol. Decreased serum concentration of indinavir. Increased risk of bleeding with antiplatelet agents (e.g. aspirin), anticoagulants (e.g. warfarin), and NSAIDs.
CIMS Class
Antidepressants / Anxiolytics
ATC Classification
N06AX16 - venlafaxine ; Belongs to the class of other antidepressants.
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