Nursing Implications for Venlafaxine (ven-la-fax′een)

VENLAFAXINE (ven-la-fax′een)

Effexor, Effexor XR

DESVENLAFAXINE

Khedezla, Pristiq

Classifications: ANTIDEPRESSANT; SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)

Therapeutic: ANTIDEPRESSANT; SNRI

Pregnancy Category: C

AVAILABILITY

Tablet; sustained release capsule; extended release tablet. Desvenlafaxine: Extended release tablet

ACTION & THERAPEUTIC EFFECT

Potent inhibitor of neuronal serotonin and norepinephrine reuptake. Antidepressant effect presumed to be due to potentiation of neurotransmitter activity in the CNS.

USES

Depression, generalized anxiety disorder; social anxiety disorder.

UNLABELED USES

Obsessivecompulsive disorder, hot flashes.

CONTRAINDICATIONS

Hypersensitivity to venlafaxine, desvenlafaxine, or other SNRI drugs; concurrent administration with MAO inhibitors or within 14 days of last dose; abrupt discontinuation; treatment for bipolar disorder; serotonin syndrome symptoms; hyponatremia; suicidal ideation; lactation.

CAUTIOUS USE

Renal and hepatic  impairment, renal failure; anorexia nervosa, history of mania or other psychiatric disorders, history of suicidal tendencies or increase in suicidality especially in individuals younger than 24 y; elevated intraocular pressure, acute closed-angle glaucoma; cardiac disorders, recent MI, heart failure; hypertension; hyperthyroidism; CNS depression; history of seizures or seizure disorders; older adults; pregnancy (category C). Safety in children younger than 18 y is not established.

ROUTE & DOSAGE

Depression

Adult: PO 25–125 mg t.i.d. Desvenlafaxine: 50 mg daily, may increase dose (max: 400 mg/day)

Geriatric: PO (venlafaxine and desvenlafaxine) Start with lower doses in older adults

Anxiety

Adult: PO Start with 37.5 mg sustained release daily and increase to 75–225 mg sustained release/day

Renal Impairment Dosage Adjustment

Venlafaxine:

CrCl 10–70 mL/min: Reduce total daily dose by 25–50%; less than 10 mL/min: Reduce total daily dose by 50%

Nursing Implications for Venlafaxine (ven-la-fax′een)

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Desvenlafaxine:

CrCl 3–50 mL/ min: Max dose: 50 mg/day; less than 30 mL/min: Max dose: 50 mg every other day

Pharmacogenetic Dosage Adjustment

Poor CYP2D6 metabolizer: Start with 70% of dose

ADMINISTRATION

Oral

• Give with food. Extended-release capsules must be swallowed whole or carefully opened and sprinkled on a spoonful of applesauce. The applesauce mixture should be swallowed without chewing and followed with a glass of water. Extended-release tablets should be swallowed whole and not divided, crushed, or chewed.
• Dosage increments of up to 75 mg/day are usually made at 4 days or longer intervals.
• Allow 14 days interval after discontinuing an MAO inhibitor before starting venlafaxine or desvenlafaxine.
• Do not abruptly withdraw drug after 1 wk or more of therapy.
• Store at room temperature, 15°–30° C (59°–86° F).

ADVERSE EFFECTS (≥1%)

CV: Increased blood pressure and heart rate, palpitations. CNS: Dizziness, fatigue, headache, anxiety, insomnia, somnolence, suicidality. Endocrine: Small but statistically significant increase in serum cholesterol, weight loss (approximately 3 lb). GI: Nausea, vomiting, dry mouth, constipation. Urogenital: Sexual dysfunction, erectile failure, delayed orgasm, anorgasmia, impotence, abnormal ejaculation. Special Senses: Blurred vision. Body as a Whole: Sweating, asthenia, Stevens Johnson syndrome.

DIAGNOSTIC TEST INTERFERENCE

False positive urine drug screen may occur for amphetamine or phencyclidine; use alternative tests to confirm results.

INTERACTIONS

Drug: Cimetidine, MAO INHIBITORS, desipramine, haloperidol may increase levels and toxicity. Should not use in combination with MAO INHIBITORS: Do not start until greater than 14 days after stopping MAO INHIBITOR; do not start MAO INHIBITOR until 7 days after stopping venlafaxine/ desvenlafaxine. Trazodone may lead to serotonin syndrome. Herbal: St. John’s wort, sour date nut may cause serotonin syndrome.

PHARMACOKINETICS

Absorption: Well absorbed from GI tract. Onset: 2 wk. Peak: Venlafaxine 1–2 h; metabolite 3–4 h. Duration: Extensively tissue bound. Metabolism: Undergoes substantial firstpass metabolism to its major active metabolite. Elimination: ~60% in urine as parent compound and metabolites. Half-Life: Venlafaxine 3–4 h, desvenlafaxine ~11 h.

NURSING IMPLICATIONS

Black Box WarningVenlafaxine has been associated with increased risk of suicidal thinking and behavior.

Assessment & Drug Effects

• Monitor for worsening of depression or emergence of suicidal ideation.
• Monitor cardiovascular status periodically with measurements of HR and BP.
• Monitor neurologic status and report excessive anxiety, nervousness, and insomnia.
• Monitor weight periodically and report excess weight loss.
• Assess safety, as dizziness and sedation are common.
• Montior lab tests: Periodic lipid profile.

Patient & Family Education

• Be aware of potential adverse effects and notify prescriber of those that are bothersome.
• Report promptly worsening mental status, especially thoughts of suicide.
• Do not drive or engage in potentially hazardous activities until response to drug is known.
• Avoid using alcohol while on venlafaxine.
• Do not use herbal medications without consulting prescriber.

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Ditulis oleh Unknown pada tanggal Sunday, July 26, 2015