Venlafaxine
CLINICAL USE
Antidepressant: Depressive illness Generalised anxiety disorders
DOSE IN NORMAL RENAL FUNCTION
37.5–187.5 mg twice daily XL: 75–225 mg daily Generalised anxiety disorder: 75 mg once daily
PHARMACOKINETICS
Molecular weight : 277; (313.9 as hydrochloride) %Protein binding : 27 %Excreted unchanged in urine : 5 Volume of distribution (L/kg) : 7.5 half-life – normal/ESRD (hrs) : 5/6–8 XL: 9–21 DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
30–50 Dose as in normal renal function 10–30 Reduce total dose by 50% and administer daily <10 : Reduce total dose by 50% and administer daily DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD : Not dialysed. Dose as in GFR <10 mL/min HD : Not dialysed. Dose as in GFR <10 mL/min HDF/high flux : Unknown dialysability. Dose as in GFR <10 mL/min CAV/VVHD : Not dialysed. Dose as in GFR=10–30 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs Analgesics: increased risk of bleeding with aspirin and NSAIDs Anticoagulants: effects of warfarin possibly enhanced Antidepressants: avoid concomitant use with MAOIs and moclobemide (increased risk of toxicity); possibly enhanced serotonergic effects with duloxetine Antimalarials: avoid concomitant use with artemether/lumefantrine Antipsychotics: increases concentration of clozapine and haloperidol Dopaminergics: use entacapone with caution; increased risk of hypertension and CNS excitation with selegiline – avoid concomitant use Sibutramine: increased risk of CNS toxicity – avoid concomitant use ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
– Comments
– OTHER INFORMATION
Withhold dose until after haemodialysis to minimise nausea and any other side effects May be used to treat peripheral diabetic neuropathy in haemodialysis patients; dose is up to 75 mg daily. www.medscape.com/ viewarticle/440202 An ECG is required before treatment .
See how to identify renal failure stages according to GFR calculation
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