SNRIs

Question 0

Duloxetine (Cymbalta)

Answer 0

• MDD, (neuropathy, stress UI)
• SSRI and NE effects at same doses
• do not use: ESRD, hepatic insufficiency, narrow angle glaucoma
• side effects similar to SSRIs, but more dry mouth and constipation relating to norepinephrine effects
• more liver side effects in pts with liver disease or heavy alcohol use
• expensive

Question 1

Venlafaxine (Effexor)

Answer 1

• MDD, Anxiety disorders (GAD)
• may have some use in ADHD
• more NE effects at higher doses, at even higher doses some DRI activity (dopamine reuptake inhibition?)
• monitor BP for elevation
• shortest half life
• side effect profile similar to SSRIs
• new form, desvenlafaxine (Pristiq), is the active metabolite of venlafaxine and is expensive
• extended release form (XR) allows for once daily dosing