Pain- SNRIs DI

Question 1

SNRIs used in pain

Answer 1

duloxetine, venlafaxine, milnacipran

Question 2

Indications for duloxetine

Answer 2

PDN, fibromyalgia, low back pain

Question 3

Indications for venlafaxine

Answer 3

off-label for PDN and PHN

Question 4

Indication for milnacipran

Answer 4

fibromyalgia

Question 5

Ratio of NE:5-HT for milnacipran

Answer 5

3:1 NE:5-HT

Question 6

Milnacipran MoA

Answer 6

NMDA receptor binding
Lacks histaminic and muscarinic activity

Question 7

Pros of SNRIs in pain

Answer 7

Can help with MDD
Milnacipran is well-tolerated and can improve fatigue

Question 8

Cons of SNRIs

Answer 8

Risk of serotonin syndrome
Milnacipran needs BID dosing and can precipitate HTN

Question 9

Duloxetine is CI’ed in what disease states?

Answer 9

Hepatic impairment, severe CKD/ESRD

Question 10

SNRIs are a preferred choice in what patients?

Answer 10

Elderly