Serotonin And Noradrenaline Reuptake Inhibitors (SNRI)

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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