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Venlafaxine
It is a structurally novel antidepressant meant for oral administration. It is chemically unrelated to tricyclic, tetracyclic or other available anti depressant agents. It selectively inhibits the neuronal uptake of serotonin, norepinephrine and to lesser extent dopamine. It has minimal affinity for muscarinic, cholinergic, histamines or a 1 and a 2 adrenergic receptors. Action in humans is believed to be associated with its potentiation of neurotransmitter better activity in the CNS has a lower incidence of the anti-cholinergic side effects.
INDICATIONS: Immediate release the treatment of depression and extended release for the treatment of generalized anxiety disorder and depression.
CONTRAINDICATIONS: Hypersensitivity, patients taking concomitant MOA inhibitors or within 14 days of stopping them.
SAFETY PROFILE: History of seizures, Mania, and with disease and conditions that could affect haemodynamic responses or metabolism. In pregnancy: - use only if potential benefits out weight the potential risk to the foetus.
ADVERSE EFFECTS: Nausea, headache, asthenia, sweating, dizziness, insomnia, vomiting, orthostatic hypotension, tremor, anxiety, fatigue, anorexia, syncope, impotence, loss of libido, constipation, dry mouth, hyponatraemia.
DRUG INTERACTIONS: Venlafaxine doses not interact significantly with diazepam, cimetidine, haloperidol, Imipramine and risperidone. Lithium: May result in neurotoxicity or serotonin syndrome, maintain carefully. Fentayl, pethidine, tramadol (serotonin syndrome), selegiline mianserin, moclobemide, TCA's, SRRI's contraindicated.
DOSAGE : Depression - initially 37.5mg twice daily, increasing 75mg per day as a single dose or two three divided dosages, If sustain release 75mg, once daily, increasing 150mg daily, if required and should be made at intervals of not less then 4 days. Maximum dose for immediate release is 375mg/day in two or three divide dose. Generalized anxiety disorder - recommended starting dose for extended release is 75mg daily as a single dose, increasing to 150mg daily if required and should be made at intervals of not less than 4 days's. Maximum dose for extended release 225mg per day in two or three divided doses.