Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in the United States
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Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in the United States

Learn about the five SNRIs approved by the FDA in the United States, including venlafaxine, desvenlafaxine, duloxetine, milnacipran, and levomilnacipran. Explore their uses in treating conditions like fibromyalgia and major depressive disorder (MDD).

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Questions and Answers

What is the typical time needed to reach maximum plasma concentration for both venlafaxine and duloxetine?

2 hours

What is the approximate bioavailability of orally administered desvenlafaxine?

80%

Which of the following SNRIs is metabolized primarily by CYP3A4?

Levomilnacipran

What percentage of milnacipran is excreted unchanged in the urine?

<p>55%</p> Signup and view all the answers

Which SNRI has the longest half-life?

<p>Duloxetine</p> Signup and view all the answers

Which SNRI has the highest protein binding?

<p>Duloxetine</p> Signup and view all the answers

Which SNRI is metabolized by both CYP2D6 and CYP1A2?

<p>Duloxetine</p> Signup and view all the answers

What is the typical bioavailability of orally administered levomilnacipran?

<p>90%</p> Signup and view all the answers

Which SNRI is excreted mostly unchanged in the urine?

<p>Milnacipran</p> Signup and view all the answers

Which SNRI has been found in breast milk?

<p>All of the above</p> Signup and view all the answers

What is the recommended initial dosage for desvenlafaxine in the treatment of major depressive disorder (MDD)?

<p>50 mg once daily</p> Signup and view all the answers

If a patient does not respond to the initial dosage of desvenlafaxine after 6 weeks, what is the recommended course of action?

<p>Increase the dose of desvenlafaxine to 100 mg per day</p> Signup and view all the answers

Which of the following statements about duloxetine is true?

<p>It was initially thought to be especially effective for melancholic depressions, but the results have been inconclusive.</p> Signup and view all the answers

Which of the following statements about venlafaxine is true?

<p>It is more activating than SSRIs and a first-line drug for sluggish types of depression.</p> Signup and view all the answers

What is the primary indication for milnacipran?

<p>Fibromyalgia</p> Signup and view all the answers

Which of the following statements regarding patient education for serotonin-norepinephrine reuptake inhibitors (SNRIs) is true?

<p>Patients should be informed about the potential withdrawal symptoms associated with abrupt discontinuation.</p> Signup and view all the answers

What was the most common adverse effect of milnacipran reported in clinical trials?

<p>Nausea</p> Signup and view all the answers

Which of the following drugs may require an adjustment of levomilnacipran dosage due to a potential drug interaction?

<p>Ketoconazole</p> Signup and view all the answers

What is the recommended initial dose of duloxetine for treating major depressive disorder?

<p>20 mg/day</p> Signup and view all the answers

Which of the following adverse effects is commonly reported by male patients taking milnacipran?

<p>Erectile dysfunction</p> Signup and view all the answers

What is the maximum recommended daily dose of levomilnacipran for the treatment of major depressive disorder?

<p>120 mg</p> Signup and view all the answers

Which of the following drugs may cause serotonin syndrome if used concurrently with milnacipran?

<p>Triptans</p> Signup and view all the answers

What is the recommended dose of milnacipran for the treatment of fibromyalgia?

<p>100 mg twice daily</p> Signup and view all the answers

Which of the following drugs may interact with venlafaxine by inhibiting the CYP2D6 enzyme?

<p>Fluoxetine</p> Signup and view all the answers

Which of the following adverse effects is commonly associated with levomilnacipran?

<p>Hyperhidrosis</p> Signup and view all the answers

What is the recommended initial dose of venlafaxine XR for treating major depressive disorder?

<p>75 mg/day</p> Signup and view all the answers

Which SNRI was approved by the FDA to treat fibromyalgia?

<p>Milnacipran (Savella)</p> Signup and view all the answers

Which SNRI has a Black Box Warning related to liver toxicity?

<p>Nefazodone</p> Signup and view all the answers

At what year was levomilnacipran (Fetzima) approved for Major Depressive Disorder (MDD)?

<p>2013</p> Signup and view all the answers

Which SNRI predominantly affects serotonin reuptake at lower doses?

<p>Venlafaxine (Effexor XR)</p> Signup and view all the answers

What is the main mechanism of action of venlafaxine, duloxetine, and desvenlafaxine as SNRIs?

<p>Inhibiting serotonin and norepinephrine transporters</p> Signup and view all the answers

Which SNRI is considered a more potent and equal serotonin and norepinephrine reuptake inhibitor than venlafaxine?

<p>Duloxetine (Cymbalta)</p> Signup and view all the answers

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