PEBC: What You Need to Know: Serotonin-Norepinephrine Reuptake Inhibitors

Examples: venlafaxine, desvenlafaxine, duloxetine, levomilnacipran

Dosing: once daily with food

Adverse Effects: Dry mouth, drowsiness, insomnia, nausea, dizziness, sexual dysfunction, constipation, increased blood pressure (at higher doses)

Drug Interactions:

-Duloxetine is a CYP2D6 inhibitor, so careful with other substrates.

-Serotonin syndrome interactions: triptans, selective serotonin reuptake inhibitors

-Contraindicated with MAO-A inhibitors due to hypertensive crisis; wait at least 2 weeks (washout) before switching antidepressants

-NSAIDs: increased risk of gastric irritation; consider proton-pump inhibitors as gastorprotection

-Blood thinners: increased risk of gastric bleed; consider proton-pump inhibitors as gastorprotection