Brian Zeidan #18Psychotropic Medication PresentationVenlafaxine/Fluvoxamine

Venlafaxine (Effexor, Effexor XR)

Indications: Generalized anxiety, social anxiety, major depressive disorder, panic disorder, ADD

Dosage:

Depression: Immediate Release75 mg/day PO divided q8-12hr Moderate: up to 225 mg/day PO divided q8-12 hrSevere: up to 375 mg/day PO divided q8-12 hrER: 37.5 75 mg PO once daily, not to exceed 255 mg/dayGeneralized Anxiety Disorder:ER: 37.5 75 mg PO once daily, not to exceed 255 mg/daySocial Anxiety:ER: 75 mg PO once daily, dosages >75 mg/day not show to be more effective

Panic Disorder:ER: 37.5 mg PO once daily for 7 days, then 75 mg once daily

ADD:18.75-75 mg/day 150 mg/day after 4 weeksTake with foodIf discounting therapy after 7 days, taper dosageModifications: Mild to severe renal impairment reduce dosage by 25-50% Mild to moderate hepatic impairment- reduce dosage by 50%

MOA: SNRI antidepressant, works by blocking the transporter reuptake of serotonin and norepinephrine. In high doses, weakly inhibits reuptake of dopamine. Adverse effects: Discontinuation Syndrome Serotonin syndrome (avoid use with MAOIs) Suicide ideation (during initial 1-2 months, adjust therapy accordingly)* Increased BP Insomnia, stimulant effects Headache Nausea Mydriasis (may trigger angle closure attack in pts with glaucoma)Fluvoxamine (Luvox, Luvox CR)

Indications: OCD, Social phobias (Panic disorder, PTSD: off label)

Dosage: Typically take 4-8 wks fo to have effectOCD:Tablet: 50 mg qHS initially, ER-Capsules: 100 mg PO qDay initially, can titrate in 50 mg/day/weekDont exceed 300 mg/day

Social Phobia:ER-Capsules: 100 mg PO qDay initially, can titrate in 50 mg/day/weekDont exceed 300 mg/dayMay be administered with food

MOA: Selective Serotonin Reuptake Inhibitor (SSRI) highest affinity for receptor. Metabolized c-P450, half life 12-13 hrs (single dose

Adverse Effects:

Suicidal thinking* Serotonin Syndrome (when administered w/ MAOI, SNRIs, TCAs) S/S: hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures Tx: cyproheptadine (Sertonin antagonist) Sexual Dysfxn (decreased libido & anorgasmia) Nausea Vomiting Loss of appetite Sleep disturbances

*Self-destructive feelings and thoughts in patients taking SSRIs may be the result of anxiety or akathisia. Sometimes a person with hidden bipolar disorder receives an antidepressant and develops an irritable manic reaction. Some patients may recover their energy and therefore their ability to act before mood improves or hope returns. The danger is greatest in the first few weeks of treatment. If a patient begins to have suicidal thoughts after many months on an antidepressant, the drug is probably not to blame. It's more likely to be caused by the underlying illness. American Academy of Child & Adolescent Psychiatry & National Inst. Of Mental Health