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