SEROTONIN AND NORADRENALINE REUPTAKE INHIBITORS (SNRI)
SEROTONIN AND NORADRENALINE REUPTAKE INHIBITORS (SNRI)
MOA:
- Inhibits reuptake of both serotonin & NA.
- Lack anticholinergic & alpha-blocking properties.
Drugs: Venlafaxine, duloxetine, desvenlafaxine, milnacipran & levomilnacipran.
Important drug description:
1. Venlafaxine:
- Novel antidepressant.
- No interaction with cholinergic, adrenergic or histaminergic receptors.
- Non-sedative.
- Faster onset of action.
- MOA: Inhibits uptake of both NA & 5-HT.
- Uses:
- Severe depression.
- For mood changes & hot flushes in menopausal syndrome.
- Anxiety.
- Eating disorders.
- Adverse effects:
- Nausea, sweating, anxiety, dizziness, impotence & withdrawal reactions on discontinuation (Prominently).
- Comparatively lesser side effects than TCAs.
- Increases BP.
- Safer in overdose.
2. Duloxetine:
- Newer SNRI.
- Neither sedative, nor anticholinergic, nor antihistaminic, nor α-blocker.
Uses:
- Panic attack.
- First line drug used for painful diabetic neuropathy (Diabetic neuropathic pain).
- Stress urinary incontinence in women – Due to increased urethral tone.
- Useful for depression.
- Fibromyalgia.
Side effects:
- Milder GI & sexual problems.
- Agitation & insomnia.
- Increases BP.
- Antidepressant efficacy (comparable to TCAs).
3. Desvenlafaxine:
- For treating major depressive disorder in adults.
- Currently under review for treatment of moderate-to-severe vasomotor symptoms associated with menopause.
Discontinuation syndrome:
- All SNRI’s exhibit discontinuation syndrome.
- Withdrawal symptoms include dizziness, headache, nervousness, nausea & insomnia.
- Venlafaxine (More intense) – Due to relatively short-acting nature.
Exam Important
- Serotonin and nor-adrenaline uptake inhibitors inhibit reuptake of both serotonin & NA.
- SNRI’s lacks anticholinergic & alpha-blocking properties.
- Duloxetine is an SSRI useful for depression.
- First line drug used for painful diabetic neuropathy is Duloxetine.
- Venlafaxine, duloxetine, desvenlafaxine, milnacipran & levomilnacipran are all SNRI drugs.
- Venlafaxine is a novel antidepressant with faster onset of action.
- Venlafaxine is used for severe depression, for mood changes & hot flushes in menopausal syndrome, anxiety & eating disorders.
- Nausea, sweating, anxiety, dizziness, impotence & withdrawal reactions on discontinuation are prominently seen with Venlafaxine.
- Duloxetine is a first line drug used for painful diabetic neuropathy (Diabetic neuropathic pain).
- Duloxetine treats stress urinary incontinence in women, due to increased urethral tone.
- Duloxetine helpful in panic attack, stress urinary incontinence in women, diabetic neuropathic pain, depression & fibromyalgia.
- Desvenlafaxine treats major depressive disorder in adults.
- All SNRI’s exhibit discontinuation syndrome with withdrawal symptoms like dizziness, headache, nervousness, nausea & insomnia.
- Discontinuation syndrome is caused by venlafaxine due to its relatively short-acting nature.
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