PRESENTATION

TITLE
Mirjam Nilsson
SELECTIVE SEROTONIN
NOREPINEPHRINE REUPTAKE
INHIBITORS

A class of medications that are effective in treating

depression. SNRIs are also sometimes used to treat other
conditions, such as anxiety disorders and long-term
(chronic) pain, especially nerve pain. SNRIs may be
helpful if you have chronic pain in addition to depression.

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 MECHANISM OF ACTION

As a class, they all increase the amount of serotonin (S) and

norepinephrine (NE) in the brain.

By decreasing the reuptake of these two neurotransmitters after they’ve

been release from the presynaptic terminals, the SNRIs allow the S and NE
to remain in the synaptic cleft longer, thereby giving them a longer chance
to bind to postsynaptic receptors.

These medications differ from each other in the relative reuptake inhibition
ratio of serotonin and norepinephrine.
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IT IS THIS INCREASE IN NOREPINEPHRINE
THAT IS BELIEVED TO BE THE REASON
WHY SNRIS ARE MORE EFFECTIVE THAN
SSRIS IN TREATING PAIN.

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LIST OF SSNRI
1. Desvenlafaxine
2. Duloxetine
3. Levomilnacipran
4. Milnacipran
5. Venlafaxine
 VENLAFAXINE

Uses(off-label):

1. Neuropathic pain (diabetic neuropathy)

2. Migraines (prophylactic)
3. Tension headaches
4. Chronic pain syndromes
5. Fibromyalgia
6. Chronic fatigue syndrome

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 DOSAGE FORM:

• Immediate-release formulation: Start with

37.5mg , and increase every 4-7 days (if
tolerated) [max of 100mg]
• Extended-release: Start 37.5 to 75mg
daily, and increase by 75mg every 4-7
days [max of 225-mg]
• Note: taper dose over 2-weeks to
discontinue

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MOST COMMON SIDE EFFECT:

 Nausea
 Dry mouth
 Dizziness
 Headache
 Excessive sweating

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SEROTONIN
SYNDROME
This most often occurs when two medications
that raise serotonin are combined, such as other
antidepressants, certain pain or headache
medications.
Signs and symptoms of serotonin syndrome
include;
Anxiety, agitation, high fever, sweating,
confusion, tremors, restlessness, lack of
coordination, major changes in blood pressure
and rapid heart rate.
 STOPPAGE TREATMENT WITH SSNRI

SNRIs are not considered addictive. However, stopping treatment abruptly or missing several doses
may cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome.
Withdrawal-like symptoms may be more likely to occur with venlafaxine or desvenlafaxine.

Withdrawal-like symptoms can include:

• Dizziness
• Headache
• Flu-like symptoms, such as tiredness, chills and muscle aches
• Irritability or agitation
• Nausea
• Insomnia or sleep disturbances, such as nightmares
• Diarrhea

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THANK YOU

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