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Sawsnriantidepress2021rec 211107204800

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) include medications such as Venlafaxine, Duloxetine, Milnacipran, Desvenlafaxine, and Levomilnacipran, which primarily function by inhibiting the reuptake of serotonin and norepinephrine. They are used to treat various conditions, including depressive disorders, anxiety disorders, and fibromyalgia, with common side effects including nausea, headache, and sexual dysfunction. Each SNRI has specific indications and contraindications, with Duloxetine being contraindicated in patients with liver disease and severe renal impairment.

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28 views11 pages

Sawsnriantidepress2021rec 211107204800

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) include medications such as Venlafaxine, Duloxetine, Milnacipran, Desvenlafaxine, and Levomilnacipran, which primarily function by inhibiting the reuptake of serotonin and norepinephrine. They are used to treat various conditions, including depressive disorders, anxiety disorders, and fibromyalgia, with common side effects including nausea, headache, and sexual dysfunction. Each SNRI has specific indications and contraindications, with Duloxetine being contraindicated in patients with liver disease and severe renal impairment.

Uploaded by

Ayan Huseynli
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Serotonin Norepinephrine

Reuptake Inhibitors (SNRIs)

SNRIs

Prof. Sawsan Aboul-Fotouh


Department of pharmacology, faculty of Medicine, Ain-Shams University
Serotonin Norepinephrine Reuptake
Inhibitors (SNRIs)

Venlafaxine Duloxetine Milnacipran

Desvenlafaxine Levomilnacipran
Mechanism of action of SNRIs

They are specific 5-HT and various


degrees NE reuptake inhibition.
Venlafaxine, at lower doses (75–100 mg/day) acts as
SSRI. As the dose increases it inhibit NE reuptake
(& 2ry ↓ DA reuptake in prefrontal cortex, which
lacks DAT→ ↑ DA).
Advantage & side effects of SNRIs

No Autonomic Blockade
H1 M 

Adverse Effects
-Nausea, headache, sexual dysfunction, insomnia.
-Hypertension & ↑HR (in high dose). “NE”
(Stahl ҆s essential psychopharmacology, 2013)

Desvenlafaxine inhibits reuptake of NE > 5-HT


Desvenlafaxine has similar efficacy, indications, Pharmacodynamic
& Side effects as venlafaxine
Desvenlafaxine is not affected by CYP2D6 inducers & inhibitors
• Venlafaxine has half-life of ̴ 6 h and Desvenlafaxine has half-life of ̴ 12 h.
Duloxetine indicated in stress
urinary incontinence
Contraindications of Duloxetine

▪ Liver disease 
▪ Severe renal impairment, end stage renal
disease (dialysis) (CrCl<30)
▪Moderate to heavy alcohol use.
Milnacipran and Levomilnacipran

Milnacipran

Therapeutic indications
(Stahl ҆s essential psychopharmacology, 2013)
A. FDA-approved
1. Fibromyalgia (Milnacipran only, 2009)
2. Major depressive disorder (Levomilnacipran only, 2013)
B. Non FDA-approved
1. Neuropathic pain/Chronic pain (Both)

Adverse Effects as SNRIs but More insomnia, & ↓appetite (as > ↑NE)

The 5-HT: NE ratios of SNRIs are: Venlafaxine = 30:1, Desvenlafaxine = 10:1, Duloxetine = 10:1,
Milnacipran = 1:1, and Levomilnacipran = 1:2 (Randy and Lori, 2014)
Q: Therapeutic Uses of SNRIs
1. Depressive disorders

2. Anxiety disorders (GAD, …….)

3. Post-traumatic stress disorder.


4. Neuropathic pain, Diabetic NP (Duloxetine , FDA 2004).

5. Fibromyalgia: (Duloxetine , 2008 & Milnacipran, 2009 ) and


Chronic musculoskeletal pain, (Duloxetine , FDA 2010).
6. Stress Incontinence (Duloxetine , off-label)

7. Vasomotor menopausal symptoms….

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